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REVIEW OF

NEUROLOGY AND PSYCHIATRY

REVIEW

NEUROLOGY and PSYCHIATRY

Editor

ALEXANDER BRUCE

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

Assistant Editors

EDWIN BRAMWELL
M.B., F.R.C.P.E. and L., F.R.S.E.

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

VOLUME VI.

EDINBURGH

OTTO SCHULZE & COMPANY
20 SOUTH FREDERICK STREET
1908

flOLOS*
UP" ■

EDINBURGH
Printed bf

TUKNBULL A SPEARS

Contents

ORIGINAL ARTICLES.

PACK

Pseudo-Myasthenia of Toxic Origin. (Petrol Fumes.) By Sir

William P. Gowers, M.D., F.R.S. .... 1

A Note on the Condition op the Postcentral Cortex in Tabes

Dorsalis. By Gordon Holmes, M.D. .... 5

Clinical and Anatomical Diagnosis of the Ankylosing Diseases

op the Spinal Column. By Dr Andr£ L4ri of Paris . . 12

Clinical and Anatomical Diagnosis of the Ankylosing Diseases

op the Spinal Column— Part II. By Dr Andr4 L4ri of Paris 65

The Epiconus Symptom-Complex in Cerebro-spinal Syphilis.

By William G. Spiller, M.D. . . . . .77

On the Spinal Changes in a Case op Muscular Dystrophy. By

Gordon Holmes, M.D. ...... 137

The Myasthenic Reaction experimentally produced in the

Frog. By J. A. Gann, M.D., B.Sc., M.A. . . . 150

The Cytological Study op the Cerebro-spinal Fluid by Alz¬

heimer’s Method, and its Diagnostic Value in Psychiatry.

By Henry A. Cotton, M.D., and J. B. Ayer, Jr., M.D. . . 207

Exophthalmic Goitre combined with Myasthenia Gravis. By

George E. Rennie, M.D., F.R.C.P. Lond..... 229

A Case op Acute Ascending Paralysis op Syphilitic Origin. By

O. Croozon and Georges Villaret ..... 275

A Note on an Associated Movement op the Eyes and Ears in

Man. By S. A. K. Wilson, M.B., B.Sc., M.R.C.P. . . 331

A Case op Partial Ptosis with Exaggerated Involuntary Move¬
ment op the Affected Eyelid: the “Jaw-Winking”
Phenomenon. By William George Sym, M.D. . . . 337

A Case op Disease op the Post-Central Gyrus Associated with

Astereognosis. By Purves Stewart, M.A., M.D., F.R.C.P. . 379

A Case op Spasmodic Syringomyelia (?). By Alexander Bruce,

M.D., F.R.C.P.E. ..390

380729

CONTENTS

Aneurism of the Anterior Cerebral Artery, with Unusual
Prolongation of Life after Rupture : Autopsy. By
Alexander Bruce, M.D., F.R.C.P.E.; J. H. Harvey Pirie, B.Sc.,
M.D.; and W. Kel man Macdonald, M.B., Ch.B.

A Case of Arterio-Venous Aneurism of the Internal Carotid
Artery and Cavernous Sinus. By Alexander Bruce, M.D.,
etc. .........

Cases Illustrating the Course and Progress in Disseminate
Sclerosis. By W. B. Warrington, M.D., F.R.C.P. Lond.

Three Cases of Hemiplegia following Scarlet Fever. By

J. D. Rolleston, M.A., M.D., Oxon.

A Case of Intracranial Tumour. By Edwin Bramwell, M.B.,
F.R.C.P.

Leptothrix Infections. A Case of Pyemia with Meningitis, and
Notes of Two Similar Cases. By E. Scott Carmichael, M.B.,
F.R.C.S.E.

The Examination of Cerebro-Spinal Fluid in Qeneral Paralysis
for Purposes of Diagnosis. By Hamilton C. Marr, M.D.,
F.F.P.S.G.

Tumour Malformations of the Central Nervous System. By

William G. Spiller, M.D.

A Rapid Method for Staining the Myelins in Nerve Fibres
of the Brain and Spinal Cord (Simple Formol or Formol
Sulphate, Freezing, Alum-Hjematein). By Dr J. Nageotte .

On the Origin of the Facial Nerve. By Alexander Bruce, M.D.,
F.R.C.P.E., and J. H. Harvey Pirie, M.D., B.Sc.

i-ac;e

441 >

462

521

530

577

631

635

677

682

685

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Original Hrtides

PSEUDO-MYASTHENIA OF TOXIC ORIGIN. (PETROL-

FUMES.)

BY SIB WILLIAM P. GOWERS, M.D., F.R.S.

The following short account of a mysterious case is published in
the hope of eliciting the experience of others regarding similar
symptoms and the effects of the conjectured cause.

The patient was a major in the army, set. 38, married for 12
years, who had never consciously suffered from venereal disease,
and had run very few risks. There was no history of preceding
grave illness or of any sore throat Six months before he was
seen he experienced, for a short time, a peculiar perversion of
taste, by which all sweet things had a salt taste. It soon passed
away, but since then he had experienced a tight feeling in the
throat when swallowing. This became worse about six weeks
before he was seen, and at the same time a definite difficulty in
swallowing came on, and rapidly increased, until he became
unable to swallow anything except such things as jellies or
soups, which, as he expressed it, could “ go down by themselves.”
Solid food he could not swallow, nor could he chew, although the
masseters seemed to contract fairly. There was no nasal character
of voice, and the palate was raised equally, though not vigorously;
fluids did not regurgitate through the nose.

His speech presented a peculiar myasthenic feature, which
had also come on during the preceding six weeks. When he
R. OF N. & P. VOL. VI. NO. 1—A

2 .SIR WILLIAM P. GOWERS

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♦ • • .

began to speak his voice was good and his articulation fair. As
he went on speaking, his voice became feeble and his articulation
imperfect. He felt, and seemed to have, great difficulty in
moving his tongue and lips, and after three or four minutes his
articulation became so imperfect that his speech was unintelli¬
gible. The first failure was in the softness of the guttural k,
and in the linguals and dentals, such as 1 and r. He could
whistle after rest, but not after a few minutes' speaking.

The eye-movements, internal and external, were normal, but
the orbiculares palpebrarum were very weak, and opposed hardly
any resistance to the separation of the closed lids. Moreover,
there was little outward movement of the angles of the mouth
when he smiled. No difference from the normal could be found
in the electrical reactions. Sensation was everywhere normal,
and prevented proper testing of fatiguability in the face by
electricity. The optic discs were clear. He was easily tired in
walking, but all reflex action was normal, and the knee-jerks
were not lessened by long reproduction.

The pulse was 64 and the heart normal, the sounds only a
little weak. He had had some peculiar attacks of pain in the chest,
a sensation of a painful strain across the level of the lower part
of the sternum, passing down to the neighbourhood of the umbilicus
and up to the throat. No other symptom attended them, and
they were not frequent. Otherwise everything was normal, and
his habits had always been temperate.

The case clearly bore a very grave aspect. The resemblance
of the symptoms to myasthenia was striking: the quickness of
exhaustion of the muscles of speech and the feebleness of de¬
glutition, the weakness of the orbicularis palpebrarum, and the
peculiar smile. Although such symptoms have not been met
with from a toxic cause, their onset in mid-life and rapid develop¬
ment suggested the possibility of this. Investigation failed to
elicit any exposure to metallic poisoning, or sign of it, and
inquiry into his occupation disclosed only one conceivable toxic
influence. His work was in a Government factory, and he had
for long been superintending the construction, and especially the
testing, of petrol engines. He was constantly engaged in examin¬
ing their working, which was done in a closed shed, and he had
been continually exposed to the fumes of burned petrol, some¬
times, perhaps, imperfectly burned. (See note below.)

PSEUDO-MYASTHENIA OF TOXIC ORIGIN

He was then, of course, unable to work. He was ordered
a hypodermic injection of strychnine nitrate, tt gr., twice a day.
After a week a distinct improvement was observed, and this went
on. I saw him again three weeks afterwards. He was able to
swallow a little solid food, and even chew it. He could talk for
five minutes without any impairment of articulation; then the
tip of his tongue felt (to him) hard, and the linguals became
imperfect, but he could speak, with rests, all day. The orbicu-
lares were perceptibly stronger, and the angles of the mouth were
better moved outwards in the smile.

His subsequent improvement was so steady, and his recovery
apparently so complete, that his medical attendant thought it
unnecessary for him to see me again. After some months he
resumed his work.

But, just a year after I first saw him, he was brought to me
again. The work he had returned to was nearly the same, and
involved the same exposure to the petrol fumes. The old
symptoms were then returning: the same ready fatiguability of
the tongue and lips, and similar attacks of thoracic pain. He
could speak well for four or five minutes, but then the tongue
seemed to him to get tired, and he could not move it quickly in
the mouth, and his linguals and dentals became faulty. If he
did not stop, the enunciation became hardly intelligible. No-
difficulty in swallowing had developed.

He was ordered to relinquish permanently the work he had
been doing, and resume strychnia in a pill. I have not seen
him again, but subsequently learned that his symptoms soon
passed off, and that he afterwards went to South Africa. It is
two years since the relapse, and had he suffered again, it is
practically certain that I should have seen him.

The case is remarkable from the close resemblance of the
symptoms to those of partial myasthenia—partial in being chiefly
conspicuous in the region of the bulbar nerves. The weakness
of the orbicularis palpebrarum was not associated with any
affection of the ocular nerves, but presented a striking corre¬
spondence with myasthenia, while the quick exhaustion of the
power of articulation was even greater than is usual in that
affection.

The course of the symptoms is thus more than suggestive of
a toxic influence, connected with his occupation, as their cause.

SIR WILLIAM P. GOWERS

but the only conceivable agent that could be heard of was
the petrol fumes to which he had clearly been exposed. It
was probable that the combustion of the petrol had sometimes
been imperfect, and we do not know the nature, or deleterious
character, of the products of its imperfect combustion. I could
not, however, hear of any affection of other workers in the
shed. This fact is of small importance, for it is common for one
individual among many to have a special susceptibility to a
given influence, and a special degree of exposure may have been
involved in the close supervision he had to give.

Polyneuritis affecting the legs has been observed from the
habitual inhalation of carbon monoxide {eg., Glynn, Brit. Med.
Joum., l, 1895), but I have found only one case bearing directly
on the effect of petrol fumes (Massanek, of Buda-Pesth; see
Neurol. Centralbl., 1904, p. 125). Two boys were shut up in a
room in which a petroleum lamp was burning and smoking.
One was dead, and his blood showed CO-haemoglobin. The
other, in a few days, developed an idiotic condition with signs of
right hemiplegia. These soon lessened, but were followed by the
symptoms of peripheral neuritis, weakness of the arms, and
paralysis of the legs, with loss of the knee-jerks. This
diminished after a few days, and had passed away at the end
of six weeks. The case has importance as showing that petrol
fumes may act on the nervous system, and makes this influence
less improbable in the case I have described.

Note.— In a recent number of the Engineering Supplement of the Times
(December 4, 1897) is an article on “The Exhaust Gases from Petrol Motors,”
by Prof. F. W. Burstall. He speaks of the great frequency in which the exhaust
products from motor-cars have a very strong and disagreeable smell. He traces
it to imperfect combustion of the vapourised petrol, which is difficult to avoid when
the engine is run to obtain the maximum power, and to the fact that some of
the petrol often comes over, as a fine spray, much of which is not perfectly burned.
“When combustion commences the higher hydro-carbons do not necessarily at
once burn to steam and carbon dioxide, but probably pass through a number
of intermediate changes, forming the gases methane, acetylene, and a number
of other hydro-carbons. This is more particularly the case if it should happen
that any fluid is present in the form of very fine spherical globules, the outer
skin of which burns, but the inner layer is unburnt. These gases, together
with a considerable percentage of carbon monoxide, are thrown out from the
motor, and give rise to the unpleasant smells.”

These facts certainly afford confirmation of the suspicion that
the products of imperfect combustion are various. They are

POSTCENTRAL CORTEX IN TABES DORSALIS 5

evidently of unknown nature, and can hardly fail to share, with
carbon monoxide, noxious properties.

▲ NOTE ON THE CONDITION OF THE POSTCENTRAL
CORTEX IN TABES DORSALIS.

By GORDON HOLMES, M.D.

In his well-known monograph on "Histological Studies on the
Localisation of Cerebral Function,” Dr A. W. Campbell has
described definite pathological changes in a portion of the cortex
of the postcentral or ascending parietal gyrus in three cases of
tabes dorsalis. This observation is of much wider interest and
greater importance than the mere discovery of a new feature in
the morbid anatomy of this disease, for, as tabes is, the author
argues, essentially a sensory disease, the conclusion may be
drawn that this area is “ the primary terminus or arrival plat¬
form for nerve fibres conveying impulses having to do with
* common sensation/ ”

If changes were found constantly in this area in uncompli¬
cated cases of tabes, and if they occur only in this or in other
affections and diseases of the sensory system, this would be a
justifiable and logical conclusion. Its significance is increased
by the fact that, while we have acquired the fairly extensive
knowledge of the cortical motor centres which we possess by the
experimental method, it does not at present seem possible by any
means at our disposal to map out accurately the sensory centres
by experiment on animals. This important task then falls to the
lot of clinico-pathological investigation, and the difficulties and
imperfections of this method are manifest.

The changes which Campbell has described bear on both the
medullated fibres and the nerve cells of this area, but from his
descriptions it appears that the alteration in the cells is the
more prominent. This alone will be referred to in this note.
These changes consisted in a noticeable reduction in the breadth
of the cortex, a remarkable deficiency in cells of large size, a
difficulty in defining the cell lamination, and a huddling to¬
gether and a distorted arrangement of the cells. These changes

GORDON HOLMES

involved all layers of the cortex, but they were most prominent
in the supra- and infra-stellate layers of large pyramidal cells,
and especially in the former, in which there was a marked
numerical deficiency of the larger cells, and apparently patho¬
logical distortion and shrinkage of those remaining. These
changes were, however, not found throughout the whole area of
the postcentral type of cortex, but were limited to the Rolandic
or anterior wall of the postcentral gyrus and the corresponding
area in the paracentral lobule. No changes were found in the
cortex of any other region.

In reviewing Campbell’s descriptions and his important con¬
clusion there are a few points which must be considered. In
the first place, if these changes in this limited area of cortex are,
as the author assumes, secondary to the degeneration of the
sensory protoneurons, the ascending morbid process must be
interrupted in at least two masses of grey matter : in the dorsal
horns of the cord or the dorsal column nuclei, and, finally, in the
optic thalamus. No definite changes are, however, constantly
found in the secondary sensory tracts or in the thalamus in
tabes dorsalis. Further, it is a priori improbable that disease of
even the final link of the sensory system—the thalamo-cortical
fibres,—and it has never been demonstrated, should be able to
produce such pronounced changes in the cells and intrinsic fibres
of a mass of grey matter to which it is only afferent. As far as
I am aware, there is very little evidence from experimental
pathology that the cells of a centre suffer so severely, except
where there has been a considerable lesion of its afferent fibres,
or when the destruction has occurred in early life. The author
attempts to escape this difficulty by assuming that the cortical
changes which he has described may be an effect of “ the com¬
plete interruption of the physiological impulses ” which the
degeneration of the dorsal spinal roots involves. But the sensory
loss in tabes is rarely if ever complete in even a limited area of
the body.

In the second place, if the area which Campbell has described
as diseased in tabes is the centre of common sensation, the amount
of change in this area and its extent should bear some relation to
the degree and the distribution of the sensory loss in the case
examined. Unhappily no mention is made of the state of
sensation in the three cases which Campbell investigated.

POSTCENTRAL CORTEX IN TABES DORSALIS 7

And finally, if this cortical change depends on a structural
alteration which ascends the sensory system, crossing over at
least two synapses, and finally leads to degeneration or atrophy
of the cells of the terminal receptive centre, it is necessary to
postulate that the primary disease, that of the sensory proto¬
neurons, has been of considerable duration. Campbell’s first
two cases escape this criticism, as in the one the symptoms of
tabes had lasted sixteen, in the other eight years; but in the
third, which was a case of tabo-paralysis, the symptoms were of
only fourteen months’ duration, and yet the “ typical ” cortical
changes were apparently as marked as in the others.

But this important question must be decided by the further
examination of the cortex in tabes dorsalis and not by such
theoretical considerations. I have had the opportunity of
examining the brains of four cases of tabes. For the first two
eases I am indebted to the kindness of Dr J. R. Lunn ; the third
case was on two occasions in the National Hospital under the
care of Dr Ferrier, who kindly permits me to refer to the clinical
notes which were then taken; the fourth case will not be referred
to in detail, as it was only one of incipient tabes with very little
sensory disturbance and relatively little degeneration of the
dorsal spinal roots and of the dorsal columns of the cord.

Only two points in the clinical features of each case may be
referred to, namely, the duration of the disease and the nature
and the distribution of the sensory disturbance which was observed
during life.

Case I.—E. D., female, aged 45 years, had suffered with
tabes for at least two years before death. The only noteworthy
feature in the case was the presence of a large but painless
arthropathy in one hip-joint. Through the kindness of Dr Lunn
I was able to examine her some weeks before her death, which
was due to pulmonary tuberculosis, but owing to her weak condi¬
tion the examination could not be made complete. There was
then marked analgesia of the inferior extremities, especially in
the distal segments, a certain amount of anaesthesia, and practi¬
cally complete loss of the sense of position and of muscle pain
sense in these limbs. There was also practically complete
analgesia and relative anaesthesia on the upper portion of the
trunk, extending as high as the second rib and down the ulnar

GORDON HOLMES

borders of the arms, and definite loss of the sense of position in
the distal segments of these limbs.

Cask II.—F. C., a female, was 43 years of age at death. In
this case the disease had lasted about five years. Shooting
pains were apparently a very pronounced symptom, but the
only sensory loss referred to in the notes was anaesthesia and
analgesia on the right hand and on the right side of tire face*
Attention was apparently directed to those regions by the
coincident atrophy of the intrinsic muscles of that hand and the
wasting of the right masseter add temporal muscles.

Case III.—A. M., a male, was 49 years of age when he
died in October 1906. He had had symptoms of tabes for at
least sixteen years. When examined in January 1905, there
was marked diminution of pain sensation everywhere below the
level of the second rib and along the ulnar borders of the arms,
complete tactile loss on the trunk between the nipples and the
groins, absence of muscle pain sense and of the sense of position
in the legs and diminution of both in the arms, and complete losa
of bone sensation to a slowly vibrating tuning-fork in the lower
limbs. He was again under observation in April 1906 ; the
loss of all forms of sensation below the level of the second riba
and along the ulnar borders of the arms was still more marked.

In all these cases the ordinary routine was followed in the
examination of the cortex of the central convolutions. The
brain was hardened whole in 10 % formaline in normal saline
solution, and after a few days the portions selected for examina¬
tion were cut out and placed in alcohol, and, after dehydration*
embedded in celloidin. Sections 15 thick were stained in
thionin. In each of the cases several portions of the post-
central gyri of both hemispheres were examined, and the
structure of the cortex was compared with the corresponding
regions in several brains which were either normal or in which
no disease of the cortical cells was present.

It may be at once stated that no definite pathological
changes could be found in the cortex of any of the four cases
of tabes, either in the postcentral area or in any of the other
regions which were examined; but it must be admitted that

POSTCENTRAL CORTEX IN TABES DORSALIS 9

as attention was centred on the ascending parietal gyrus, the
examination of the rest of the brain was not complete.

In every case there was a marked difference between the
structure of the cortex of the summit and that of the Rolandic
wall of the postcentral gyrus, and this difference corresponded
more or less closely to that described by Campbell in tabes; but
the difference is equally marked and, as far as I can see, identical
with that which is found in the normal brain. In the latter it
is so striking that any one who has seen it must be surprised
that so careful an observer as Campbell has failed to describe it.
Brodmann has accurately described the difference between the
cortex of these two contiguous areas in man and the lower apes ;
in fact, he has differentiated two distinct types of cyto-archi-
tecture in the postcentral gyrus which together correspond to
the superficial extent of Campbell’s postcentral area. Brodmann’s
type 1 may be loosely described as that which extends over the
convexity of the ascending parietal gyrus, and which in structure
corresponds to Campbell’s postcentral type, while his type 3
covers the Rolandic wall of this gyrus and is visible on the
surface only as a narrow strip which bounds the precentral
cortex, or the area gigantopyramidalis, posteriorly in the para¬
central lobule. Contrasted with type 1 the structure of type 3
is distinguished by the narrowness of the cortex, in fact “ diese
Rinde gehort zu den schmalsten Typen des ganzen Cerebrum ”;
the large pyramidal cells of the supra-stellate layer are smaller
and more closely packed together, the layer of stellate cells is
also narrower, and in the infra-stellate layer very few large cells
are found. It will be at once seen that the difference there is,
according to Brodmann, between the type of cortex which covers
the Rolandic wall of the postcentral convolution and that of the
convexity of this gyrus, corresponds fairly closely to the differ¬
ence which Campbell has described between the cortex of these
two regions in tabes dorsalis, and which he attributed to
pathological changes in the Rolandic wall. Further, on com¬
parison of Brodmann’s figures with the illustrations in Plate IX.
of Campbell’s monograph, it may be seen that there is a fairly
accurate correspondence between the superficial extent of Brod-
mann’s type 3 and the “ affected tabetic area ” of the English
author.

In the brains of the four cases of tabes which I have

GORDON HOLMES

examined, as well as in a large number of control preparations,
I have made careful comparison between the cortex of the two
regions, and I have, as already mentioned, failed to find any
evidence of pathological change in either area in the tabetic
brains.

Finally, it must be pointed out that Campbell, in illustrating
the changes which he regarded as pathological, has unhappily
not drawn the figures which he reproduces for contrast from the
same region of the normal brain. In Plate VII. tbe “ affected
tabetic area” is drawn from halfway down the Rolandic side
of the postcentral gyrus, the normal from the Rolandic lip of
the same convolution; while in Plate VIII. the figure which
illustrates the normal has been drawn from the posterior wall of
the gyrus.

Mention may be made of a few points in the histology of the
Rolandic wall of the postcentral convolution, especially with
reference to Campbell’s descriptions. As Brodmann has pointed
out, the diminished breadth of the cortex of this region is one
of its most striking features. I have measured it and the
cortex from the convexity of the same gyrus, in a large number
of specimens, and have found that the relative breadth of the
former, as compared with that of the latter, varies between the
ratios of 1 to 1*25 and 1 to 1*5. [Fig. 3.] Of course for this pur¬
pose only sections were taken in which the cortex was cut absolutely
vertically. There is a considerable variation in the depth of
the cortex of each region : the figures just given have been
arrived at by taking the average of a large number of observa¬
tions. In Brodmann’s photomicrographs (Bd. IV., Tafel 6, Figs.
1 and 3), which represent the cortex of these two regions under
the same magnification, the breadth of type 3 in proportion to
that of type 1 is approximately as 1 to 1*4.

In my cases of tabes the relative breadth of the cortex of the
two areas did not exceed the normal limits.

My observations on the character and the arrangement of
the cells in the area under consideration coincide so closely with
those of Brodmann that detailed description is unnecessary.
Attention may be, however, drawn to two points. In the first
place, that the cortex of the Rolandic wall of the postcentral
gyrus is not by any means a uniform layer: there may be
considerable variations in its breadth over even a short stretch.

POSTCENTRAL CORTEX IN TABES DORSALIS 11

and the number of larger cells, especially in the supra-stellate
layer, which are contained in it at different points, is far from
constant. Campbell, too, has observed these irregularities in its
cortical architecture. “ The area could not be described,” he says,
"as a continuous and uninterrupted strip of diseased cortex,
because, more or less healthy patches running through two or
three sections were come across here and there.” In addition
to their small size, the cells of this region, and especially those
of the supra-stellate layer, are often irregularly arranged, and
not infrequently cells are seen in which the apical dendrite is
widely deflected from the vertical direction.

From these facts the conclusion must be drawn that
Campbell was in error in regarding the difference, which he
observed in tabes between the structure of the anterior wall and
of the summit of the postcentral gyrus, as due to pathological
changes in the former, and that though the clinical and experi¬
mental evidence which indicates that the sensory centres lie
behind the fissure of Rolando is ever growing stronger, we have
as yet no proof that the centre for “ common sensation ” is co¬
extensive with the distribution of any type of cortex, or with
any structural area.

References.

Brodmann, K. Journal f. Psychol, und Neurolog ., Bd. ii., S. 79. Ibid., Bd.
iv., S. 177. 1906.

Campbell, A. W. "Histological Studies on the Localisation of Cerebral
Function,” Cambridge, 1905.

Description of Figures.

Fig. 1 . —Drawing with the aid of a Leitz drawing-ocular from the convexity
of the postcentral gyrus, just below the superior genu of the fissure of
Rolando. It was taken from the point marked A in Fig. 3.

Fig. 2.—Drawing made with the same magnification as Fig. 1, from the
Rolandic wall of the postcentral convolution in the position marked B,
Fig. 3. It shows the reduction in breadth of the cortex, its less distinct
lamination, and the absence of larger cells from layers iv. and vi.

Fig. 3.—A section of portions of the precentral and postcentral gyri, just
below the level of the superior genu of the fissure of Rolando, drawn
accurately to scale. It shows that the cortex on the Roland ic wall is
narrower than that on the apex of the postcentral gyrus, the positions
in the sections from which Figs. 1 and 2 were drawn, and the extent
of the two types of cortex in the postcentral area. The double line
represents Brodmann’s type 1, the broken line his type 3.

ANDK t L^RI

CLINICAL AND ANATOMICAL DIAGNOSIS OF THE
ANKYLOSING DISEASES OF THE SPINAL COLUMN.

By Dr ANDRE L^RI of Paris.

Only a few years ago all the affections of the spinal column
that were accompanied with more or less pain, and with a
greater or less tendency to ankylosis and which were not
manifestly due to tuberculosis were ascribed to rheumatism. The
word rheumatism was a convenient term under which were
grouped promiscuously all articular or peri-articular diseases. It
even included many conditions which affected the shafts of the
long bones. Confusion was bound to attain its maximum in regard
to diseases of the vertebral column, formed as it is of a long
series of small bones and small articulations, the lesions in
which cannot be clinically differentiated, and perfect anatomical
demonstration of which is surrounded by numerous difficulties.

With regard to the limbs, the progress of clinical medicine and,
up to a certain point, of bacteriology have clearly separated acute
articular rheumatism, a disease apparently microbial in origin,
from various other forms of acute rheumatism, and from all the
varieties of “ chronic rheumatism ” which have a different
pathogenesis; but the clinical subdivisions which have been
made, and which are still incomplete, took into account for the
most part the anatomical differences previously recognised. With
regard to the spine, various clinical forms have been successively
picked out from the chaos of “ spinal rheumatism,” and subse¬
quently anatomical examination has justified the creation of these
morbid entities. (It is mainly in the group of chronic and
ankylosing affections that Professor Pierre Marie has been able
to distinguish new and quite independent clinical varieties, by ne
means rare as a matter of fact, but previously misunderstood by
the writers who had occasion to observe them because they had
not been sufficiently isolated and described. We do not require
further proof than the frequency of spondylose rhizomdlique, of
which in the year following its description (1898) 1 we were able
to collect more than thirty cases published previously under

1 Pierre Marie, Soc. Mid. dts H6p de Paris, Feb. 11, 1898, et Rev. de Mid.,
April 1898.

Andre L4ri, “ La Spondylose Rhizom&ique,” Rev. de Mid., Aug.-Sept., Oct., 1899.

ANKYLOSING DISEASES OF SPINAL COLUMN 13

various names, and of which a few years later there had been
published hundreds of cases, examined in all countries; at
present the observations have become so common that for the
most part they are not published.)

Along with Professor Pierre Marie, we have devoted ourselves
to the anatomical differentiations of these morbid forms, and
the examination of the spinal columns has shown very manifest
differences between each, and has at the same time thrown light
upon their pathogenesis. It is especially to the clinical, and then
to the anatomical descriptions of these various chronic ankylosing
diseases of the spinal column that we shall devote this article.

I. Clinical Diagnosis.

1. Spinal Rheumatism ,.—We may say that in the great
majority of cases, the involvement of the spine in chronic
deforming and ankylosing rheumatism occurs at a late stage of
the disease. The small articulations of the extremities, especially
of the hands and feet, are always, or almost always, the first to be
affected. Chronic deforming rheumatism is essentially acromelic.

When later the spinal column is attacked in its turn, and
more or less ankylosed, it is almost always by the examination
of the deformities of the hands, which are so well known and so
characteristic, that one can at a glance give the diagnosis of true
"spinal rheumatism."

Pain in the spinal column may be essentially variable both
in intensity and especially in site: it may from the very first
extend through the whole of the spinal column; it may be and
may remain localised to one of its divisions, and the cervical
segment seems to be the region of predilection. The ankylosis
which subsequently develops may also be generalised; more
frequently it is localised either in the cervical region or in the
lumbo-dorsal region. When it involves the whole spine the
head of the patient may be bent forwards to a more or less
marked degree, and the spine may present a more or less
marked cyphosis; but in other cases the head may be erect and
the spine may be absolutely upright, straight and rigid as a bar
of iron, even with obliteration of the slight normal antero¬
posterior curves.

The rest of the trunk is not materially deformed when the

ANDRti L^RI

spine is straight; when the latter is curved, the thorax
frequently presents a dilatation of variable extent, in the form of
a barrel, more or less analogous to that found in emphysema; but
there is never a marked antero-posterior flattening (Fig. 1).

The spine is frequently affected after the small joints of the
extremities, without the large joints being markedly affected, and
ankylosis of the spine does not in any way presuppose ankylosis
of the hips or knees. In a general way one may say that the
affection evolves by a succession of attacks, almost without any
order, except that it commences in the small joints of the limbs.
With regard to the attacks of pain, they are almost always very
severe and frequently present the characters of intercostal
neuralgia.

The subjects of the disease are most frequently already up in
years, men or women, perhaps most often women. In their
antecedents we may sometimes discover an infection which we
may regard as causal. More frequently it can only be said that
they belong to the class of “ grands netvro-arthrUiques”

2. Spondylose RhizomAlique. — Spondyloae rhizom&ique, first
noted by Striimpell, described by Pierre Marie in 1898, and
studied by L6ri more particularly in its clinical evolution in
1899, presents a quite different clinical picture.

Its subjects are generally young, either adolescent or in the
first part of adult life, up to the age of 35 or 40. In almost all
cases it is men who are affected. They are not generally neuro-
arthritics; but we find in the previous history of almost all of
them evidence of the infection of which the existing group of
ankylosing symptoms would appear to be the consequence. This
infection is frequently tuberculosis, much more frequently still
gonorrhoea; sometimes it is one of a variety of other infections.
Moreover, very commonly close examination of the patient shows
that the causal infection is still active; that the tuberculosis is
frequently still in evolution, sometimes after a longer or shorter
period of remission, which might have been mistaken for recovery.
The gonorrhoea has usually left as a residue, either a morning
gleet, or at least a slight turbidity of urine, indicating the
presence of a very mild cystitis. It is, above all, after repeated
and prolonged attacks of gonorrhoea that spondylose is to be
observed.

The ankylosis is limited to the spinal column, to the hips and

ANKYLOSING DISEASES OF SPINAL COLUMN 15

shoulders, often to the knees ; frequently also to the sterno¬
clavicular and temporo-m axillary joints. This does not imply
that the pains, at the very commencement, may not be more or
less generalised; but the ankylosis never attacks the joints of the
extremities, with the exception of some very rare cases, in which,
at a very late period , it may also involve the small joints of the
limbs ; but in general the ankylosis is clearly spondylotic and
rhizomelic.

The evolution of the ankylosing process is variable, We may,
however, draw up a general scheme which corresponds to the
majority of the cases. In the first period of the disease the
pains occupy the sacro-coccygeal region and are frequently very
violent and persistent there. When they cease, we find that the
lumbo-sacral column has become rigid. The hips become anky-
losed almost at the same time, and with or without local pains.
They may become ankylosed in more or less complete extension
or in demi-flexion, perhaps according to whether the patient can
or cannot continue to walk. It is this variable flexion of the
thighs on the pelvis that gives to the patient the attitude which
we have called the “ flexion type,” or the “ extension type ” (Figs.
2 and 3).

To this period of “ inferior ankylosis,” there usually succeeds
a period of remission, during which the dorsal region becomes
ankylosed in its turn, but in a more or less painless way, in any
case without the violent intercostal pains which are frequently
observed in spinal rheumatism.

Then comes the period of “ superior ankylosis,” characterised
by violent pains in the cervical region, followed by ankylosis of
this part of the spine. The neck then becomes bent to a degree
which varies according to the case and according to the degree of
flexion of the hips, but it never remains straight as we some¬
times observe in spinal rheumatism.

If at this period we ask the patient to separate his arms from
the body, we see that this movement of abduction and elevation
is almost always very limited, that the arms frequently do not
reach the horizontal position. If a hand is placed on the
shoulders, we discover coarse crepitations in the joint. The
ankylosis is almost never complete at the shoulder joints, while
on the other hand it frequently is so at the hip joints.

The knees are, as a rule, attacked later, and often to a slight

ANDRIS L&RI

degree, so that sometimes one may only note that in extreme
flexion the heel cannot come into contact with the buttocks. The
sterno-clavicular and temporo-maxillary joints are frequently
affected more or less early and more or less severely, generally
with a certain degree of local pain.

The thorax is almost always flattened from in front back¬
wards, the sternum being approximated to the spinal column and
the ribs being more oblique than in the normal condition. This
deformity is often very marked. The pelvis is also involved in
the antero-posterior flattening, but this fact is more difficult to
verify ; it arises perhaps in part, but only in part, from a kind
of slight tilt of the bones of the pelvic girdle. Radiography
shows, however, a marked deformity of the pelvis, which, as a
result of the subsidence of the spinal column, assumes the form
more or less of a heart on playing cards.

The evolution of this affection is essentially chronic. Follow¬
ing the two principal stages of development (viz., that of pain
and that of ankylosis), affecting first the lumbo-sacro-coccygeal,
then the cervical region, there may occur further periods of
pain, more or less acute, generally much less marked than the
former, and mainly cervical in their localisation. But as a
general rule the disease tends towards a stage of final ankylosis
without pain; patients are left in this state of disablement
without a tendency towards further progress of the disease.

3. Hereditary Traumatic Cyphosis .—Hereditary traumatic
cyphosis, described by Bechterew as “ ankylosing rigidity of the
spinal column,” and studied specially by Pierre Marie and Astid,
presents an absolutely different clinical picture. Most frequently
the subjects are already old, and in their hereditary antecedents,
direct or collateral, we discover the tendency to abnormal spinal
curvatures, cyphosis or hunchback. In most cases the disorder
arose from a sudden injury in patients who already had a more
or less marked degree of senile or pre-senile cyphosis. The
accidents hitherto described have been of two kinds ; either the
patient has fallen on his back, perhaps while carrying a heavy
load, or a weight has fallen on his back. We can understand
that in either case the accident would tend to straighten the
physiological dorsal curve, and still more so if the spinal column
were already abnormally cyphotic. However that may be,
during the days following the injury the dorsal pain becomes

ANKYLOSING DISEASES OF SPINAL COLUMN 17

somewhat violent, the cyphosis is very marked, and the patient
stoops in walking. Then the pain abates, the patient straightens
himself, and during the next few months walks sometimes more
erect than before. Then slowly, gradually, with or without fresh
pains, but without apparent reason, there appears a very marked
dorsal convexity (gibboviM ), not angular but semi-circular, and
frequently of very small radius. This convexity occupies the
extent of four, five, or six vertebrae ; it cannot be reduced by sus¬
pension of the patient, whilst the cyphosis, which persists above
and below it, can still be reduced. Thus it is clearly only at
the level of the convexity that the vertebrae are ankylosed.

This ankylosis is not as a general rule accompanied by very
severe pain, at least not by spontaneous pain. The vertebrae,
however, remain for a long time painful to pressure at the level
of the convexity. The thorax is always very much dilated from
in front towards the back, as in all cases of hunchback (Fig. 4).

It would seem that the ankylosis is not always permanent,
and a manifest improvement, if not recovery, may supervene
after rest in bed and the wearing of a corset.

All the other joints are inta&t, and in short, this hereditary
traumatic cyphosis behaves just like a local accident, and not, as
in the preceding affections, like a general disease. It can be
easily recognised with a little care. The etiological difficulty is
constituted by the long period which has elapsed since the
occurrence of the injury, but it is precisely its peculiar evolution
in two parts which is one of the best diagnosing signs. More¬
over, it is much more rare than spinal rheumatism and spondylou
rhiz&m&ique.

A fact which it is important to note, however, is that in
very rare cases of traumatic cyphosis there may appear signs of
compression of the spinal cord which are’ more or less serious and
persistent. Henle, in a case of this kind, observed a tendency
to spasticity. We ourselves have had the opportunity of observing,in
a case as yet unpublished, a true spastic paraplegia. Pathological
anatomy has seemed to us to give the key to the explanation of
these unusual and serious symptoms. We shall return to this
question further on.

4 . There exist without doubt many other varieties of non-
tubercular vertebral ankyloses,but they are almostalways more dis¬
tinctly limited than the preceding forms, and the spinal ankylosis

ANDRtf LfiRI

is merely an accidental and limited localisation of a more general
disease. As they are little known clinically and anatomically, it
is unnecessary to do more than mention them.

Gout of the spine , described by IAcorch6, is as a rule merely
a localisation of the general affection, preceded for a considerable
time by acute and repeated attacks in the small joints, especially
that of the great toe, and frequently by various non-articular
manifestations of gout. It presents two predominating localisa¬
tions, the lumbar region and the cervical region. The uratic
deposits cause severe local pains, crackings of the joints, symptoms
of nerve compression, neuralgias, amyotrophies, paraplegias, but
they do not lead to true ankylosis.

Syphilis of the spine, which appears to be very rare, produces
a true “ syphilitic Pott’s disease,” localised principally in the
cervical region. Apart from the ulcerous form, analogous to
tubercular Pott’s disease, Leyden notes the existence of an
osteophytic form, which would be very much analogous to chronic
rheumatism, but as yet we have not sufficent pathological data to
permit of our describing a spinal syphilitic ankylosing disease of
the spinal column.

Various abnormal attitudes of the spinal column, resulting
from conditions rather physiological than truly pathological, may
give rise to confusion with the ankylosing diseases of the spine
which we have described. Amongst these the duplicature
champitre (peasants’ stoop), described by Pierre Marie, consists
of a cyphosis with ankylosis of the lumbar region in the position
of flexion. It is observed in field-workers who are constantly
stooping over their spades or their ploughs. It is accompanied
neither by ankylosis of the whole of the spine nor by pronounced
ankylosis in the joints of the limbs (Fig. 5).

Senile cyphosis, a gradual curvature of the trunk which occurs
in a great number of old people, and which may be easily
recognised, has not, to our knowledge, been hitherto described,
and has not been anatomically studied. Without as yet being
very positive, we believe, from, what we have been able to observe,
that it results mainly from a real subsidence of the rarefied verte¬
bral bodies (rarefied as, for example, is the neck of the femur in
old people). It is this subsidence which in old people produces
the shortening of the figure; which also, especially at the
anterior part of the vertebral bodies (because it is there that, on

Plat* 2.

ANKYLOSING DISEASES OF SPINAL COLUMN 19

account of the normal dorsal curvature, they undergo the greatest
pressure), produces a senile cyphosis which is sometimes very
marked. The bodies of the vertebrae thus form an angle with
each other, and we doubt whether there are produced in this
case any true spinal ankyloses. It is for this reason, that apropos
of the clinical study, we have made this incursion into the patho¬
logical anatomy. We reserve for the anatomical study which
follows the three great ankylosing diseases of the spinal column,
of which we have described the differential clinical characters.

(To be continued.)

Description of Figures.

Fig. 1 . — Chronic Ankylosing Vertebral Rheumatism, with commencing
ankylosis of the hip-joints. The deformities of the hands and the
slight relative curvature of the vertebral column are to be noted.

Fig. 2.— Spondylose Rhizom£lique, “ flexion type.” Note the flexed position
of the hip-joints.

Fig. 3. —Spondylose Rhizom£lique, “ extension type,” with in addition dis¬
location of the cervical column. Note the slight curvature of the spinal
column, the flattening of the thorax, and the normal state of the
extremities.

Fig. 4—Hereditary Traumatic Cyphosis; the extreme degree of curvature
limited to the donal region.

Fig. 6 . — Duplicature champStre, or Peasant’s Stoop of Marie. Note the
cyphosis in the lumbar region and the stooping attitude.

ABSTRACTS

abstracts

ANATOMY.

ON CERTAIN PERIVASCULAR CORPUSCLES IN THE OERB-
(1) BRAL SUBSTANCE. (Sopra special! corpuscoli perivasali
nella sostanza cerebrals.) U. Cerletti (of Rome), Riv. Sper.
di Fren., Vol. xxxiii., Fasc. 2-3.

The elements described by the author are found in the perivascular
spaces in the cortex, both in normal and in pathological conditions,
in animals as well as in man. They stain faintly, show no nucleus,
have semilunar or ovoid shape, appear homogeneous or granular;
they are most easily demonstrated by means of a pyronin, methy¬
lene-green stain (Unna-Pappenheim); they are morphologically
distinct from the well-known ectodermal and mesodermal elements
of the cortex; their meaning is not known. Nine figures are given
to illustrate these perivascular bodies.

C. Macfie Campbell.

PSYCHOLOGY.

RESULTS OF FATIGUE MEASUREMENTS IN 64 SOHOOL-
(2) CHILDREN. (Ergebnisse von Ermiidungamessungen an 64
Schulkindern.) Eduard Quirsfeld, Prag. med. Woch., Oct.
24, 1907.

Stimulated by the interest awakened by the results of the
measurement of fatigue in school children made public by
Dr Schuyten at the thirteenth International Hygienic Congress
in Brussels (1903), Dr Quirsfeld undertook an investigation on
similar lines.

The children selected were the brightest in the class, and were
divided by the teacher into visual and auditive types. To secure
their confidence, a preliminary set of memory tests was under¬
taken. The material used consisted of series of letters or num¬
bers, mental division, etc. The following are the chief results
obtained:—

When five seconds were allowed for writing down the remem¬
bered letters, the auditive children surpassed the visual; but when
ten seconds were allowed, the visual children were superior.
When numbers formed the material, the visual were always
superior. The visual boy was better than the auditive in mental
arithmetic, and the boys better than the girls.

ABSTRACTS

For his experiments Dr Schuyten had used rows of figures,
and by testing the memory for these rows had sought to compare
the mental activity of children in the morning with that in the
afternoon. The afternoon test was made one day and the morning
one the following day. In both boys and girls the morning results
were superior. Dr Quirsfeld repeated these experiments, taking
the morning tests on the first day, the afternoon ones on the
second; he found that in both boys and girls the afternoon results
were superior. He then assured himself that, whether the exercises
were begun morning or afternoon, the second result was invariably
the better.

With twelve girls and twelve boys he then tried a series of
similar experiments, taking the children on four successive days.
The following figures, representing the intellectual activity of the
scholars at the times mentioned, show the results obtained:—

At the beginning of the forenoon instruction
At the ena ,, „

At the beginning ,, afternoon
At the end ,, „

»»

Boys.

Girl*.

39-93 %

42-68 7.

51-1# 7.

44-77 7.

45-83 •/.

46-66 7.

44-34 7.

86%

These results show that some hours’ work improves the
memory, but that fatigue does actually set in during the afternoon
instruction, which must, therefore, be reckoned as of less value
than that of the morning.

Dr Quirsfeld undertook another series of investigations, using
a turning cylinder with numbers printed on it, and causing the
children to add the numbers in pairs and say the sums aloud.
Each trial lasted for fifteen minutes. Mistakes occurred most
frequently in the second half of the period ; the maximum number
of additions was made between the sixth and tenth minutes, the
minimum between the tenth and fifteenth. Visual children gave
the best results, and the boys far surpassed the girls.

In conclusion. Dr Quirsfeld emphasises the desirability of a
knowledge of psychology on the part of the teacher, and the
necessity of instruction being suited to the enormously varying
individualities of the children concerned.

Margaret Drummond.

THE SLEEP OF ANOTHER. (Der Schl&f des Andern.) Dr Paul
(3) Kronthal. Carl Marhold, Berlin, 1907. Pp. 45.

This pamphlet is an expansion of a paper on Sleep delivered on
November 5th 1906, to the Berlin Society for Psychiatry and
Nervous Diseases.

The author begins by making clear his point of view. He
thinks that the reason why scientific men have not yet agreed on

ABSTRACTS

any theory of sleep is that they have treated it now from the
subjective, now from the objective side, without clearly realising
that in shifting their ground in this way they alter all the pre¬
suppositions on which their arguments are based. As soon as the
subjective is introduced we pass to a world in which agreement is
unattainable, because every man's sensations are known to himself
alone, and by no possibility can be made known to another for
purposes of investigation and comparison. Hence the man of
science must confine himself exclusively to the objective; matter,
energy, time, space, number, the laws of logic, and the law of
causality form his postulates; and he must not inquire into the
grounds on which these conceptions rest. When he has resolved
a problem as far as is possible for the senses, then his work
is done.

In accordance with this view Dr Kronthal proceeds to an
examination of sleep as a purely objective phenomenon—“the
sleep of another.” His definition of sleep from this standpoint is,
“ the temporary condition of a living organism in which most of
the reflexes are set aside or arrested.” According to this definition
the cessation of reaction which is brought about when a detached
frog’s muscle is stimulated continuously for some time is Bleep.
Moreover, the pathological states brought about by the action of
chloroform, ether, etc., and cold arise not only in animals with
highly developed nervous systems, but in organisms without
nervous systems at all and in bits of muscles. Hence sleep is not
dependent, as is commonly supposed, on the nerve cells of the
brain ; on the contrary, every cell in the body suffers from fatigue
and periodically requires rest or sleep.

The importance of the nerve cell has, according to our author,
been greatly exaggerated; every disease of which we know nothing
has been set down as “ nervous,” in spite of the fact that in many
such diseases, e.g., hysteria, mania, melancholia, epilepsy, the
nervous system may be perfectly healthy. As a matter of fact
the central nervous system has no special directing authority, but
is merely an office by means of which stimuli are transmitted to
the motor apparatus.

If the definition given is a true one, then sleep should occur
(1) when stimuli fail, (2) when the sense organs do not act, (3)
when the conduction of stimuli to the motor apparatus ceases. In
all these three cases we find that sleep actually does arise, thus
confirming the truth of the definition; but in only one of them,
the third, is the condition brought about by the state of the
nervous system. The brain being the central office, whither
sensory paths converge, is the only place where an injury can
interfere sufficiently with conduction to arrest most of the reflexes
and so give rise to sleep.

ABSTRACTS

The attribution of special directive agency to the part of the
nervous system containing the most nerve cells, viz., the brain,
Dr Kronthal attributes to the belief that the soul is situated in
the brain and thence directs the body. He proceeds therefore to
inquire what, from a naturalistic point of view, is the meaning of
the term “ soul” Its meaning he finds to be simply “ the sum of
the reflexes”: the more reflexes, the more soul. An infant, in
whom comparatively few sensori-motor arcs are developed, has
little soul. As we descend in the animal scale, the sum of the
reflexes decreases, and corresponding to this we find less and less
soul. The introduction and discussion of the term soul evi¬
dently arises from the felt necessity of unifying the reflexes.
But in using the term soul in this way Dr Kronthal robs it of
all the most important part of its content. A writter in the
Hxbibert Journal recently defined the soul as “ that which feels,”
but feeling Dr Kronthal excludes altogether from his material
He expressly says, “Of feeling we can never know anything.
Whosoever, therefore, conceives of will and feeling as faculties of
the soul removes the bouI to the realm of mysticism.” We
sympathise heartily with the writer in his endeavour to view his
subject from one clearly defined standpoint; but we think it
would be better if in so doing he rejected the term soul, with
its ineffaceable connotation, as decisively as he rejects the term
feeling.

In his attribution of fatigue to all the cells Dr Kronthal
disagrees with Professor Mosso and other authorities, who regard
it as being always nervous in character. The valuable and
suggestive examination set forth in this paper might well be
supplemented by an inquiry into what actually takes place in the
individual cells when fatigue sets in.

The clear recognition of the postulates of science and of the
special standpoint of the scientific man lends considerable philo¬
sophic interest to this treatise. We are, however, inclined to
think that the author exaggerates the difficulty of comparing
subjective experiences. After all, it is from our subjective sen¬
sations that we construct the whole spatial world in which
measurement rules supreme, and the very fact that in this par¬
ticular instance we all do construct the same world, gives good
ground for the presumption that our more intimate worlds, where
hope, fear, desire, and purpose hold sway, have also so much in
common as to render understanding and comparison possible. The
valuable results in psychology which have been obtained by the
researches of Galton, James, and other students, are a standing
proof that this presumption is justified.

Margaret Drummond.

ABSTRACTS

PHYSIOLOGY.

ON AN APPARENT MUSCULAR INHIBITION PRODUCED BY
(4) EXCITATION OF THE NINTH SPINAL NERVE OF THE
FROG, WITH A NOTE ON THE WEDENSKY INHIBITION.

V. J. Woolley, Jowm. of Physiol., Vol. xxxvi., Nos. 2 and 3,
p. 177.

Nicolaides and Dontas showed that if a continuous tetanus of the
frog’s gastrocnemius is produced by a strong excitation of the eighth
spinal nerve, then a weaker stimulation of the ninth will often
bring about a relaxation. This was supposed by them to prove
that the ninth spinal nerve contains inhibitory fibres to the gastro¬
cnemius. The author believes, however, that this phenomenon is
a particular case of the Wedensky inhibition, and that it is not
due to the presence of inhibitory fibres in the ninth nerve.

Sutherland Simpson.

STRYCHNINE AND REFLEX INHIBITION OF SKELETAL
(5) MUSCLE. C. S. Sherrington, Joum. of Physiol., Vol. xxxvi,
Nos. 2 and 3, p. 185.

The “ flexion-reflex ” of the hind limb in the cat was used in this
research. The femur was firmly clamped, the vasto-crureus (ex¬
tensor) and semi-tendinosus (flexor) isolated, and one or other
attached to a recording lever, the flexion-reflex being induced by
stimulating faradically the afferent nerve—either a branch of the
internal saphenous or the musculo-cutaneous division of the
peroneal.

When this reflex is brought about, the flexor group of muscles
(for the knee-joint) contract, and at the same moment there is a
relaxation of the extensor group, this relaxation of the vasto-
crureus being indicated by a fall of the lever. This relaxation is
due to a central inhibition which quells any centrifugal discharge
which may be exciting or maintaining contraction in the muscle.
But following on this relaxation-phase of the extensor there is, if
the exciting stimulus be strong or prolonged, a second phase of
contraction indicated by an upward movement of the lever. The
first, or relaxation-phase, lasts as long as the external stimulus is
applied; the second, or contraction-phase, ensues on cessation of
the external stimulus.

After strychnine, even in small doses, the relaxation-phase is
abolished in the extensor part of the flexion-reflex and replaced by
a contraction-phase, the normal second or rebound contraction-

ABSTRACTS

phase being suppressed. The extensor part of the “ flexion-reflex ”
cornea therefore under strychnine to resemble the flexor part, both
groups of muscles contracting at the same moment, and so the
normal co-ordination is completely destroyed. Under chloroform
and ether the strychnine effect disappears, and the normal simul¬
taneous contraction of flexors and relaxation of extensors can be
again brought about, but if the narcosis is remitted, the change
induced by strychnine returns. Sutherland Simpson.

ON THE RELATION BETWEEN THE PHYSICAL, CHEMICAL
(6) AND ELECTRICAL PROPERTIES OF THE NERVES.

Part I. N. H. Alcock and G. R. Lynch, Joum. of Physiol .,
Vol. xxxvi., Nos. 2 and 3, p. 93.

In this preliminary communication the authors have estimated the
percentage of water and of chlorine in the nerves of different
animals (cat, dog, goat, horse), and in different nerves of the same
animal, and they have also tried to determine the percentage
solutions of NaCl aud of KC1 isotonic with these nerves, by immers¬
ing them in the above solutions and observing at what concentra¬
tion they neither gain nor lose in weight. They summarise as
follows:—

(1) The average percentage of water in the medulla ted nerves
of cats is 67*3; dogs, 69*7; goats, 75*4 ; horses, 69-3; and for non-
medullated nerve from the horse, 81*2.

(2) The percentage of water varies in different animals of the
same species, and in different nerves of the same animal, e.g., the
internal popliteal nerve of the cat has invariably a higher percent¬
age than the external popliteal.

(3) Nerves of the cat placed in solution of pure NaCl in
distilled water of approximately 1*16 per cent, remain unchanged
in weight. This differs from the 0*9 per cent, usually taken as
isotonic with mammalian tissues.

(4) The average percentage of chlorine (0*23 per cent.) is the

same for both non-medullated and raedullated nerves of the horse.
This does not agree with the results of Macallum and Menten,
who state that the medullary sheath is practically free from
chlorides. Sutherland Simpson.

ABSTRACTS

PATHOLOGY.

TRAUMATIC LESION OF TEE PONS AND TEGMENTUM WITH
(7) DIRECT AND RETROGRADE DEGENERATION OF THE
MEDIAN FILLET AND PYRAMID, AND OF THE HOMO¬
LATERAL OLIVE. A. Meyer, Joum. of Nerv. and Mental Dis .,
Nov. 1907.

A short paper is given describing the above lesion as a consequence
of an injury to the neck, causing apparently a fracture of the base
of the skull. John D. Comrie.

ON THE PATHOLOGY OF THE LENTICULAR NUCLEUS. (Sulla
(8) patologia del nucleo lenticolare.) G. Francesco (of Rome),
Riv. Sper. di Fren., Vol. xxxiii., Fasc. 2-3.

The author reports the history of a patient with a haemorrhagic
cyst of the putamen, and describes the pathological anatomy with
the secondary degenerations, illustrated by eight figures. He also
refers to a case with a lesion of the retro-lenticular region. The
following are his main conclusions:—

Haemorrhage of the putamen, when the retro-lenticular region
of the capsule is implicated, gives rise to a very complicated
symptomatology, which often simulates that of a focal cortical
lesion with a mental syndrome. The median fillet passes mainly
into the lenticular nucleus, but is also connected with the thalamus
through the hypothalamic nucleus; the lenticular nucleus is
connected with the nuclei of Goll and Burdach of the opposite
side through the hypothalmic nucleus and the median fillet. The
pes lemniscus profundus is probably a trophic path. The com¬
missure of Meynert is in relation with the lenticular nucleus, and
has no connection with the optic tract. Pseudomelia parestesica
is related to lesions of the lenticular nucleus or of the retro-
lenticular region of the capsule. The putamen is an important
trophic station in connection with long trophic paths which cross
over in the cord. Lesions of the putamen can produce acute
cerebral hemiatrophy. C. Macfie Campbell.

SYRINGOMYELIO LESION IN A CASE OF CATATONIC
(9) STUPOR. (Lfeions syringomydliques chez une catatonique.)

G. Deny et A. Barb£, L’Enctyhale, Sept. 1907, p. 283.

The patient, a woman of 50, had been catatonic for seven years;
no syringomyelic symptoms were noted during life. At autopsy the

ABSTRACTS

cord appeared normal till cut. Sections revealed the presence of
a cavity continuous with the central canal extending from about
C 4 to D 10. The shape varied from an antero-posterior slit in
the cervical enlargement, to an irregular polygon in the upper
dorsal region; the posterior grey commissure was the only part of
the cord which suffered much. The tissue around the cavity was
of the usual gliomatous type. A peculiarity of the case was the
presence in the cavity of small glial columns (like the column*
carneae), each containing a blood-vessel running their whole length.
They argue in favour of the cavity being associated with a pre¬
existing anomaly of the central canal from the presence of an
asymmetry of the grey matter in the cervical matter which they
take to be a congenital malformation. From the illustrations one
could not tell that it was more than collapse of the cord when the
fluid escaped from the syringomyelic cavity.

J. H. Harvey Pirie.

A CONTRIBUTION TO THE STUDY OF “ NEUROTOXIO
(10) SERUMS” AND THE LESIONS OF THE NERVOUS
SYSTEM INDUCED BY THEM—ISO-NEUROTOXIC SERUM.
(Oontributo alio studio dei “ sieri neurotossici ” e delle lesion!
da essi provocate nel sistema nervoso —siero iso-neurotoesico.)
Rossi, Rev. di Patolog. Nero, e Meni., F. 9, 1907, p. 417.

The serum is prepared in the following manner. An animal is
killed by bleeding from the carotid, the brain cut into small
pieces, what little blood remaining being washed out by physio¬
logical solution. A quantity is then weighed, triturated into a
homogeneous mass, and sterile physiological solution added until a
determined quantity of nerve substance is obtained for injections.
The emulsion so obtained is then filtered. All details are carried
out with the strictest aseptic precautions. The emulsion is now
injected into the peritoneum of an animal from which the toxic
serum is to be taken. The injections are performed at intervals
of 4 or 5 days, and repeated a varying number of times.

The animal is then bled 6 to 7 days after the last injection, the
blood collected in sterile tubes and the serum then separated.
Injection of this serum is performed directly into the nervous
centres.

Condtisions. —1. The injection into an animal of a certain
species, of nerve substance from another species, gives to the
serum of the former a toxic power towards the nervous system
of the latter. 2. The injection of grey or white substance, in the
process of preparing the serum, does not give the same clinical
results afterwards. 3. If one injects an emulsion of the brain of

ABSTRACTS

a guineapig into a guineapig, the serum, after a certain number
of injections, becomes neurotoxic to this animal. 4. The action of
these sera is not quite specific. 5. All the properties of these
sera do not correspond to those possessed by a typical cytolytic
serum. 6. The anatomical changes induced are constant; the
gravest are those of the nervous system. David Ork.

PLASTICITY AND AMtEBOIDISM OF THE CELLS OF THE

(11) SENSORY GANGLIA. (Plasticity et Amiboisme des Cellules
des Ganglions sensitifs.) 6 . Marinesco, Rev. Neurol., Nov. 21,
1907, p. 1109.

As in the author’s previous papers, the plexiform ganglion was
transplanted under the skin of the ear (rabbit, auto-transplanta¬
tion), and the modifications the cells undergo are again given in
detail. But in this article Marinesco theorises as to the manner
in which the surviving cells become morphologically altered, and
ascribes the increase in volume of, and formation of expansions
in the cells at the periphery of the ganglion, to movement. A
certain number of these cells, besides throwing out protuberances
and ramifications, appear swollen, indicating the penetration of
liquids into their interior.

The production of these expansions is not due to variation of
osmotic pressure, nor to accumulation of the products of dis¬
integration and C0 2 , which always raise the osmotic pressure, for
such new formations are only found in the cells at the periphery
of the ganglion, i.e. in those which survive the process of trans¬
plantation. David Orr.

PERIVASCULAR INFILTRATION WITH PLASMA CELLS IN

(12) THE CENTRAL NERVOUS SYSTEM OF ALOOHOLI8ED
RABBITS. (Pexivaskul&re Plasmazelleninflltration, etc.)

J. Montesano (of Rome), Centralbl. f. Nervenheil. u. Psych.,
Nov. 15, 1907.

The presence of a diffuse perivascular plasma-cell infiltrate in the
cortex is a very important differential point in the histopatho-
logical diagnosis of general paralysis. In chronic alcoholism the
vessel walls show chiefly regressive changes, and the perivascular
lymph-spaces show no infiltrate.

The author gave rabbits up to 12 ccm. absolute alcohol di¬
luted with water daily, sometimes in conjunction with an intra¬
venous injection of adrenalin, for variable periods; in four cases
he found plasma-cell infiltration of the cortical vessels.

C. Macfie Campbell.

ABSTRACTS

THE PATHOLOGICAL CHANGES IN THE OENTEAL NERVOUS

(13) SYSTEM IN EXPERIMENTAL DIPHTHERIA. CHARLES
Bolton and S. H. Brown, Brain , Oct. 1907, p. 365.

The authors confirm by their work previous results obtained by
Crocq, Nouraviefif, and Rainy on rabbits, and have also found that
the nerve cells of the monkey are susceptible to the action of
diphtheria toxin, and that the medullary centres of this animal are
more definitely affected than are those of the rabbit, where the
cells of the spinal cord are chiefly affected. The cerebrum, cere¬
bellum, and spinal ganglia were in all cases normal, the nerve-cell
degeneration being limited to the cord, medulla, pons, and mid-
brain. The degenerate cells are scattered, not in any definite
focus, and are mingled with others apparently normal. The changes
in the cells are, on the whole, slight, although in some the degene¬
ration is extreme.

They believe that the degeneration is a direct effect of the
diphtheritic toxin, not secondary to circulatory changes; that the
peripheral nerves are also directly affected, their degeneration not
being merely a result of their central cells being affected ; that the
fatty degeneration of the heart is also direct, not merely subsequent
to the medullary affection. J. H. Harvey Pirie.

CLINICAL NEUROLOGY.

HERED ITY IN DISEASES OF THE NERVOUS SYSTEM, WITH

(14) SPECIAL REFERENCE TO HEREDITY IN EPILEPSY.

Philip Coombs Knapp (Boston), Boston Med. and Surg. Joum.,
October 10, 1907, VoL clvii., p. 485.

Otjb ideas as to heredity have been considerably modified by the
doctrines advanced by Galton, Weismann, Mendel, and others.
Weismann’s theories indicate that morbid heredity occurs only
when the germ plasma is pathologically altered by certain injurious
causes, such as intoxication, infection, constitutional disease, or
local disease of the generative tract, causing constitutional weak¬
ness of the individual Galton and Mendel have emphasised the
fact that when such morbid heredity does occur it tends to
disappear in succeeding generations by the influence of new blood.
The present data as to morbid heredity as a cause of nervous
disease are of little value. Similar heredity is rare, and is seen
chiefly in certain very uncommon diseases, such as Huntington’s
chorea, Friedreich’s ataxia, muscular dystrophy, amaurotic idiocy,
etc^ although it is also rather frequent in migraine. Although a
hereditary tendency is common in these diseases, many cases occur

ABSTKACTS

without any such taiut. Dissimilar heredity, in the form of the
neuropathic or psychopathic predisposition, is thought to be much
more frequent. The statistics of such heredity in insanity are
invalidated by the fact that wholly different diseases are classed
under the one heading of insanity and conclusions are then drawn.
Epilepsy is a syndrome rather than a disease, so that the* statistics
as to epilepsy are open to the same objection, although in a some¬
what less degree. The statistics as to neuropathic heredity vary
enormously, from 11 to 87 per cent. In 1200 cases at the
Massachusetts Hospital for Epileptics, neuropathic heredity was
found in 14*5 per cent.; in 320 personal cases it was found in
35 per cent. Similar heredity was likewise found to vary from
0*9 to 37*2 per cent. It is possible that similar heredity has some
influence. The existence of other forms of nervous and mental
disease in the antecedents in a certain percentage of cases has been
unwarrantably assumed to be evidence that morbid heredity was
an important factor in the aetiology of nervous and mental disease.
The special aetiology of these antecedent cases of nervous disease,
however, must be considered, and cases due to trauma, infection, or
toxic influences excluded. It is also unfair to assume that the
existence of nervous disease in the antecedents is evidence of a
morbid heredity, unless the percentage of nervous disease is
greater than that occurring in the antecedents of healthy persons.
Very few studies have been made to show how often nervous
disease does occur in the antecedents of healthy persons, but
Thomann-Koller and Diem have found it in 59 and 66*9 per cent,
respectively, a percentage greater than has been reported in many of
the collected cases of epilepsy. In many cases the morbid suscepti¬
bility of the patient is due not to a special nervous heredity, but to
the fact that he is a weakling, the weakness manifesting itself in all
parts of the body, the offspring of parents in whom the germ plasma
was pathologically altered from some of the causes above indicated.
The individual case must be studied on its merits, and the exist¬
ence of nervous or mental disease in the antecedents is not to be
accepted as proof of the hereditary character of the patient’s
ailment without thorough investigation of the aetiology and nature
of such diseases in the antecedents. Authob’s Abstract.

ACUTE ANTERIOR POLIOMYELITIS, OR ACUTE SPINAI*
(15) PARALYSIS OF CHILDREN. (Remarks on the Epidemic
now prevailing in New York.) Joseph Collins (New York),
Med. Bee., Nov. 2, 1907, p. 725.

Epidemics of acute anterior poliomyelitis have been recorded by
Medin (Stockholm, 1887), Looft (Norway, 1900), Leegard (Norway,

ABSTRACTS

1901), Mackenzie (New York, 1902), Wade (Sydney, 1904), and
Litchfield (Sydney, 1904).

Collins draws attention to what he regards as an epidemic at
present in progress in New York. He states that at the out¬
patient department of the Hospital for the Ruptured and Crippled
more cases of acute anterior poliomyelitis are seen each year than
in all the other institutions of New York. At this hospital, during
the year October 1905 to September 1906, 379 cases of anterior
poliomyelitis and infantile paralysis were diagnosed, while during
the following twelve months there were 550 such diagnoses ; 272
of the latter cases occurred during August and September. These
figures appear to clearly show that during August and September
of the present year acute anterior poliomyelitis has been very
prevalent in New York.

It is interesting to note that the past summer in New York
has been cool and extremely dry. Among the 150 cases examined
by Dr Collins or his assistant at the Hospital for the Ruptured
and Crippled since August, in only 14 cases was there a history of
marked digestive disturbance; nor was it possible, although in
every case this point was inquired into, to make out any relation¬
ship to defective sanitary surroundings. No special district of the
city has been selected. In four instances more than one member
of the family was affected; in one instance three children, in the
other three, two. The majority of the children were in good health
when they were seized by the poliomyelitis.

One of the most striking clinical features of the epidemic is the
percentage of cases which make a fairly good recovery. Thus in
a considerable number of cases the muscles do not begin to atrophy,,
but gradually regain their function. Another interesting point is
the relatively large number of cases in which the medulla and pons
are the seat of the lesion.

The author concludes by indicating that such an epidemic
affords exceptional opportunities for examining cases in the first-
few days of illness, at a period when observations may be expected
to throw light upon the pathology of the disease.

Edwin Bramwell.

TWO GASES OF DISSEMINATED SCLEROSIS, WITH AUTOPSY.

(16) J. A. Ormerod, Brain, Oct. 1907, p. 337.

The first of these cases was of interest because the disease was not
suspected during life. There were few or no facts suggesting it.
Both cases are reported very fully. The summary of the first is as
follows: Woman of 54, onset sudden, ten months before admission.

ABSTRACTS

Extensive spasms of legs, with diarrhoea, repeated on four successive
days. Further cramps in legs five weeks later, with pain, finally
assuming the form of flexor spasms, lasting for some months.
Gradual development of flexor contracture of the lower limbs.
Painful tingling in legs six weeks after onset; incontinence of
urine with anaesthesia of bladder. Rigidity of abdominal muscles
two months before admission. Pain in back and lower limbs. On
admission, lower limbs firmly flexed at hip and knee; much tender¬
ness to touch or manipulation; incontinence of urine. Legs
straightened under chloroform two and a half months after ad¬
mission ; death from exhaustion nine days later.

The localisation of the disease found post-mortem did not
adequately explain the clinical features. There were plaques of
disseminated sclerosis in the spinal cord, but principally in the
cervical region, and the descending degeneration of the pyramidal
tracts was very slight. There were also patches in the pons,
medulla, right optic thalamus, and optic tract.

The second case was remarkable for two things. Firstly, the
extremely close interweaving of hysterical symptoms with those of
disseminated sclerosis. A woman of 38, at one time with an
extensive hemiansesthesia and completely bedridden, able after a
few weeks’ treatment to get about the ward. Babinski’s sign and
optic atrophy were, however, constantly present. Secondly, a
peculiar rash of the skin, coming and going over a considerable
period. It began as raised papules, which increased in size and
formed either bullae,small sores, or oval excoriations of the skin. The
rash only occurred on anaesthetic skin. Its nature is left in doubt,
possible explanations being (1) the expression of an organic nerve
lesion, (2) hysterical, (3) manufactured by the patient—this view is
favoured but it could not be proved, (4) nutritional change in
anaestheticed skin.

There is a good photograph of the position and form of the
rash, and diagram of the distribution of the patches of sclerosis.

J. H. Hakvey Pirie.

THE SAORAL TYPE OF DISSEMINATED SCLEROSIS. (Zur
(17) sakralen Form der Sclerosis multiplex.) H. Oppenheim,
Neurol. Centralbl., Dec. 1, 1907, p. 1106.

Oppenheim describes briefly a case which he regards as an example
of disseminated sclerosis, the disease manifesting itself in symp¬
toms pointing to disease of the sacral portion of the spinal cord.

The patient, a man aged 46, had been suddenly seized twelve
years previously, with retention of urine and weakness in the legs.
Rapid improvement followed, though incontinence of urine re-

ABSTRACTS

mained. In January 1906, he had another attack of retention.
In June of the same year severe pains in the legs, and later
incontinence of faeces, which had been previously present in slight
degree, developed. For two years he had been impotent. He
had had no cerebral disturbance with the exceptiou of slight
giddiness.

On examination, there was no distinct loss of power and no
anaesthesia of the lower limbs. The superficial and deep anal
reflexes were absent, and there was slight impairment of the
perception of cutaneous tactile and painful stimuli in the region
around the anus. The left tendo-Achillis jerk was absent, the
knee-jerks were very active, the abdominal reflexes were absent,
the Babinski sign was present on both sides.

The diagnosis lay between spinal syphilis and multiple
sclerosis. No history of syphilis was obtained.

From a study, not only of this case, but of “half-a-dozen
similar cases ” which he has met with, and the after history of
some of which it has been possible to trace (although no details
are given in the present short communication), Oppenheim is of
opinion that it is permissible to describe a sacral type of dis¬
seminated sclerosis. Edwin Bramwell.

ACUTE MULTIPLE SCLEROSIS OR DISSEMINATED MYELITIS.

(18) E. Stadblmann und M. Lewandowsky. Neurol Ceniralbl.,
Nov. 1, 1907, p. 1001.

A servant girl, aged 26, on August 12, 1906, suddenly com¬
plained of pain in the head and, a few days later, of double
vision, inequality of the pupils, and a tight feeling round the
waist. In the course of the next four weeks vision became very
indistinct, and she became unable to walk. On September 15th
it was found that she had double optic neuritis; ptosis on the left
side; a dilated left pupil immobile to light; inability to count
fingers; some weakness of upper extremities; spastic paraplegia
with almost complete loss of power in the lower extremities;
increased tendon jerks and the Babinski sign ; marked diminution
in the perception of all forms of stimuli below the third rib; loss
of the abdominal reflexes; incomplete paralysis of the bladder and
rectum; increased cerebrospinal pressure with marked increase of
the cellular elements. A fortnight later there was distinct atrophy
of the optic discs; nystagmus on looking to the left; parsesthesi®
in both arms and legs; moderate ataxia in the upper extremities,
but no intention tremor. On September 19th patient was
somnolent, cystitis was present, and the temperature raised.
Death occurred two days later,
c

ABSTRACTS

On microscopic examination great numbers of patches were
found throughout both the brain and spinal cord. In the cerebrum
these were situated chiefly at the junction of the grey and white
matter. The patches, which were all alike in structure, consisted
entirely of glial elements. Even with Bielschowsky’s method no
stained elements were to be seen in the axis cylinders. Although
a widespread secondary degeneration was met with in the myelin
sheaths, there was no well-defined degeneration confined to special
tracts such as is seen when the axis cylinders are completely
destroyed. The authors suggest that the axis cylinders were
probably preserved although their presence was not demonstrable.

Finkelnburg and others have urged that the persistence of the
axis cylinders is a distinctive feature which characterises acute
disseminated sclerosis as opposed to acute disseminated myelitis.
The authors regard their case as one of acute disseminated
sclerosis. Edwin Bramwell.

DISSEMINATED SCLEROSIS OB CEREBROSPINAL SYPHILIS.

(19) (Multiple Sklerose Oder Lues cerebrospinalls.) Kuckro,
Munch. Med. fFchn., Nov. 5, 1907, p. 2238.

The difficulty in distinguishing between some cases of disseminated
sclerosis and cerebro-spinal syphilis has been recently emphasised
by E. Muller, Erb, Curschmann, and v. Vordt. The therapeutic
test is not necessarily decisive, for it may happen that one of these
striking periods of improvement, which are well known to occur
in the former disease, may coincide with the administration of
antisyphilitic treatment. The author describes the case of a young
man, aged 30, who eight years previously had had syphilis, which
had been thoroughly treated. Paresis and ataxia in the lower
limbs with “ bladder trouble ” developed. These symptoms came
on suddenly with severe headache and giddiness. On examination,
the condition was as follows:—ataxic paraplegia; increased tendon
jerks with the Babinski sign; absence of the abdominal reflexes;
normal pupils; right-sided hemihypaesthesia with ataxia of the
right hand and diminution of taste, smell and hearing on the right
siae, pallor of the temporal halves of both papillae, a central
scotoma for colour on the right side. There was no increase of
lymphocytes or albumen in the cerebro-spinal fluid. Under potas¬
sium iodide and mercury considerable improvement took place.
Emphasis is laid upon the central colour scotoma, the absence of
the abdominal reflexes, and of a lymphocytosis in the cerebro¬
spinal fluid as points in favour of disseminated sclerosis, the
diagnosis to which the author inclines. Edwin Bramwell.

ABSTRACTS

ON THE UNION OF TABES DORSALIS WITH DISEASES OF THE

(20) HEART AND VESSELS. (Ueber die Vereinigung der Tabes
dorsalis mit Erkrankungen des Herzens und der Goftsse.)

Strumpell, Deut. med. Wochenschr., Nov. 21, 1907.

As late as 1885 the writer remarks von Leyden in an article on
tabes, referred to the frequent coincidence of aortic disease with
tabes, but denied any intrinsic relationship between them. Different
statistics are quoted giving the prevalence of aortic insufficiency in
tabes as 1 in 12 to 1 in 7.

He concludes that in patients with aortic incompetence or
atheroma, one often finds on special search the signs of oncoming
tabes, and in a considerable proportion of cases both diseases are
equally far advanced. This is explained by both having the same
essential cause, viz. syphilis, which can be found with certainty in
at least 62 to 72 per cent, of the cases of the two diseases. He
holds the absence of pupillary reaction to light stimulus to be of
special value in diagnosing a syphilitic stigma, and so arriving at
the cause of aortic disease which may be present.

John D. Comrie.

THE SYNCHRONOUS MOVEMENTS OF THE LOWER EYELIDS

(21) WITH THE TONGUE AND LOWER JAW OBSERVED IN
CERTAIN DISEASES. H. J. Robson, Lancet, Dec. 14, 1907,

p. 1681.

The author has observed slight eversion of the lower eyelids on
protrusion of the tongue or depression of the lower jaw to be
present in various acute diseases, and also in chronic cases where
there is marked asthenia or long-standing pain. It is, he says,
never present in health, and may be a clear index or sign of
disease. The explanation of the phenomena is not very clear.

J. H. Harvey Pirie.

ON THE URINARY CONSTITUENTS IN THE HEMICRAN LAB.

(22) (8ul ricambio urin&rio nolle emicr&nie.) M. A. Bioglio (of
Rome), Riv. Sper. di Fren., Vol. xxxni, Fasc. 1.

In every form of hemicrania there are alterations in the elimina¬
tion of the principal organic and inorganic elements of the urine.
The nitrogen metabolism is slightly retarded in the hemicranias
during the intervals between the attacks; the amount of chlorides,

ABSTRACTS

total sulphuric acid, and earthy phosphates is below the normal;
elimination of phosphoric acid is normal. During the attack the
nitrogen elimination is constantly accelerated ; the other elements
may or may not vary. There is a marked difference between the
epileptic and the hemicranic with regard to metabolism.

C. Macfie Campbell.

A CASE OF APHASIA BOTH “ MOTOR ” AND “ SENSORY,” WITH
(23) INTEGRITY OF THE LEFT THIRD FRONTAL CONVOLU¬
TION : LESION IN THE LENTICULAR ZONE AND IN¬
FERIOR LONGITUDINAL FASCICULUS. Dercum, Jour n.
of Nerv. and Mental Dis., Nov. 1907.

The writer gives a brief rdsum^ of the views lately advanced by
Pierre Marie on the subject of aphasia, and states his belief that
much of the previous writing upon aphasia was deduced simply
from complicated diagrams and schemes, and was found to be at
variance with observed facts. He records in detail a case which
forms a parallel to one of Marie, and expresses his conviction that
the function of the lenticular nucleus is the co-ordination of
complex muscular movements—among others, those of speech.
There are references to the various papers of Marie and others
dealing with the subject, but the article does not lend itself to be
shortly abstracted. John D. Comrie.

ANEURISMS OF THE LARGER CEREBRAL ARTERIES. C. F.

(24) Beadles, Brain, Oct. 1907, p. 285.

This article is based on a study of 555 recorded or inspected true
aneurisms of the cerebral arteries, and resolves itself into the
symptomatology. Is it possible, from the symptoms produced, to
form a diagnosis of aneurism, and of its situation, when occurring
within the cranial cavity ? The author’s answer is, in brief—No,
that it is quite impossible to diagnose an aneurism of any one of
the cerebral arteries except in the most unusual circumstances.
Only two or three have ever been diagnosed during life, and even
in these cases it was scarcely certain. He goes further, and says
that in the vast majority of cases of aneurism a tumour even
cannot be diagnosed. If there is any one sign to which special
attention might be drawn, it is the occasional intermittent
character of the symptoms. But these form a small proportion
even of those cases where tumour symptoms were present. He
classifies them into four groups: (1) Those where the first indi¬
cation is an apoplectic attack from rupture of the sac—46*3 %.

ABSTRACTS

(2) Those in which a fatal apoplexy has been preceded by symp¬
toms suggesting a cerebral tumour or other lesion—20’7 %. (3)
Those in which there have been indications of a cerebral tumour
only—16‘39 %. (4) Those causing no symptoms during life-—
16-61 %.

Notes of symptoms of a considerable number of cases are
given. It may be noted that slowly progressive signs suggestive
of a tumour, with subsequent apoplectic seizure, are by no means
diagnostic of aneurism. The statement, copied from book to
book, that there is often a murmur, audible to both patient and
auscultator, should have received here its deathblow. There
are only two cases proved after death to be uncomplicated true
aneurism, in which a murmur was heard during life. One of these
was an aneurism of the vertebral, the other of the cavernous
portion of the internal carotid. There are none on record in
proved cases of aneurism of the true intracranial portion of the
carotid, or on any of the other larger arteries at the base of the
brain. The paper is illustrated by a considerable number of plates
and figures, and there is a bibliography.

J. H. Harvey Pirie.

EPILEPTIFORM CONVULSIONS AND HEMIPLEGIA IN TYPHOID
(25) FEVER. (Convulsions Ipileptiformes et hdmipllgie an conn
d’nne ftevre typholde.) Bari£ et Llan, Bull, et Mim. de la
Soc. mid. des Hdp. de Paris, Oct. 31, 1907, p. 1080. Laignel-
Lavastine, ibid., Nov. 15, 1907, p. 1217.

A girl, aged 19, whose mother suffered from epileptic fits, had
two attacks of Jacksonian epilepsy, followed by left hemiplegia on
the fifteenth day of typhoid fever. The paralysis was already
much attenuated at the end of twenty-four hours, and had com¬
pletely disappeared within a week. Hemiplegia with or without
aphasia is the rarest form of typhoidal paralysis. Only 34 cases
have hitherto been recorded. In this case the date of the onset
does not correspond to that noted in most of the cases. Landouzy
and most of the other writers agree that the paralyses of typhoid
are most common in convalescence, whereas in the present case the
attack occurred during the height of the disease. In discussing
the pathogeny of the phenomena the writers exclude hysteria,
owing to the presence of Babinski’s sign on the hemiplegic side.
Cerebral haemorrhage is also excluded by the absence of coma and
the rapid retrogression of the motor phenomena. Meningeal
haemorrhage is negatived by the fact that lumbar puncture did
not reveal blood in the cerebro-spinal fluid. In cerebral softening
due to embolism or thrombosis restoration of function would not

ABSTRACTS

have been observed so soon. Uraemia could not be regarded as the
cause, since there were no other signs of uraemia, e.g., oedema,
gallop rhythm, dyspnoea, coma, or gastro-intestinal disturbance.
Serous meningitis was set aside by the absence of characteristic
clinical signs and by the condition of the cerebro-spinal fluid,
which was normal when first examined, and only showed a few
leucocytes four days after the appearance of the nervous pheno¬
mena. The cause of the convulsive and paralytic symptoms was
probably a slight and transitory alteration of the cortical cells by
the typhoid toxines. In the child of an epileptic parent the nervous
system constituted a locus minoris resistentice, and so was specially
liable to be affected.

Laignel-Lavastine’s case was that of a medical student, age 28,
who was free from any nervous taint. After a moderately severe
attack of typhoid, and shortly before the temperature had reached
normal, left hemiplegia, with ankle clonus but no Babinski’s sign,
developed. The paralysis lasted a week. The pathogeny was
probably the same as in the previous case. J. D. Rolleston.

GLUTEAL HERPES FOLLOWING LUMBAR PUNCTURE. (Zona de
(26) la fesse cons6cutif h la ponction lombaire.) Achard, Bull, ct
Mim. de la Soc. mid. des HSp. de Paris, 1907, p. 1330.

A woman, aged 23, who was suspected to have syphilis, had
lumbar puncture performed. Clear fluid without leucocytes was
withdrawn. Five days later she complained of pain in the lumbar
region, and a herpetic eruption was found four inches in length,
extending obliquely downwards and outwards from the lower end
of the sacrum. The eruption, which was associated with a little
swelling of the glands in the corresponding groin, soon healed.

J. D. Rolleston.

HERPES IN EPIDEMIC CEREBRO-SPINAL MENINGITIS. (Ueber
(27) Herpes bei meningitis cerebrospinalis epidemics.) Einhorn,
Wien. klin. Woch., No. 23, 1907, p. 700.

Herpes occurring in epidemic cerebro-spinal meningitis is remark¬
able for its extensive distribution, atypical localisation, and rela¬
tively long duration. The eruption may cover the lips, cheeks,
ears, neck, and eyelids, and has even been known to extend from
the scalp to the nipple Its atypical localisation is illustrated by
the fact that it often attacks the front and back of the pinna, the
eyelids, the thumbs, or the scalp. The eruption comes out in
crops, fresh vesicles coexisting with scabs, whereas in most other
infectious diseases the eruption all appears at once. It usually

ABSTRACTS

occurs from the third to the sixth day of disease. It was present
in about half of Einhom’s cases, in about a quarter of which it
•affected the mucosa. The distribution of the eruption on the
mucous membranes is as manifold as on the skin. The hard
palate and gums of the upper jaw are most frequently affected,
but the soft palate, uvula, conjunctiva, and nasal mucous mem¬
brane may also be involved. The pathogeny is still obscure.
Drigalski alone has found the meningococcus in the vesicles.
There are no complications nor sequelae. The eruption has no
prognostic significance, and requires no special treatment.

J. D. Rolleston.

CLINICAL AND BACTERIOLOGICAL REMARKS ON EPIDEMIC

(28) CEREBRO-SPINAL MENINGITIS. (Kliniscbe und bakterio-
logische Bemerkungen zur epidemischen Genickstarre im
Anschluss an drei sporadische F&lle.) Bennecke, Muench. med.
Wochenschr., Oct. 29, 1907.

The writer discusses several important features of the disease in
reference to three cases which he records very fully. Two of
these, in young men, were not fatal, but the diagnosis was estab¬
lished through lumbar puncture. In both cases the meningococcus
was found to grow quite as well upon ordinary agar as upon
serum agar. The first symptoms of illness in one case followed
within some hours of a severe box upon the ear, which the writer
is disposed to regard as of a causal nature. In the second case an
unusual point was that the spinal fluid was withdrawn at a
pressure of 520 mm. of mercury. In the third case, which was
that of a woman of 50, and was fatal, the meningococci failed to
grow upon ordinary agar, but developed vigorously on serum agar.
In this case they were obtained also from the circulating blood.

The writer gives a copious list of references to papers of the
past two years dealing with the bacteriology of cerebro-spinal
meningitis. John D. Comrie.

POLYNUCLEOSIS OF THE CEREBRO-SPINAL FLUID IN THREE

(29) OASES OF TUBERCULAR MENINGITIS. (Polynucldose
r&chidienne dans trois cas de mdningite tuberculeuse.) Lan-
dowski and Claret, Arch. Gin. de Mid., Aug. 1907.

The observations of three cases of tubercular meningitis in which
the cellular content of the cerebro-spinal fluid consisted almost
entirely of polymorphonuclear elements. In one case a series of
punctures showed that the polynucleosis passed into an almost
pure lymphocytosis. C. Macfie Campbell

ABSTRACTS

KERNIG’S SIGN. (A Propos du Signs de Kemig.) Charles Mon-
(30) CANY, Gaz. des H6p., Dec. 10, 1907, p. 1684.

The author believes that Kernig’s sign depends on rigidity
more or less pronounced of the spinal column. Rigidity of the
neck and spine, which may be unaccompanied by contracture
specially affecting the lower limbs, was present in almost all the
cases he examined. Again, the sign is present in all cases of spinal
rigidity with lumbar lordosis, Pott’s disease, spinal ankylosis,
rheumatic contractures in the muscles, and simple lumbago.
Flexion of the extended limb to a right angle with the trunk is
only obtained at the expense of definite bending of the dorao-
lumbar region of the spinal cord. The rotation of the pelvis
which results diminishes the distance between the origin and
insertion of the hamstring muscles. If, however, rigidity of the
spine, from whatever cause, prevents this rotation taking place,
the distance between the ischium and tibia remains unaltered,
with a consequence that Kernig’s sign can be elicited. This ex¬
planation of the phenomenon, it will be observed, in no way
diminishes the practical value of the sign in diagnosis.

Edwin Bramwell.

OTITIC BRAIN ABSCESS. E. B. Dench, Amer. Joum. Med. Sc.,
(31) Nov. 1907, p. 692.

Short notes are given of two cases (one of cerebellar abscess and
the other an abscess of the inferior frontal convolution), with an
analysis of 102 recorded cases of cerebellar and 100 cases of
cerebral abscess: the full bibliography of these cases is appended.

Cerebellar Group. —The route of infection was through the
petrous bone in 30 cases, through the lateral sinus in 30, through
the mastoid apparently in 4, secondary to a cerebral abscess in 3,
uncertain in 35.

Of symptoms, the most prominent and constant was headache
(71 cases), seldom localised; vomiting was rarely noted as absent,
and was prominent in 54 ; vertigo occurred in 30, nystagmus in
17, retraction of muscles of neck in 12, stupor in 44, Cheyne
Stokes’ respiration in 3, cessation of respiration at operation in 6;
pulse was slow in 40; temperature subnormal in 26, high in 5.
In 10 cases the state of knee-jerks was noted: in 6 the jerk on
the side of the abscess was exaggerated, in 1 the jerk on the
opposite side was slightly increased, in 3 the jerk was absent.
Pupils were “ unequal ” in 9 cases, the pupil on the side of lesion
being more often dilated; strabismus, usually internal, was present

ABSTRACTS

in 9 cases. Optic neuritis was present in 34, absent in 37, not
noted in 31 cases. Of the 102 cases, 33 recovered. In 45 cases
the abscess was opened behind the lateral sinus, in 11 cases in
front of the sinus; in 46 the method of operation was not stated.
The method must depend upon the probable route of infection:
Dench, however, thinks it is a fairly good rule, unless the surgeon
can definitely trace the infection from the lateral sinus, to make an
exploratory opening in front of the sinus, where this is possible.

Cerebral Group. —In 77 cases the abscess followed chronic
otitis media, in 20 it followed acute otitis, in 3 cases the duration
of the otitis was not stated. The chief route of infection was
through the tegmen tympani (40 cases). Of symptoms, the most
prominent and constant were headache (77 cases) and vomiting
(44 cases). Slow pulse was noted in 37, rapid pulse in 1; tem¬
perature normal or subnormal in 20, high in 7; vertigo in 32,
coma and stupor in 31, mental dulness in 20, general convulsions
in 5, nystagmus in 4, pupillary symptoms in 17, aphasia in 10.
Motor paresis, varying from slight motor loss to complete hemi¬
plegia, was present in 17 cases—on the side opposite the lesion in
15, on the side of lesion in 2. Reflexes were abolished in l,
exaggerated in 7. Optic neuritis was present in 32, absent in 20,
not noted in 48.

Of the 100 cases, 52 recovered. In 41 cases the abscess was
opened through the tegmen (27 recoveries), and in 37 cases
through the squamous bone (18 recoveries); method of operation
not stated in 22. The best results are obtained by operating
primarily along the route of infection ( i.e . in most cases, through
the tegmen), as the risks of secondary meningitis and of hernia
are thus reduced to a minimum. If more space is needed, the
opening may be enlarged upwards and outwards through the
squamous plate. A. W. Mackintosh.

THE DEFINITION OF HYSTERIA. (Quelques mots stur la definition
(32) de l’Hystdrie.) Ed. Claparede, Arch, de Psych., Oct. 1907,
pp. 169-93.

L Misunderstandings arise from the different points of view,
anatomical, physiological, or psychological, of definers, or from
their unconscious imprisonment within the bounds of familiar
specialities, or from the reaction of their therapeutic experience on
their conception of the disease. The definition of the disease is
a problem distinct from the question of its nature. A definition
must needs be the final outcome and not a fundamental condition
of the study of the neurosis. Babinski enters the cavil that the
delimitation of any subject must precede the systematic study;

ABSTRACTS

his demand is only legitimate if the delimitation be accepted as a
provisional approximation.

II. Babinski thus defines hysteria: A special mental state
made manifest mainly by disorders that can be called primary, and
incidentally by disorders that are secondary. The characteristic
of the primary disorders is their potentiality of being reproduced
with rigorous exactitude in certain subjects, and being made to
disappear again by the sole agency of persuasion. The character¬
istic of the secondary disorders is their intimate dependence on
the primary.

Babinski’s practical preoccupation is the differential diagnosis
of organic and functional disease, and the full sweep he gives to
his definition demands the added corollary : “ None of the classical
diseases of to-day outside of hysteria can be reproduced rigorously
by suggestion.” The reference to “ certain subjects ” lacks pre¬
cision, and the definition has the graver ambiguity of leaving the
reader in doubt whether it expresses a theoretical opinion as to the
nature of hysterical disorders or whether it simply makes empirical
enunciation of a diagnostic sign.

III. Is the exaggerated suggestibility of hysterical patients
really a cause of the hysterical manifestations ? Could it not by
any chance be an effect, a symptom on the same footing as its
fellows ? Of the psychogenesis in time of exaggerated suggesti¬
bility there are three possible hypotheses: (a) It may be a
fundamental characteristic immediately dependent on constitu¬
tional mental disorder. ( b) It may be an exaggerated reaction.
If hysterical disorders are the result of exaggerated reactions, the
function of suggestibility may itself be one of the reactions ex¬
aggerated. For suggestion is a normal mental function, a sort of
mental reflex having the same biological value for the mind that
mimicry has for the body, (c) It may be nothing but a weakening
of the personality resulting from the inhibition of certain groups
of images and memories.

As to invoking auto-suggestion, why should a patient auto-
suggest to himself some derangement which has no significance
for him, and which he could certainly never beget in his mind ?
How could the idea of actualising a stricture of the oesophagus or
a contracture of the arm or a loss of the power of standing erect
suggest itself spontaneously to a patient ? It is the auto-fabrica¬
tion of the idea which is so important. Now the disorder considered
in itself is always very different from the idea which gave it birth.
Vomiting may be the result of disgust inspired by an action or
person, not of the idea of vomiting. The form of hyeterical dis¬
orders does not as a rule correspond to any representation the
patient has made in advance, and so a hysterical disorder is not
necessarily a product of suggestion or auto-suggestion.

ABSTRACTS

IV. Architecturally, hysteria is built storey upon storey.
Various manifestations which are habitually placed on the same
plane do not all belong to the same rung of the evolutionary
ladder. They are the fruits of the same tree, but have not ripened
on the same branch. A bird’s-eye view of the disease can only be
got by rising above the raw facts and leaving the atmosphere of
purely clinical observation for that not only of psychology but of
general biology.

The search after biological significance lets us know whether
a reaction is a purposive act or simply an accidental practice. It
permits us to recognise family resemblances and a common origin
in reactions of dissimilar aspect, and lets it be seen, finally, in
what way a reaction becomes abnormal, by excess, by defect, or
by deviation.

The examination of hysterical patients establishes the fact that
they oppose a considerable resistance to the remembrance of
certain groups of memories which bring pain in their train, and
are therefore banished out of consciousness. This inhibition is
illuminated by the biological interpretation which represents
consciousness taking arms against the invasion of painful images
or sensations. The suppression is a defensive reaction, and accord¬
ing as it deals with memories, acts, or regions of the body, so it
supplies amnesias, paralyses, or anaesthesias. When the inhibition
is total we have a fainting fit, which can be considered as the
homologue of the simulation of death so widely spread among
animals. Applying the same criterion, we may regard the globus
hystericus as symbolic of an act of organic defence. In man moral
causes may provoke the sensation of physical disgust, with con¬
traction of the pharynx.

Trophic, cutaneous, or vaso-motor manifestations may be ex¬
plained similarly by reference to the important part the external
skin plays in the whole animal kingdom as an organ of protection
not only passive but active. Perchance hysterical stigmata are
revived ancestral reactions whose utility can only be grasped
among practising animals. We still have goose-skin and sudden
pallor as evidences of fear: such skin phenomena would appear
no less bizarre to us than the blisters of hysteria were they
equally rare.

What is the cause of this exaggerated and abnormal reactivity?
This is the fundamental question of the constitution of the
hysterical subject. The nervous apparatus is one with a tendency
to reversion, to atavism, a sort of instability or infantilism facilitat¬
ing the loosening of the latch which holds in check the rudi¬
mentary reflexes. In favour of this view is the infantilism so
often a feature of the hysterical mind. So also is the greater
frequency of hysteria in women, the female being the more con-

ABSTRACTS

eervative sex. The play propensities are easily understood as an¬
other expression of infantile nervous organisation.

For the proper elucidation of hysteria it is necessary to study
the hysterical subject in his lucid intervals or after cure. There
remains to explain a crowd of accidents like tics, hallucinations,
and algias, which can hardly be considered as throw-backs.
Whence comes the augmentation of suggestibility and the dupli¬
cation of personality ? They occupy a more recent place in the
genealogical tree. The inhibitions of the hysterical mind throw
out of action part of the woof of personality. Mental control is
lessened; the ideas which enter consciousness translate themselves
more quickly into action; the state of suggestibility is set up.
The group of ideas banished into subconsciousness may end by
taking a predominant share in directing the activities of the
subject, so arises a second personality. The persistent duration
of hysterical reactions is a possible result of the disarray of the
habitual psychological means of expression and control.

J. Roy Tannahill.

A FATAL OASE OF OHOEEA ASSOCIATED WITH DOUBLE

(33) OPTIO NEURITIS AND HYPERPYREXIA IN A CHILD
AGED THREE AND A HALF YEARS. George Car¬
penter, Lancet, Nov. 30, 1907, p. 1521.

Rheumatic hyperpyrexia is exceedingly rare in children. In the
case here reported the illness began with rheumatic fever, was
followed in a fortnight by chorea, and in six weeks there was a
mitral bruit and rheumatic nodules. Under arsenic the chorei¬
form movements became less, but hyperpyrexia ensued. The
necropsy report is:—Slight thickening of mitral valve, Peyer’s
patches injected, intestines otherwise normal, brain normal.

J. H. Harvey Pirie.

CONTRIBUTION TO THE KNOWLEDGE OF TETANOID STATES

(34) IN CHILDHOOD. (Zur Kenntnis der tetanoiden Zust&nde
des Kindesalters.) Escherich, Muench. med. Wochenschr .,
Oct. 15, 1907.

The writer remarks that the recognition of tetany as a serious
neurosis does not date farther back than to 1890. He means by
the term “tetanoid state” an overexcitability of the muscles to
mechanical and galvanic stimulation, reserving the name of tetany
for actual spasm of the muscles or general convulsions. As the
result of examination of 328 children in a Viennese creche during
the first six months of life, he found that this tetanoid state rose
in frequency from 2 per cent in the first month to 56 2 per cent

ABSTRACTS

in the sixth, being most frequently observed in rachitic and arti¬
ficially fed children. The writer believes in the theory that the
various forms of tetany in childhood are referable to degeneration
of the parathyroid bodies, and in support of this quotes researches
from his clinic, in which haemorrhages were found in 38 para¬
thyroids out of 89 cases of tetany examined. He has not, how¬
ever, obtained any satisfactory result from the administration of
parathyroidin. John D. Comrie.

PAROXYSMAL TACHYCARDIA. E. Schmoll, Amer. Journ. Med.
(35) Sc., Nov. 1907, p. 662.

This paper, based on nine cases, is “ an attempt to show that in
paroxysmal tachycardia we have to deal, not with a single patho¬
logical entity, but with different pathogenic forms.”

The cases are divided into four etiological groups:—

(1) Cases occurring in patients with previously damaged heart.
Notes of three such cases are given, and it is pointed out that the
heart lesion alone does not cause the symptom-complex, which
originates only when a new weakening influence ( e.g ., a febrile
attack, strain, over-exertion) interferes with the action of the
heart.

(2) Cases occurring in patients affected by dysthyreosis.
Paroxysmal tachycardia was also noted in a case of Dercum’s
disease (adiposis dolorosa).

(3) Cases occurring in patients with central nervous lesions.
Notes are given of one case, in some respects resembling an atypical
case of multiple sclerosis, but believed—in view of age and
extensive arterio-sclerosis—to be a case of vascular disease of the
central nervous system, the attacks of paroxysmal tachycardia
probably being due to vascular disturbance of the medulla
oblongata.

(4) Cases of apparently functional character, so-called idiopathic
group.

From a study of a series of pulse tracings of an example of the
last group and also of the case of Dercum’s disease, Schmoll is led
to these conclusions :—

(a) We must distinguish two forms of paroxysmal tachycardia:
in one the auricular wave is present, in the other it is absent in
the tracing of the jugular pulse during the tachycardiac rhythm.

(b) The paroxysmal attack is best explained in both forms by
assuming that it is due to a series of extra systoles originating
below the auricle, viz., from the bundle of His.

It is interesting to note that paroxysmal and permanent brady¬
cardia, as well as paroxysmal tachycardia, can be referred to a
lesion of this bundle. A. W. Mackintosh.

ABSTRACTS

ON MOTOR, 8ENSORT, AND VASOMOTOR SYMPTOMS DUB
(36) TO CORONARY ARTERIOSCLEROSIS. (Ueber motorische,
sensorische, and v&somotorische Symptome verursacht dutch
Koronarsklerose and sonstige Erkrankungen der linkseitigen
HerzhUfte.) Schmoll, Muench. med. Wochenschr., Oct. 8,
1907.

The writer finds these three groups of symptoms present in cases
of arteriosclerosis of the coronary vessels not only during anginal
attacks, but also in the intervals between them. Of the sensory
symptoms the sense of impending death, and that of pain in the
chest and down the left arm, are the most notable. The latter, in
the writer’s experience, may affect any of the segments from the
second cervical to the eighth dorsal, although most common in the
parts connected with the eighth cervical and the first dorsal. He
states that if the pain is referred to the right side it always, in
his experience, is associated with disorder of the right ventricle.
Between attacks hyperalgesia is very commonly found in the
affected areas. Among the motor symptoms the feeling of con¬
striction (due to spasm of the intercostal and pectoral muscles)
and paralysis, causing feebleness of the left arm and inability to
hold objects, are the most common. Between attacks, weakness
and disproportionate smallness in size of the left arm are common,
while some cases have been recorded of actual paralysis and
reaction of degeneration in the muscles. The vasomotor symptoms
sometimes precede an attack, and then consist, as the writer finds,
of irritative nervous phenomena, such as pallor of the fingers of
the left hand; but at other times, in persons liable to attack, there
is a tendency to vaso-dilatation.

The writer explains all these phenomena as referred somatin
symptoms from segments of the cord, disordered by constant
afferent impulses by the sympathetic fibres from the diseased
heart. He mentions incidentally that aortic diseases are extra¬
ordinarily common in San Francisco. John D. Comrie.

PSYCHIATRY.

TWO OASES OF GENERAL PARALYSIS WITH CEREBRAL
(37) SYPHILIS. (Due casi di demenxa paralitica con aifllide
cerebrate.) F. Giacchi (of Reggio-Emilia), Biv. Spar, di Fren.,
Vol. xxxiiL, Fasc. 2-3.

The first case presented, in addition to the histopathological lesions
of general paralysis, a patch of gummatous meningitis, and one of

ABSTRACTS

syphilitic meningo-myelitis. In the second case the syphilitic
element in the picture consisted of well-marked syphilitic endar¬
teritis (Heubner) most marked in branches of the Sylvian artery.
The author does not discuss the question of the specificity of
Huebner’s endarteritis, and with regard to the first case the topo¬
graphical distribution of the histopathological changes is unfor¬
tunately not given very fully. In neither case were there
sufficient clinical grounds for diagnosing more than general
paralysis. C. Macfie Campbell.

DELIRIUM TREMENS AFTER WITHDRAWAL OF ALCOHOL.
(38) (Delirium Tremens nach Alkoholentzug). Hosch, Muench.
med. Wochenschr., Oct. 29, 1907.

A case is recorded in which the patient suffered from old standing
non-progressive phthisis and was a strong drinker. On admission
to hospital his alcohol was completely stopped and an epileptiform
seizure appeared next day, and was succeeded by a typical attack
of delirium tremens lasting a week. The writer quotes the opinions
of numerous eminent authorities upon the point whether with¬
drawal of alcohol is capable of causing delirium tremens, and comes
to the conclusion that it is safer to diminish the alcohol gradually
in patients. John D. Comrie.

PSYCHOPATHIC INTOXICATION WITH TRANSFORMATION OF
(39) THE PERSONALITY. (Ivresse psychique avec transforma¬
tion de la personality.) 6 . G. de CiArambault, from the
Notes of the late Paul Garnier (of Paris). Ann. Mid.-Psych.,
Sept.-Oct, Nov.-Dee., 1907.

Garnier separated three forms of psychopathic intoxication, and
in his notes was found the description of a modification of one of
these forms, with a transformation of personality.

In this article three cases exemplifying the disorder are
recorded. The patients were mildly maniacal, had a feeling of
well-being, and had a delirium of megalomanic colouring; they
were convinced of their high rank, and this conviction, with
elements derived from the past life of the individual, con¬
tinued during the whole period of intoxication, and tended to
recur in future attacks. This disorder may develop suddenly in
alcoholic degenerates, and the megalomanic element is frequently
overlooked owing to the preponderance of the hallucinations.
Treatment in an asylum is advisable, and is frequently spontane¬
ously sought by the patient. J. D. Rankin.

ABSTRACTS

ON THE ETIOLOGICAL HOLE IN INSANITY OF VARIOUS
(40) ALCOHOLIC BEVERAGES. (Enqudte snr l’importance dn
rdle jou4 dans l’ali&iation mentale par l’alcool et les boissons
k base d’alcool contenant des essences.) M. Mirman, Directeur
de 1’Assistance et de l’Hygi&ne publiques, Ann. Mid.-Psych.,
Sept.-Oct. 1907.

A statistical report of the alcoholic insane of both sexes in
France, showing the proportion of cases in each county. The
report also gives the statistics of the different alcoholic beverages
responsible for insanity. The comparison of the report of 1897
with that of 1907 shows an increase of 57 per cent, in the number
of the alcoholic insane. J. D. Rankin.

HYSTERIA AND LITIGIOUS INSANITY. (Hysteric nnd Quernl-
(41) antenwahn.) E. Heilbronner (of Utrecht), CcntraXbl. f.

Nervenh. u. Psych., Oct. 15, 1907.

The author reports the histories of two cases before taking up
the general discussion. The first case was a single woman of 43,
constitutionally abnormal if not definitely hysterical. On hearing
of the engagement of a physician who had treated her for two
years, she began to accuse him of sexual misconduct, and brought
a lawsuit against him. The court ordered an investigation into
her mental condition, and the diagnosis submitted was “ hysteria
with pathological mendacity.” For years she continued to annoy
the physician in various ways, and even placarded the town with
scandalous accusations. The latter referred not only to her own
treatment, but also to the treatment of many other girls, with
regard to which she made very elaborate, but absolutely false
statements. The condition had lasted for eight years, and there
was no evidence of mental enfeeblement.

The second patient was a man, 55 years of age, with a history
of a previous attack of astasie-abasie. On quite inadequate grounds,
a quarrel over a pet dog, he began an embittered lawsuit, although
previously of a good-natured disposition.

After several months of continual strife, in the course of which
he carried his claims to the highest authorities, he fell ill and had
a delirium, with hallucinations derived from the circle of his
morbid ideas. On recovery from the delirium he obstinately main¬
tained the same aggressive attitude for some time, and accused the
various authorities of injustice, but was finally persuaded to regard
the incident as closed. He continued to maintain a grudge against
his adversary, but was able to resume his ordinary routine.

ABSTRACTS

The two ca9es are well-marked examples of litigious insanity
(Querulantenwahn), one variety of paranoia, that form of mental
disorder in which there is the development of a fixed system of
delusions without mental enfeeblement. Kraepelin has very much
restricted this group by excluding from it all cases with evidence
of deterioration. These latter he has grouped under dementia
paranoides. Litigious insanity he considered to be one of the
purest types of paranoia. Some authors (Neisser, Siefert, Bon-
hoeffer) have taken a different view, and insist on the difference
between litigious insanity and paranoia as regards the genesis and
symptomatology. In paranoia there is a long initial stage with
various symptoms, and only after considerable time does the
patient arrive at the formulation of his system of delusions, which
is a secondary affair, and the content of which is to a certain
extent irrelevant to the fundamental process and changeable.

In litigious insanity the central theme is primary, and may be
determined from without and not, as in the paranoiac, from within.
It forms the centre round which other delusions are elaborated.
The fixed idea of injustice causes misinterpretation of the actual
facts, while the paranoiac, in his system of delusions, attempts to
explain a long series of already morbid phenomena. The paranoiac
shows in the early stage a diffuse morbid suspicion and ideas of
reference. In litigious insanity a whole system of ideas of reference
springs up; this is not diffuse, but is only in relation to the one mor¬
bid trend. Paranoia has essentially a chronic progressive course; in
litigious insanity the delusional formation is not fatally pro¬
gressive, but may come to a standstill, and there may be partial
recovery with a certain degree of insight.

As to the mechanism in the two cases; in the first case a
morbid idea, arising from a hysterical basis, obtained pathological
value and was supported by luxuriant fabrications of the same
hysterical origin; in the second case, the extent of the morbid
ideas had an external origin, and when a hysterical delirium later
occurred, it borrowed its colouring from the morbid trend. In the
first case the disorder seemed to spring from the original character
of the patient; in the second, it seemed in contrast with his
previous character. Although the author in this discussion ap¬
proaches the attitude of Magnan, who holds that slow progressive
delusional formation arises on the basis of a degenerate consti¬
tution, he emphasises the fact that degeneracy in all cases of
litigious insanity is not at all established as yet. It is premature
to apply the term degeneracy to the individual predisposition on
which the disorder arises. With regard to the whole question of
paranoia, the study of the individual constitution and of the early
mechanism is very important. C. Macfie Campbell.

ABSTRACTS

THE EXPERIENCE OF SEXUAL TRAUMATA AS A FORM OF
(42) INFANTILE SEXUAL ACTIVITY. (Das Erleiden sexneUer
Traumen als Form infan tiler Serualbetfttigung.) E. Abraham
(of Zurich), Centralbl.f. Nervenheil. u. Psych., Nov. 15, 1907.

Ah abnormal psycho-sexual constitution is, according to Freud, the
fundamental condition for the development of the neuroses.
Children predisposed to hysteria, owing to this condition, react in
&n abnormal manner to sexual impressions of every kind. A
sexual trauma does not cause a neurosis, but may determine the
nature of the symptoms. The question which the author attacks
is, Why do so many neuropathic and psychopathic individuals
give a history of sexual trauma in childhood? He refers to
Freud’s important demonstrations that sexuality is an important
factor in childhood long before puberty, and calls attention to the
fact that children react differently to such traumata. One child
immediately relates the experience, another child keeps it secret.
The reason is, that in many cases the child, through its subcon¬
sciousness, is to a certain extent not merely passive in these
episodes. Brief references are made to actual cases confirming
this point of view, and the psychological mechanism in hysteria
and dementia prsecox is discussed.

What has been said of sexual traumata is also of wider appli¬
cation. Frequently an accident is due to the subconscious
co-operation of the victim without there being a definite purposeful
attempt at suicide. In functional disorders after trauma, with the
question of compensation under discussion, the frequency of sub¬
sequent traumata to reinforce the claims is due to the same
mechanism. In one case this was manifested in an interesting
manner by the dreams of the patient, which consisted frequently
in the receiving of an injury; the author interprets this as being
an example of the fulfilment of a wish on the part of the patient,
according to Freud’s well-known interpretation of dreams.

C. Macfie Campbell.

RESEARCHES ON INDOXYLURIA IN MENTAL DISEASES.
(43) (Ricerche sulT indoesiliiria nei malati di mente.) fiiv. Spur, di
Fren., VoL xxxiii., Fasc. 1.

The author, using the methods of Obermayer and Maill&rd,
examined the urine of 118 patients for indoxyl, and found in all
an excessive amount present; he tries to correlate in some detail
the latter with the clinical symptoms. It is difficult to reconcile

ABSTRACTS

such results with the completely negative results obtained by
Folin in his careful metabolism experiments (vid. Am. Jov.ru.
Insan., 1904), and by Borden in his still more careful investigation
of indican in the urine of the insane (vid. Joum. of Biol. Chem.,
March 1907). C. Macfie Campbell.

SECRETION OF THE GASTRIC JUICE IN ITS RELATION TO
(44) PSYCHOPATHOLOGIOAL CONDITIONS. (Die Sekretion des
Magensaftes und ihre Beziehungen zu psychopathologischen
Zustaadsbildern.) Mayr, Wien. klin. Wochenschr., Oct. 17,
1907.

The writer records briefly the results of over 200 estimations of
the hydrochloric acid, pepsin, and rennin present in the gastric
juice of some 90 psychiatric patients. The method adopted was
to run 15 cc. of fresh cow’s milk into the patient’s stomach
through the nasal catheter and to withdraw the fluid after five
minutes.

In mania the hydrochloric acid, pepsin, and rennin were all
diminished.

In amentia the acidity is low, the pepsin very low, but the
milk always curdled.

In hysteria and similar conditions, the acidity is strikingly
high, the rennin slight, and the pepsin very slight in amount.

In chronic paranoia the conditions are similar to the last
mentioned. John D. Comrib.

ON A CASE' OF TRAUMATIC SOFTENING OF THE CORPUS
(45) CALLOSUM. (Su un caso di rammollimento traumatico del
corpo calloso.) V. Forli (of Rome), Riv. Sper. di Fren.,
Yol. xxxiii., Fasc. 2*3.

The case of a man 47 years of age, who after a severe fall passed
through a short period of excitement, with transitory paralysis of
the seventh and twelfth cranial nerves of one side, into a state of
marked dementia, with no neurological symptoms; he was dis¬
oriented, did not recognise his relatives, could give no account of
himself, was unclean in his habits; he died one month after the
injury. The only lesion found post-mortem was a small circum¬
scribed haemorrhagic softening of the corpus callosum at the level
of the anterior extremity of the optic thalami. Apart from this
lesion, the result of macroscopic and microscopic examination of

ABSTRACTS

the brain and meninges was negative. Forli considers the case
one of post-traumatic dementia, and refuses to correlate the lesion
of the corpus callosum with the mental symptoms. A general
review of the various opinions held as to the composition and
function of the corpus callosum forms part of the article, and a
bibliography containing eighty-two references is appended.

C. Macfie Campbell.

TREATMENT.

CONTRIBUTION TO THE STUDY OF THE ELECTRICAL TREAT-
(46) MENT OF FAOIAL TIO-DOULOUREUX BY THE INTRO¬
DUCTION OF THE SALICYLIC ION. (Contribution k
l’Btude du traitement du Tic-Doulourenx do la Face par
llntroduction £lectrolytique de l’lon Salicylique.) Ren A
Desplats, Arch, d'Elect. mid., Nov. 26, 1907, p. 867.

The writer describes three cases of very severe, long-standing,
and intractable tic-douloureux of the face which he has treated
by Leduc’s method of electrolytic introduction of the salicylic ion.
The negative pole, carrying a current of 25 m.a., was placed upon a
compress of absorbent cotton-wool soaked in a solution of sali¬
cylate of soda, and applied to the affected branch of the nerve for
periods varying from one-half to a whole hour.

The results were remarkably encouraging, cure being per¬
manent and complete in two cases, and improvement very marked
in the third; and the writer would, in similar cases, have no
hesitation in again employing this method of treatment.

Alexander Bruce.

SUBCUTANEOUS INJECTIONS OF AIR AS A MEANS OF
(47) RELIEVING CERTAIN PAINFUL MANIFESTATIONS.

Alfred S. Gubb, Brit. Med. Jovm., Nov. 9, 1907.

The results obtained by the iujection of air under the skin are
approximately the same as those produced by similar administra¬
tions of oxygen, hydrogen, nitrogen, or carbonic acid gas. The
proceeding is simple and perfectly safe, no untoward consequence
having been yet recorded, although the treatment must have been
employed in some thousands of cases. The air is pumped by a
rubber bellows, such as is used in connection with a Pacquelin’s
cautery, through a glass bulb containing sterilised cotton-wool, and
then through a needle introduced into the subcutaneous tissne

ABSTRACTS

over the painful area. A rounded swelling forms at the seat of
puncture, and the air passes along nerve and vessel sheaths, so
that secondary swellings may appear at a distance. The initial
blanching of the skin is soon followed by a pronounced redness
which persists for some hours. As soon as the needle is with¬
drawn the tumour must be thoroughly massaged, and the massage
must be repeated daily until all the air has been absorbed.
Absorption is not usually complete for several days. The amount
of air injected varies with the seat of the pain. The writer in¬
stances 200-300 c.cm. for the gluteal region, and 10-30 c.cm. over
the thorax, but in some of the cases detailed as much as 2000
c.cm. was employed in the treatment of sciatica. The procedure
is applicable to the relief of pain due to all forms of neuralgia and
neuritis. The writer has not yet ventured to treat any of the
varieties of facial neuralgia by this means, but thinks that there
is no reason why it should not he employed for such cases when
analgesics have been found to be insufficient. The article con¬
cludes with a summary of nine cases in which the treatment
yielded almost uniformly satisfactory results. Five of the patients
Suffered from sciatica, one from pleurisy, one from intercostal
neuralgia, one from a painful burn cicatrix, and one from perforat¬
ing ulcers of the feet associated with severe pain.

Henry J. Dunbar.

THE TREATMENT OF ECLAMPSIA. (Die Behandlung der

(48) Eklampsie.) Bumm, Devi. med. Wochensckr., Nov. 24, 1907.

The writer declares that in the very severe forms of eclampsia,
numbering 2 to 3 per cent, of all the cases, we are still almost
powerless to render successful treatment He gives the syndrome
of symptoms of decreased renal efficiency which in his opinion
demand conclusion of pregnancy. Subcutaneous injection of
normal saline solution in large quantities three times daily he
strongly recommends, and also hot baths or packs. He does not
advocate any drugs as beneficial in this condition.

John D. Comrie.

THE VALUE OF SYSTEMATIC LUMBAR PUNCTURE IN THE

(49) TREATMENT OF OEREBRO SPINAL MENINGITIS. (Der
Wert der systematischen Lumbal-punktion in der Behandlung
der Oerebro-Spinal Meningitis.) Von B6kay, Devi. med.
Wochenschr ., Nov. 21, 1907.

The writer quotes the opinion of various authorities for and
against the value of lumbar puncture as a curative measure in

ABSTRACTS

cerebro-spinal meningitis. Among others Franca has employed
the method of injecting into the spinal canal 3 to 9 c.cm. of a 1
per cent, lysol solution. Out of 17 cases treated by the writer,
by means of repeated lumbar puncture, 10 recovered, of whom one
was totally deaf and one partially so. He believes that the case
should be punctured at intervals of 1, 2, or 3 days according to
the intensity of the disease, but that in children not more than
30 c.cm. should be removed at one time. If the fluid is distinctly
purulent or no fluid can be obtained, the use of any treatment is
questionable. John D. Comrie.

THE TREATMENT OF ARTERIO-SOLEROTIC ATROPHY OF THE
(50) CEREBRUM. (Die Behandlung der arteriosklerotischem
Atropine des Grosshirns.) Cramer, Deut. med. Wochemehr.>
Nov. 21, 1907.

In a clinical lecture the writer describes the types and treatment
of this condition. The early symptoms of importance are head¬
aches, giddiness, and increasing loss of memory; and when these
show themselves treatment is urgently demanded. The callings
which he finds most liable to this condition are those of publicans,
actors, officers, bankers, members of parliament and of boards
generally. In treatment he recommends immediate withdrawal of
the person from his calling and its attendant excitements, avoid¬
ance of alcohol in all forms, removal from the diet of articles which
cause flatulence or which are difficult to digest, cessation of violent
forms of exercise, and above all regular movement of the bowels.
The drugs which he has employed are iodide of potash or of soda,
or iodipin, and with these he sometimes combines bromides in
equal amount. John D. Comrie.

A SURVEY OF THE NEURALGIAS AND THEIR TREATMENT.

(51) A. Eulenburg (Berlin), Folia Therapeutica, Oct. 1907, p. 104.

A brief paper laying stress on the fact that treatment should be
causal and not merely anti-neuralgic, although relief of the pain
is frequently also imperative. Surgical measures, such as excision
of scars, neuromata, etc., are referred to. Specific causes, such aa
malaria, influenza, syphilis, readily yield to appropriate treatment
when recognised. For the frequently occurring neuralgias in
anaemic persons he recommends iron and arsenic, particularly in
their combination with albumen, marketed as Arsenoferatose. In
neuralgia in persons of gouty or rheumatic diathesis little need be

ABSTRACTS

expected from colchicum and similar drugs. Regulation of diet
and whole manner of living is usually required.

When the cause seems to be some local or general circulatory
disturbance, suitable hygienic and therapeutic measures should he
adopted j these are very varied. Frequently the cause is not dis¬
covered, or it may be beyond direct treatment (inoperable tumours
e.g.y. Special anti-neuralgic remedies and the various forms of
physical treatment are to be considered subsequently.

J. H. Harvey PnuE.

NOTE ON TREATMENT OF TRIGEMINAL NEURALGIA BY
(52) INJECTION OF OSMIO ACJID INTO THE GASSERIAN
GANGLION. G. A Wright, Lancet, Dec. 7, 1907, p. 1603.

Professor Wright, who has already reported the use of osmic acid
injection into nerves, has now extended the use of this method for
destruction of the Gasserian ganglion as an operation which is
much less severe than that required for its removal. Two cases
are here reported briefly where the results have been very satis¬
factory so far, but the time is much too short to warrant a con¬
clusion that the result is a permanent success.

J. H. Harvey Pirie.

THE VARIOUS FORMS OF PSYCHOTHERAPY. (La Psycho-
(53) thfrapie dans ses difflrents modes.) A. W. Van Ren-
terghem. Amsterdam: Van Rossen, 1907, p. 184.

In this book the author publishes his communication to the
International Congress held at Amsterdam in 1907. The larger
part of the book is occupied with reports of cases of various
functional neuroses. He emphasises the importance of hypnotism,
and does not agree with Dejerine and Dubois in their criticisms of
this form of suggestive treatment. J. D. Rankin.

REVIEWS

IReviews

LES CENTRES NERVEUX OErEBRO - SPINAUX. A. Van

Gehuchten. Louvain : A. Uyatpruyet-DieudonnA 1908.

Pp. 469, with 337 Illustrations. Price 25 f.

Van Gehuchten, who is the author of the well-known text-book,
“ Lemons sur l’anatomie du syst&me nerveux,” has recognised that
the anatomy of the nervous system, as it is generally taught to
students, or as it is treated in the larger text-books, may not be
suited to the needs of the physician who desires an acquaintance
with the structure of the brain and spinal cord merely for prac¬
tical application in the study of the symptoms which arise from
diseases in them. The author has consequently attempted, and
in our opinion with marked success, to supply the want with this
volume, which may serve as a guide to the construction of the
nervous mechanisms as far as we at present understand them.
His aim has been to present the fundamental facts in as concise a
form as possible, excluding those which are merely of morpho¬
logical or scientific interest, and making only cursory reference to
points which are not yet definitely settled.

But in addition to dealing purely and simply with the anatomy
of the nervous system, he discusses the physiology and the
functions of each part after having described its structure and
connections, and he has, wherever it has appeared necessary, dealt
with the more essential points of its affection by disease. The
pages which are devoted to the physiology and pathology of the
neurone are most instructive.

The volume is divided into three parts: the first is devoted to
the macroscopical anatomy or morphology of the nervous system;
in the second the histology, physiology, and pathology of nerve
cells and fibres are first considered, and then the minute anatomy
of each part of the nervous system is described with the aid of
excellent illustrations and diagrams. The practical manner in
which the subject is treated may be illustrated by reference to the
chapter on the mid-brain. When the anatomy of this part has
been described, the next section is devoted to the consideration
of the mid-brain as a special organ, the chief function of which is
the innervation of the ocular muscles; here the mechanism for
the conjugate movements of the eyes and the pupillary reflex arcs
are discussed, and the significance of the disturbance of the func¬
tion of each is referred to. In the second section the mid-brain is
regarded as one of the higher nervous centres and the seat of
complex reflex functions, while in the third section it is considered

REVIEWS

as a part of the brain-Btem through which the tracts connecting
the fore-brain and thalamencephalon with the metencephalon and
spinal cord must pass.

In the third part the different bundles and systems of fibres
which connect the various centres of the nervous system are
described and their functions discussed.

The volume is illustrated by 337 figures, including many
diagrams, which will allow the reader to follow the anatomical
descriptions with as much ease as possible. It is, perhaps, un¬
fortunate that authorities are not cited and that no index is
provided; but the book will undoubtedly prove of great value, not
merely to students and practitioners who desire only a practical
knowledge of the anatomy of the nervous system, but also to
neurologists who wish to become acquainted with the more
important results of the work of recent years.

Gordon Holmes.

BERIOHT UEBEB DIE LEISTUNGEN AUF DEM OEBIETB DEB
ANATOMIE DBS CENTS ALNEBVENSYSTEMS. Dritter
Bericht, 1905 und 1906. L. Edinger und A. Wallenberg.
S. Hirzel, Leipsig, 4 M.

In this report on the contributions to the anatomy and histology
of the nervous system which appeared during the years 1905
and 1906, 711 papers are tabulated, and critically abstracted and
reviewed.

The report is arranged on the same lines as its now well-known
predecessors, and it must be regarded as indispensable to all
who are interested in the anatomy or physiology of the nervous
system.

The most striking feature of the published work of the last
two years is the very large number of papers which have
appeared on the finer histology of nerve cells and fibres: over 300
are cited in this review. This has been evidently due to improve¬
ments in our technique, and especially to the more general use of
Gajal’s and Bielschowsky’s stains for neurofibrils, and to the fresh
impetus these have given to the still raging controversy on the
neurone theory. The critical collation of these numerous papers
which the report contains must prove of general interest and
value to those who have not the time or opportunity to read the
original publications.

The section which is devoted to recent modifications or im¬
provements of the methods of examining the nervous system is
evidently complete and excellently arranged. The section on the
cerebral cortex was entrusted to Brodmann, while Kappers is

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responsible for part of that on the comparative anatomy of the
brain.

The report extends to nearly 240 pages.

Gordon Holmes.

THE PSYCHOLOGY AND THERAPY OF NECROTIC SYMPTOMS.
(Zur Psychologic and Therapie neurotischer Symptoms. Bine
Studio auf Grand der Neurosenlehre Fronds.) Arthur
Muthmann. Halle: Marhold, 1907, S. 115.

This interesting and remarkable book makes its appearance at an
opportune moment, when Freud’s work is arousing so warm a con¬
troversy in Germany. The reviewer is at once faced with the
difficulty of discussing the value of the book without being in¬
volved in a discussion of Freud’s work—a task which is so huge
as to be impossible to attempt within the necessary limits of a
review. Comment will therefore be confined to considering the
merits of the book itself, and the extent to which its objects have
been fulfilled From this point of view one can have nothing but
the highest praise, and we congratulate Dr Muthmann on having
given us a valuable and moderately worded contribution to the
present debate. The object he has had in view appears to be a
twofold one: first, to give an adequate sketch of the present stand¬
point of Freud’s theory, and of the recent criticisms and extensions
thereof; and, secondly, to bring in support of it fresh evidence
based on his personal experience with Freud’s method.

As regards the first aim, this has been carried out in a singu¬
larly objective manner. Although the author is a whole-hearted
supporter of Freud, lie chiefly confines himself to giving an im¬
personal account of the subject, and contributes few fresh criticisms
or arguments. The most valuable of his original contributions is,
perhaps, that concerning Ricklin’s recent criticism of Freud’s
standpoint on the function of conversion, and in the reviewer’s
opinion Muthmann’s remarks on this point are incontrovertible.
This first part of the book was to be considered chiefly, then, as an
exposition of Freud’s theory rather than as a further contribution
thereto. In this the author has succeeded admirably, and in spite
of its elimentariness this book is at present the most complete
and precise exposition of the present position of psycho-analysis
that we possess outside of Freud’s writings. The only adverse
criticism we have to make in this connection is the inadequate
account given of Freud’s work on dream interpretation, which is
amongst his most original and striking contributions to clinical
psychology.

The second and longest part of the book comprises a detailed

REVIEWS

account of three psycho-analyses, together with shorter accounts
of several others. As the author justly remarks, the question as
to the truth or falsity of Freud’s theory does not differ from any
other problem of natural science, in the fact that it can be solved
by only one method—the test of experience. He therefore con¬
siders that no adverse criticism and no support of the theory is of
any value that is not based on actual experience and laborious
work, so that the method he adopts of furthering our knowledge
of the problems is to relate personally observed facts, and to allow
them to speak for themselves. Only by an accumulated mass of
such original additions to our knowledge can the various problems
at issue be solved. From this empiric standpoint no scientific
man can dissent.

In conclusion, we can heartily recommend this volume to any¬
one who wishes to become acquainted with the new science of
psycho-analysis as represented by Freud. Although incomplete,
it presents advantages over Freud’s writings in being written in a
more acceptable and intelligible style, in being less open to mis¬
interpretation, and, in spite of occasional obscure passages, in
being worded in a German that is more easily comprehensible to
a foreigner. Ernest Jones.

DAS FRBUD’SOHE IDEOGENITATSMOMENT UND SEINE BE-
DEUTUNG IM MANISOH-DEPRESSIVEN IRRESEIN
KRAEPEUN’S. (Freud’s Psychogenic Principle and its
Importance in Manic-Depressive Insanity.) 0. Gross (of
Graz). Leipzig: Vogel. 1907. Pp. 50. M. 1.20.

The methods of psychological analysis, by means of which Freud
has contributed so much to the knowledge of the psycho-neuroses,
have proved fertile in the whole field of general psycho-pathology.
The Vienna professor succeeded in certain cases in tracing back
mental and bodily symptoms to distressing emotional episodes in
the distant past, with regard to which there had been an inade¬
quate mental adjustment on the part of the individual. He
analysed the process by which such mental elements, submerged
and not digested, cause disorders in the conscious life, the origin
of which disorders is often unknown to the patient, and is only
discovered by the physician after careful analysis. In attributing
a dynamic value to such psychological elements, Freud does not
profess to have exhausted the etiological factors at work. The
disorder often arises only on the basis of a peculiar constitution,
such as the hysterical constitution.

In his work, “ The Psychology of Dementia Prsecox ” (vide Rev. of

REVIEWS

Neur. and Psych., May 1907, pp. 411-20), Jung of Zurich has shown
that iu this disorder, as in the psycho-neuroses, the nature of the
symptoms is to a large extent determined by underlying trends and
exiled mental elements, which withdraw energy from the conscious,
purposeful life of the individual, and distort his thought and
emotions. The dynamic relation of the deterioration to constitu¬
tion and toxic agents is outside of the scope of Jung’s psycho¬
logical work.

In the present work Gross now examines the bearing of the
above principles on a quite different group of cases, those, namely,
with the constitutional tendency to a reaction of the manic-
depressive type. After some general considerations, in which he
insists that the ideogenous nature of certain mental disorders
renders the principles of general pathology inadequate in mental
pathology, he passes to the somewhat fragmentary, but lengthy,
report of a case. The patient was a woman with a history of a
series of attacks of depression and of excitement, who had
kleptomania in its most classical form, a typical uncontrollable
impulse.

The analysis of the latter phenomenon led the author to con¬
sider that the morbid impulse to steal was simply the distorted
expression of certain elements in the sexual life of the patient.
The patient, therefore, was a case of manic-depressive insanity,
who at the same time presented the typical symptoms of an obses¬
sion-neurosis (Freud). The author discusses in general terms the
mutual relationship of the mechanisms involved in the two
disorders, which he does not consider to be merely casually
associated in this case.

He takes for the basis of his argument Anton’s general
principle of the compensatory activity of the unaffected parts in
lesions of the central nervous system. While a compensatory
equilibrium may thus be established, the reserve power of the
nervous system is thereby reduced, and symptoms reappear on
slighter provocation than with an intact nervous system; thus the
symptoms of a focal brain lesion, of a hereditary anomaly, of a
psychic trauma, which have been concealed by the compensation,
may be elicited during a condition of intoxication.

Similarly, to return to the special subject under discussion, the
latent disposition to an endogenous disease, such as manic-
depressive insanity, may become patent when the reserve power
has been reduced by an ideogenous (psychogenic) disorder; and
conversely, the latent ideogenous disorder may first manifest itself
during the course of an endogenous disorder, which has reduced
the store of compensatory energy of the system.

The author next discusses the part which the ideogenous factor
plays inside of mauic-depressive insanity itself. In addition to

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the two typical phases of this disorder, the manic phase with
elation, motor excitement and flight of ideas, the depressed phase
with depression, motor retardation, and sluggishness of thought,
there are mixed conditions, phases where the symptoms of the two
triads are mixed, e.g., a depression with motor excitement and
flight of ideas. While the circular mechanism, a constitutional
modification of a deep biological principle, may explain the pure
conditions, an additional factor must be assumed to explain the
dissociation of symptoms seen in the mixed conditions, a dissocia¬
tion by means of which one of the triad is split off and escapes
from the general action of the circular mechanism.

The author concludes with the enumeration of various possible
combinations into which enter as elements the individual con¬
stitution, the compensatory mechanism, and ideogenous factors.
Such expositions are stimulating, and Gross has presented his
views very lucidly, but one regrets the absence of well-analysed
cases which would form the most solid foundation for such general
theories. C. Macfie Campbell.

DIE MBLANOHOLIE EDT ZUSTANDSBILD DES MANISGH-
DEPRESSIVENIBBE8EINS. Eine klinische Studio. Georges
L. Dreyfus (of Heidelberg). With a Preface by E. Rraepelin
(of Munich). Jena : Gustav Fischer, 1907. 7 M.

Ik this work the author subjects the Melancholia of Kraepelin,
the agitated depression of the involution period, to a thorough
analysis. On the basis of the cases which Kraepelin himself used,
he comes to the conclusion that involutional melancholia is not
entitled to be considered a nosological entity, but that it is merely
one clinical picture within the large group of manic-depressive
insanity.

The wider issues raised by the conception of manic-depressive
insanity are not discussed ; it is an endeavour to carry Kraepelin’s
own views to their logical outcome. It is therefore rather a dis¬
cussion within the Kraepelinian school than an endeavour to
strengthen the general doctrines of the school by answering the
criticisms directed against the formation of the group of manic-
depressive insanity.

The author begins with a historical sketch of the process by
which the extremely general term melancholia came to receive
more and more definition. At first used to include practically all
morbid depressions, it was later differentiated into an essential
melancholia, and the melancholia which was supposed to be the
initial phase of all psychoses. Kahlbaum was the first to ener-

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getically protest against this latter being considered as an inde¬
pendent psychosis.

The separation of catatonia by Kahlbaum, of amentia by
Meynert, and of circular insanity by the French school, tended
to further reduce the heterogeneous group of melancholia; many
depressions previously called melancholia were now included in
circular insanity.

When Kraepelin, in 1883, brought out the first edition of his
text-book, he had not yet advanced beyond the standpoint of his
predecessors, and under melancholia we find the heterogeneous
varieties melancholia simplex, melancholia attonita, melancholia
activa, periodic melancholia—psychoses with different symptoma¬
tology and different outcome.

As Kraepelin’s breadth of view increased, and when he began
to group cases on a wider basis than that of symptom pictures,
taking now into consideration mode of onset, symptomatology,
outcome, he gradually evolved the conception of manic-depressive
insanity. This is essentially a psychosis of a recurrent nature,
the various attacks being liable to take either of two forms.
The manic phase is characterised by elation, motor restlessness,
flight of ideas, while the depressed phase presents a picture of
sadness and retardation of thought and action. Besides these two
contrasting pictures, there may occur other conditions in which
there is a mixture of the symptoms of the two phases.

The great mass of the depressions which were not part of a
deteriorating psychosis (dementia prsecox), or did not belong to
definite disorders, such as general paralysis, were now embraced
in this large group. Kraepelin refused to include in this group
one form of depression, viz. a depression in the involution period,
characterised by an anxious agitation, delusions of sinfulness and
persecution, and hypochondriacal ideas. The onset of this disorder
appeared to be connected with commencing involution; the out¬
come in the majority of cases was permanent mental enfeeblement.
For this group Kraepelin reserved the name melancholia.

Dreyfus having followed Kraepelin so far in his bringing the
depressions under the manic-depressive conception, will go farther
and maintains the thesis that the agitated depressions of the
involution period are merely further varieties of the manic-
depressive disorder; and in his preface Kraepelin practically
accepts the conclusions of the author.

The grounds on which Dreyfus bases his conclusions are the
result of an analysis of the Heidelberg material, but he was able to
trace the further history of the patients for more than a decade
after Kraepelin had left them. Cases which the latter had
described as permanently enfeebled, and which had swelled his
percentage of cases resulting in dementia to 49 per cent., were

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found to have later completely recovered; and out of 79 patients
traced by Dreyfus, only six showed permanent dementia, four of
these being undoubted cases of manic-depressive insanity com¬
plicated with arterio-sclerosis.

Besides the difference in outcome which the further investiga¬
tions of Dreyfus showed in these cases, they also disclosed the
occurrence of subsequent attacks, sometimes of a manic nature;
while a more searching probing of the early history of the patients
revealed the frequent occurrence, if not of a previous depression
or excitement, at least of characteristic variations of mood.

Not only did these personal inquiries furnish grounds for
including the cases under manic-depressive insanity; an analysis
of the hospital case-histories elicited characteristic symptoms of
manic-depressive insanity. Under this head he mentions the
occurrence of transitory elation, irritability, loquacity, flight of
ideas, ideas of greatness. The last of these had been wrongly
interpreted by Kraepelin to indicate mental deterioration. In
view of the fact that the older records had been made without
special reference to the present issues, it is probable that such
symptoms were much more frequently present chan was noted.

In the depressed phase of manic-depressive insanity, which is
characterised essentially by sadness and a general blocking of
thought and action, the latter may not be shown objectively; it
is represented subjectively by a feeling of inadequacy on the part
of the patient. The absence of this blocking in melancholia had
been insisted on by Kraepelin as a differential point from the
manic-depressive depression. Dreyfus admits that it may not
be present in a marked form, but considers that it is extremely
frequent in the form of a mild subjective feeling of diminution of
the intellectual functions, of the emotional responsiveness, of
volitional vigour, and in the form of a feeling of fatigue and
languor. The author lays great stress on this “ partial subjective
blocking,” which he uses, perhaps, in a somewhat schematic
manner.

The material upon which the clinical analysis is based consists
of 81 cases, which are presented fully and in an extremely
convenient form. The orderly presentation of the histories, with
short summaries in tabular form, make the facts easily accessible.
This is the first opportunity which one has had to examine the
actual clinical material which Kraepelin used in arriving at the
views put forth in his text-book. A similar publication of the
cases used in the development of the group of dementia procox
would be very acceptable.

The excellent work contained in this book brings out the
absolute necessity of careful clinical records, and the advantage of
following cases over a long period. The author is to be con-

REVIEWS

gr&tulated on the extremely clear and orderly presentation of the
subject, which makes the argument easy to follow.

His point of view may, perhaps, allow a somewhat limited
outlook, but this consistent elaboration of the Kraepelinian doctrines
clears the way for the discussion of the wider issues involved.

C. Macfie Campbell.

DIE ERKENNUNG UND BEHANDLUNG DEE MELANOHOUE
IN DEE PRAXIS. (Diagnosis and Treatment of Melancholia
in Practice.) Prof. Th. Ziehen (of Jena). Halle: Marhold.
1907. 2nd Edition, pp. 67. Price 2 M.

In this edition, as in the first, Professor Ziehen aims more at
giving a useful description of the symptomatology and treatment
of the cases which he groups as melancholia, rather than at dis¬
cussing the more general psychiatric issues. In the differential
diagnosis he does not discuss the diagnosis between melancholia
and the melancholic phase of circular insanity, and in his dis¬
cussion of periodic melancholia he states that in only one of about
thirty cases had a manic attack followed the melancholia. In
several cases, however, he had noted what he calls a “ reactive ”
elation after the attack. He gives as the essence of melancholia a
primary, unmotived depression, and a primary retardation of the
thought process.

The depression is complicated by anxiety, except in hypomelan-
cholic conditions, and secondary delusions of a depressive nature
frequently ensue. The anxiety has frequently a special somatic
localisation, and various sensory symptoms are complained of.

The bedside examination of the patient, the important points
to note at each visit, the considerations which should determine
the advisability of home or hospital treatment, are all clearly gone
over. In the treatment Ziehen emphasises the value of opium,
which guarantees both a shorter and milder course of the disease;
with this many will be inclined to disagree.

The second edition is based on a considerably wider material
than the first, and while not treating the subject in its wider
aspects, is an excellent practical guide to the physician.

G. Macfie Campbell.

IReview

IReurolocjp anb flbs^cbtatri?

Original articles

CLINICAL AND ANATOMICAL DIAGNOSIS 07 THE
ANKYLOSING DISEASES OF THE SPINAL COLUMN.

By Dr ANDRE LtfRI of Paris.

Part II.

II. Anatomo-Pathological Diagnosis and Pathogenesis.

Clinical study reveals differences between these forms of
ankylosing diseases which are sufficiently clear to justify their
having been separated from each other and to prevent their being
re-assimilated. Various writers, however, have refused to separate
spondylose rhizomdique and even hereditary traumatic cyphosis
from the ill-defined group of so-called rheumatic afEections. They
base their views mainly on the etiology, which shows that rheuma¬
tism and spondylose rhizomdique may be preceded, although with
very different degrees of frequency, sometimes by an infection,
sometimes by the arthritic diathesis, and even sometimes, in the
case of one of these affections, by a more or less severe trauma.
I myself have observed a case of spondylose rhizomdique in a man
who had had a fracture of the cervical part of the spinal column.
Is this a sufficient reason for identifying these processes ? Patho¬
logical anatomy, as much and even more than clinical observation,
shows clearly that they may and ought to be distinctly separated,
even if, in virtue undoubtedly of certain common etiological con¬
ditions they may, very exceptionally, occur together.

R. OF N. & P. VOL. VI. NO. 2—E

ANDRti Ltm

1. Rheumatism of the Spine .—Rheumatism of the spine has
been very well studied from the anatomical side especially by
Professor J. Teissier (of Lyons). The spinal column is either
straight or curved to a variable degree. The great anterior common
ligament is thickened and ossified throughout the whole length or
at one part only, but always irregularly. It is moniliform, much
thicker at the level of the intervertebral discs than at the level of
the vertebral bodies (Fig. 1). At the level of each disc, and some¬
times in the intervals between them, there exists a very marked
bony protuberance, either over the whole breadth or over a portion
only of the breadth of the disc. This hyper-ossification is especially
marked in the lumbar region, and irregular bony protuberances,
osteophytes, are its most characteristic sign. For this reason
Professor Teissier has well proposed to give it the denomination of
“ vertebral osteophytic rheumatism.”

The protruding bony proliferation is present over every portion
of the spine; the vertebral bodies which are not fused together
present on their superior and inferior margins a protru ding mar gin
of newly-formed bone, which considerably increases their surface
(Fig. 2). All the apophyses, spinal, transverse, articular, as well as
the laminae are thickened, as if puffed out (souffUes), and are
more or less fused together by the partial and irregular ossification
of their ligaments. The intervertebral discs are partially ossified.
As to the intervertebral foramina, they are irregularly narrowed
by the thickening of the neighbouring pedicles, or by the presence
of osteophytes, which explains the compression of the nerves and
spinal roots and the very severe, intercostal neuralgic pains which
are frequently noted in spinal rheumatism.

In short, the dominating feature in chronic spinal rheumatism,
localised or generalised, is the protuberance and the irregularity
of the osseous new-formations. These encroach upon the bones,
upon the cartilages, upon the ligaments, upon all the peri-articular
parts. The extreme deformity of the spine strikes one at first
sight.

2. Spondylose Rhizomelique .—This is not so in spondylose
rhizomelique. A well-prepared spinal column from a case of
spondylose has at first sight exactly the appearance of a normal
col umn , apart from the general curvature. One is surprised to
find, however, that it is completely ankylosed and constitutes
only one single bony mass.

ANKYLOSING DISEASES OF SPINAL COLUMN 67

The anterior common spinal ligament is almost completely
intact, with the exception of some small ossified portions, mainly
in the cervical and lumbar regions (Figs. 3 and 8). This ossification
is not accompanied by projection. The spinal apophyses, elongated
but not swollen, are fused together, especially in the dorsal region,
by ossification of the slender band of the interspinous ligament
(Fig. 3). The intervertebral discs are completely, or almost
completely, free from any ossification (Fig. 5). The articular
apophyses are fused together by a perfectly smooth osseous collar,
which represents the articular ligaments. After a longer or shorter
time we find on section that their spongy tissue has become fused
and continuous. The ligamenta sub-flava are especially ossified
(Fig. 5). These ligaments and the laminae which they unite form
only one continuous, slightly undulating osseous band. The ribs
are united to the vertebrae by direct ossification, partly of the
costo-transverse ligaments and partly of the costo-vertebral liga¬
ments (Figs. 6 and 7). These latter ligaments are formed of three
bundles, the superior and the inferior, which are strong, uniting
the rib to the neighbouring vertebral bodies, and the middle,
which is weak, uniting it to the disc. This latter alone is generally
slightly, if at all ossified, and forms a depression between the small
bony columns formed by the superior and inferior fascicles.

Thus the predominant feature here is the ossification of the
ligaments, and this ossification takes place in the substance of the
ligament itself, without forming any projection, and in an almost
absolutely regular manner. We may also say that it takes place
fibre by fibre, an osseous band replacing each fibre of the ligament
without the intervention of a cartilaginous phase, for, in the still
incompletely ossified yellow ligaments, we could follow the process
and see the remaining parts of the ligament of the fibres, becoming
directly continuous with true osseous stalactites or stalagmites,
coming from the neighbouring vertebral plate (Fig. 9). There is un¬
doubtedly a certain degree of accessory hypertrophy of the articular
extremities, since we could note the continuity of substance from one
articular apophysis to the other, but always without any abnormal
projection.

At the hip joints I have observed a large collar of bone, more
or less irregular, corresponding to the capsular ligament and to the
completely ossified cotyloid ligament, with conservation of the
inter-articular space (Figs. 10, 11, 12, 13).

ANDRti LtiRI

Thus we have the explanation, as I had previously suggested,
of the limitation of the ankyloses, apart from the spinal ankyloses,
to the joints of the hips, the shoulders, the knees, and to the sterno¬
clavicular and temporo-maxillary joints. The ankylosis of spondy-
lose rhizomdigue results essentially from the ossifications of the
ligaments. The glenoid and cotyloid ligaments and the menisci
are reinforcements of the ligaments—complementary fibro-car-
tilaginous ligaments. Now the ankylosis affects precisely all the
articulations, and these only, which have a meniscus or an intra-articular
fibro-cartilage similar to the cotyloid ligament; this is because they
alone have an ossification of their capsular ligament, sufficient to
prevent the movements of the joint. Other joints may be affected
by the process, as is proved by the frequent diffusion of the pains
at the onset over all the joints; but it is only in very exceptional
cases and at a very late stage that they become ankylosed and
that their ligaments, which have not the re-inforcing structures
mentioned above, become sufficiently ossified to limit the movements.

There remained the further question, by what process an
infection such as gonorrhoea, for example, could bring about
such a general and systematic ossification of ligaments ? We have
discovered the cause in our clinical and anatomical observa¬
tions. Clinically, the constant, regular, and always pronounced
curvature of the spine, the very remarkable flattening in every case
of the thorax and pelvis, already suggested a bony softening. The
satisfactory therapeutic results of straightening the spinal curvatures
by means either of continuous traction or by the simple action of
weight, confirmed this hypothesis. Radiography had revealed
a veritable subsidence of the lumbar column into the pelvis, with
a tilt of the sacrum, so that the picture of the pelvis, like a heart
on a playing-card, recalls that of an osteomalacic pelvis. A woman
suffering from spondylose, observed by Ascoli, had in fact been
treated first as an osteomalacic. Dr Beclere, whilst making a
radiographic study of one of our cases, has brought to our know¬
ledge the abnormal transparency of the vertebral bodies, of the
transverse apophyses, and of the part of the iliac bone correspond¬
ing to the fossa. Pathological anatomy confirms all these facts
by showing us (Pierre Marie) the extreme thinness and abnormal
friability of the bones, the diminution of the compact tissue, both
near the joints (cotyloid cavity, head of the femur, etc.) and at a
distance from them (iliac fossa, transverse apophyses, femur, tibia.

ANKYLOSING DISEASES OF SPINAL COLUMN 69

etc.). In one case notably the transverse process could be crushed
between the fingers, the head of the femur could be almost cut with
a knife, the bottom of the cotyloid cavity and of the iliac fossa
were as thin as a sheet of tissue paper. Hilton Fagge, in a case
published in 1876, had already noted the extreme friability of the
bones.

It is thus clear, from clinical and anatomical facts, that the
softening of the bones precedes the ossification of the ligaments
which essentially constitutes spondylose rhizomdlique. The disease
is primarily a ratifying osteopathy, a kind of osteomalacia, pre¬
dominating certainly in the epiphyses, just as the ordinary
osteomalacia is limited mainly to the diaphyses. This osteopathy
is of infectious origin.

But by what mechanism is the subsequent ossification of the
ligaments brought about? Are we dealing with a special and
isolated mechanism, or with the application of a general law ?
In our opinion we have to do solely with an ossification “ by
f unctional adaptation ,” and with a simple application of a general
mechanism of consolidation, of repair—in short, of recovery from
the atrophies or softening of bone. Julius Wolff has studied the
transformation of the osseous tissue when it has to sustain pressure
or exaggerated traction. His “ law of transformation of the bones ”
is thus formulated. “ The exaggeration of pressure and of traction,
by reason of trophic stimulation and in the interest of statics,
results in the formation of a material which is in a condition to
maintain the requisite resistance.” Holzknecht, forming his
opinion from numerous radiographs of fractures, dislocations and
nervous arthropathies, has also explained the abnormal ossifica¬
tions of connective tissue by the importance of the functional
adaptation. “ There exist,” he says, “ in conditions in which
pressure has become abnormal new formations of bony substance
in the soft parts. These new formations compensate in a crude,
and therefore all the more striking way the impaired equilibrium
of the bones. . . . They supervene when the skeleton can no longer
compensate the disturbance by a transformation of its own internal
substance. . . . They do not occur accidentally, here and there.
They do not appear ever to be primary , but always secondary, and the
primary modifications are always coarse destructions of the skeleton ,
of passive maintenance of the weight of the body, which on one hand
markedly diminishes its solidity, and on the other hand produces

ANDRti LriRI

this modification.” Thus we have the explanation of “ the ossi¬
fication of the capsules and of their reinforcing structures, peri¬
articular ligaments, tendons, muscles and aponeuroses.” This
explanation applies absolutely, in our view, to the ossification of
the ligaments which, following a primary ratifying osteopathy,
constitutes spondylose rhizomelique.

But still further, in the case of the spine itself, we have had
numerous proofs that it is indeed by functional adaptation that
the ossification of the various ligaments takes place when the
skeleton has become insufficient. We have found in very numerous
specimens from Pott’s disease that, when deep erosion of a vertebral
body tends to produce, or has already produced, a forward curvature
of the spine, it is not in front, between the vertebral bodies, that
the ankylosis usually takes place, but almost always behind, be¬
tween the vertebral laminae, at a distance from the tubercular focus
(Figs. 14, 15, 16, 17). This ankylosis is due to ossification of
the overstrained ligamenta sub-flava, and is' destined to meet the
needs of “ functional adaptation.” In specimens of spinal frac¬
tures and dislocations we have found the same consolidation by
ossification of the over-strained ligaments (Figs. 18, 19, 20). In
marked scolioses we have also observed the ossification of the costo¬
transverse and costo-vertebral ligaments on the concave side, the
side at which they are more strained, and where they sometimes
constitute a strong, newly-formed osseous column, which limits
the tendency to lateral displacement of the vertebrae (Fig. 21).
Even in spondylose rhizomelique the localisation of the ossifica¬
tions shows that they are formed by functional adaptation. The
ossified ligaments, in fact, occupy the convexity of the curvatures;
for example, the interspinous ligaments in the cyphotic dorsal
region, the most anterior part of the discs, or the anterior common
spinal ligament at the level of slight cervical and lumbar lordoses ;
that is to say, that they could not be better placed for the purpose
of limiting the deformities and abnormal curvatures of the spine.

Thus we see how essentially different in pathological anatomy,
pathogenesis, and clinical appearances are the two great ankylosing
diseases of the spinal column.

3. Hereditary Traumatic Cyphosis. —The third disease which
we have to consider, hereditary traumatic cyphosis, differs quite
as much from the two preceding forms.

It is at the concave part of the hunch-back that in this case we find

ANKYLOSING DISEASES OF SPINAL COLUMN 71

almost the whole of the new osseous formations (Figs. 22 and 23).
The m a i n lesion consists in the moniliform ossification of the great
anterior common spinal ligament, an ossification of a variable and
irregular extent, and occupying in length the anterior part of the
bodies of 4, 5, or 6 vertebras. There are many other new bony for¬
mations, but very irregular in distribution, in certain portions of the
interspinous ligament, for example, or in certain very limited parts
of some ligaments sub-flava; and like those of the anterior common
ligament, these ossifications take the form of projections and of
limited nodosities (Fig. 23), either outside the spinal cavity, or in
the spinal canal, or in the inter-vertebral foramina.

The anatomical investigation which we have made has given
us a very exact idea of the singular evolution of this cyphosis, which
suggested to some authors (Kiimmel, Henle, etc.) 1 the most varied
hypotheses. We have said that the causal trauma is always pro¬
duced in one of two ways—either by the subject falling on his
back, or by the fall of a heavy weight upon his back, the effect of
both accidents being to suddenly straighten the normal dorsal
cyphosis. The result is a severe laceration or a detachment, with
or without involvement of the vertebral periosteum, of the anterior
common ligament. These lesions are naturally all the more marked
when the normal cyphosis has been already exaggerated by a
hereditary or acquired predisposition, and when the suddenly
straightened arc of the circle already had a short radius. In the
days following the patient suffers pain at the level of the lesion,
and the cyphosis becomes accentuated by reason of the pain and
the reflex contracture. Then he straightens himself again, fre¬
quently to a more erect position than before the accident, precisely
because the lacerated anterior ligament no longer contracts the
spinal arc as before in its movements of extension. But in the
months which follow, repair takes place, and there, as elsewhere,
the lacerated ligament, along with the small portions of injured
periosteum or cartilage, becomes repaired by more or less exuberant
ossification; and it is this ossification itself which produces the
more or less marked curvature of the spine. That is why in cyphosis

1 Kiimmel had supposed that the friction of the vertebral bodies by the trau¬
matism might disturb their nutrition to such a degree as to cause the subsequent
softening: this hypothesis was admitted by Hattemer and by Kaufmann. Mikulicz
and Henle think the formation of a traumatic hsematoma, inside or outside the
dura mater, would cause the softening of the vertebra by the compression of the
spinal roots and ganglia.

andk£ Ltim

we find the new bone formations limited mainly to the concavity
of the curvature, and not, as in spondylose, to the convexity. Its
localisation is such that we can see a priori that it must have pro¬
duced the curvature and not limited it. That is the reason also
why this projection (gibbosite), whether it be permanent or not,
cannot be reduced by suspension, because it is the result of an
osseous ankylosis, whilst the cyphosis, which may have been pre¬
existing or not, remains reducible.

We have had, apart from hereditary traumatic cyphosis, other
anatomical demonstrations of this pathogenesis of traumatic lesions
of the spine. We have, in fact, observed a very similar ossification
of the great anterior or spinal ligament, a large moniliform ossifica¬
tion, extending the length of 4 or 5 vertebrae, in a spine in one
of the vertebral bodies of which we found a revolver bullet which
had been received some years previously. The violent injury had
in this case undoubtedly acted in the same way as the traumatisms
of cyphotics, by suddenly straightening the spinal curvature and
by lacerating or detaching the anterior ligament.

But this, the main lesion of the anterior ligament, is not the
only one ; isolated or grouped fibres of various ligaments may have
been ruptured by the injury. Repair takes place there also by
more or less exuberant new-formations of bone. These form
the small disseminated nodosities which we have described.
When, as we have observed, these nodosities are situated on the
internal surface of the ligamenta sub-flava, in the spinal canal,
they may compress the cord and produce the more or less serious
signs of compression of the cord of which we have spoken.

III. Therapeutic Deductions.

We see, in short, that the anatomical diagnosis, as well as the
clinical diagnosis of these three ankylosing affections of the spinal
column is absolutely distinct. But the knowledge of this anatomy
has an advantage quite apart from a purely theoretical interest.
It has a practical therapeutic bearing, and that of the first order.
Certainly our knowledge of spinal ankyloses is still far from complete,
but such as it is, such as we have just described it, it already lends
itself to important therapeutic deductions.

Chronic deforming rheumatism of the spinal column will be
treated medically in the same way as chronic rheumatism of any
other localisation—with salicylates, iodides, etc., according to the

Plate 3.

Fio. 2,

#JN»

Plate 4.

Fig. 4.

> v*

Plate 6.

Fio. 10.

Plate 8.

Fig. 15.

Plate P.

Fk». ]ti.

Plate 11.

Fid. 21.

ANKYLOSING DISEASES OF SPINAL COLUMN 73

case. But if there appear severe intercostal neuralgic pains, we
will know that they are caused, in all probability, by a shortening
of the intervertebral foramina, and the knowledge of the radicular
localisation of the disturbances of sensibility will, in certain
particularly persistent cases, allow of a direct attack, by surgical
intervention, upon the cause of the pains.

In spondylose rhizomelique , some interventions have been made,
notably by Dr Nelaton, which aimed at removing the ankylosis
of the hip by resection of the head of the femur. These have all
failed, and even the interposition of a muscle between the osseous
surfaces could not prevent a return of the condition. We can
now perfectly understand these failures, since the new ankylosing
ossification is not the cause of the disease, but a process of recovery,
since this process of recovery is the simple application of a law of
general pathology, and since, in default of articular ligaments, the
new formations may and must take place in all the peri-articular
tissues, connective tissue, tendons, even muscles, as Holzknecht
has seen in some cases. In order to attack the joints with any
chance of success, it would be necessary to make sure that the
“ osteomalacic period ” of the disease is passed; and as yet we
have no criterion by which to make sure of this.

On the other hand, the procedures which are directed not to
the hyper-ossification—the secondary process,—but to the bony
softening—the primary process—have often yielded remarkable
results. We have found, as Baumler also did, that the simple
action of weight, applied, for example, whilst the neck is supported
by a cushion, allowing the head to hang down without a pillow,
will straighten a marked forward inclination of the head. We have
also found, in the wards of Dr Walther, that continuous traction,
applied by means of a chin-strap for the same purpose, may have a
rapid and remarkable result. These results may not be permanent,
but they may be repeated on several occasions, and in any case
will render very great service to the patient. We have also found
that somewhat forcible passive movements will restore to a shoulder
joint, through rupture of the still slight peri-articular ossifications,
a mobility which was very much restricted.

This is not all: the same medical treatment which is of service
in infectious chronic rheumatism, by means of salol, for example,
may also be of very real service in cases of spondylose which have
the same infectious etiology. And very frequently it will be possible

ANDE^l LtfRI

to attack it at the source of the infection, which, as we have said,
is often more or less latent, but is by no means always inactive.
In numerous cases, for instance, the causal gonorrhoea may still be
revealed by a slight turbidity of the urine, and repeated washing
of the bladder has seemed to us to be in such cases the best thera¬
peutic adjunct, and if not to bring about the retrocession of the
ankylosing process, at least to limit it.

In hereditary traumatic cyphosis the projection may, as we
have said, be more or less completely cured, when the ossification
of the anterior ligament is not yet too marked, by rest in bed and
the wearing of a corset. Later there may sometimes appear more
or less serious signs of compression of nerve roots or spinal cord.
It is most important to know that this compression is due to small
nodes of bone, and that by searching for the well-known localising
signs of lesions of the cord or its roots we may possibly be able,
by a timely surgical intervention which is comparatively simple,
to procure the disappearance of the intractable neuralgias or the
paraplegic symptoms.

The study, especially the anatomical study, of spinal ankylosis
is as yet only at its commencement. It seems to us even now to
furnish therapeutic indications sufficiently precise and important
to deserve in future more numerous investigations, the more
especially when we consider that we are dealing with affections
against which surgery has hitherto appeared to be absolutely
powerless.

Description of Figures.

Fig. 1.— Spinal Rheumatism. Note the numerous and irregular osteophytes,
the voluminous protuberances, especially at the level of the discs.
(Muse'e Dupuytren.)

Fig. 2.—A vertebra, seen from above, in a case of Spinal Rheumatism. Note
the development of the osteophytes which surround the vertebra and
almost double its surface.

Fig. 3 .—Spondylose Rhizomelique. Note the general curvature of the spine
without any gibbosite , the integrity of the anterior spinal ligament apart
from some absolutely smooth ossifications in the cervical and lumbar
regions, the complete absence of osteophytes, the integrity of the inter¬
vertebral space, the ossification of the supraspinal ligament in the dorsal
region. (This figure was published in the Report on “The Clinical
Forms of Chronic Rheumatism,” by Prof. J. Teissier, Congros de
Medicine de Liege, 1905.)

ANKYLOSING DISEASES OF SPINAL COLUMN 75

Fig. 4. —Spondylose Rhizomdlique. (In this case there is a fracture of the
cervical column in addition to the spondylose.) Note the smooth
ossification of some parts of the anterior spinal ligament or of the discs
in the dorso-lumbar region, the absence of osteophytes, the ankylosis of
the ribs to the vertebr®, the subsidence of the spine into the pelvis, the
tilt of the sacrum, the complete ankylosis of the hips formed by the
ossification of the ligaments surrounding the joint.

(Figs. 5, 6, 7, 8.—Different portions of the spinal column in
Spondylose Rhizomelique.)

Fig. 5.— Cervical portion . Note the complete ossification of the ligaments
sub-flava (the plates and the ligaments forming one continuous osseous
band), the integrity of the discs and the absence of any osseous pro¬
tuberance.

Fig. 6.— Mid-dorsal portion. Note the ossification of the costo-vertebral
ligaments (especially the superior and inferior fascicles), of the costo¬
transverse ligaments, and the lengthening of the spinal apophyses.

Fig. 7. — Mid-dorsal portion. —Note specially the mode of ossification of the
coeto-vertebral ligaments.

Fig. 8.— Lumbar portion. Note the slight, smooth protuberances at the level
of the discs, aud the ossification of the inter-articular ligaments.

(These figs, were published in the Nouv. Icon, de la Salpitrihe , 1906.)

Fig. 9.— Spondylose Rhizomdique. Lines a, b, and c point to the osseous
stalactites at the level of the intervertebral discs in the ligamenta
sub-flava.

Fig. 10 .—Spondylose Rhizom&ique. Oblique section of the hip seen in Fig. 4.
Note the conservation of the joint cavity, the integrity of the head of
the femur and of the cotyloid cavity, the ossification of the cotyloid
ligament and of the other ligaments which has produced the complete
ankylosis, the rarefication of all the bony tissue. (Fig. published in the
Nouv. Icon, de la Salpet)' j ure J 1906.)

Figs. 11 and 12.—The hip joint of the preceding fig. divided into two por¬
tions. Note the nodes of new-formed osseous tissue protruding greatly
upon the iliac bone at the level of* the cotyloid ligament which has
entirely disappeared, and upon the femur at the point of contact of the
node, the marked thinness of the bottom of the cavity, and the great
spongiosity of all the tissue except that which is new-formed. (Figs,
published in the Nouv. Icon, de la Salp 'triere, 1906.)

Fig. 13.—Hip in rheumatism (morbus cox® ?). In spite of the persistence of
the articular inter-line, one is struck by the absolute dissimilarity
between this lesion and the lesion of the hip in spondylose. (Mvsde
Dupuytren.)

76 ANDR £ l£RI

Figs. 14 and 15 .—Dorsal Pott?6 disease. Distinct angular inflexion of the
spinal column from destruction of the vertebral bodies. In Fig. 15
(which represents the inferior part and the apex of the angle seen from
behind) we see the simple ossification of the yellow ligaments (which
has occurred without any osseous protuberance) between the spinal
plates which are not affected by the tubercular process. This ossifica¬
tion could hardly be better placed for the purpose of limiting the
deformities; it seems to be due to a “ functional adaptation ” of the
tissue of these ligaments. (Muste Dupuytren.) (Figs, published in the
Report by Dr L4ri on the “ Pathogeny of the Ankyloses, and especially
of the Vertebral Ankyloses,” Congr&s pour TAvancement des Sciences,
Lyon, 1906.)

Figs. 16 and 17 .—Lumbar Potfs disease. Destruction of the body of the 5th
lumbar vertebra (Fig. 16) has produced an inflexion of the column
which is limited behind by the ossification of the ligamenta subflava.
This ossification is best seen in Fig. 17 at the points marked a. {Musts
Dupuytren.)

Fig. 18 .—Fracture of the 2nd lumbar vertebra by the buffer of a locomotive ;
death five months later. Note the new-formed osseous band, due to the
ossification of the lacerated spinal ligament, perhaps also of the connective
tissue which ascends along the 3rd and 2nd lumbar vertebrae. This
ossification, produced by the traction, could not be placed better for the
purpose of limiting the descent of the superior portion. {Muste Dupuy¬
tren.) (Fig. published in the Report by Dr L^ri on the “ Pathogeny of
the Ankyloses,” Congrcs de Lyon, 1906.)

Figs. 19 and 20 .—Dislocation of the Gth cervical vertebra on the 7th. In Fig. 20
we have the posterior view of the smooth ossification of the substance
of the ligamenta sub-Hava which limits the displacement. {Musts
Dupuytren.)

Fig. 21 .—Scoliosis of the 3rd to the 12th dorsal vertebra:. Note the thick new-
formed ossifications of the vertebras and ribs, which, from the concave
side, “line” the spinal column, as one might say, and prevent the
forward movement from becoming more marked. The new ossifications
are found chiefly (1) on the concave margin of the intervertebral discs,
at the point where the disc undergoes the maximum traction and the
vertebral bodies the maximum pressure; (2) at the level of the costo¬
vertebral and costo-transverse ligaments. The latter, oblique from above
downwards and from the outside inwards, from the superior rib towards
the transverse apophysis, and from the transverse apophysis towards the
inferior rib, are particularly exposed to the strain from the concave side
of the scoliosis. {Muste Dupuytren.)

Fig. 22.—Spinal column in hereditary traumatic cyphosis (B), between two
columns from spondylose rhizomtlique (A and C). Note the difference
in inclination—gentle and complete in the spondylose (column A shows

CEREBRO-SPINAL SYPHILIS

in addition a cervical fracture), abrupt and almost angular, but very
limited in the cyphosis. Also ossification in the latter of the anterior
vertebral ligament at the level of the concavity of the column. (Fig.
published in the Nouv. Icon, de la Salpitribre, 1906.)

Fig. 83 .—Hereditary traumatic eyphotie. Median section at the level of the
gibboeitd. Note (1) the dense ossification of the anterior spinal ligament
and of the anterior part of the column at the level of the concavity (a);
(2) a protruding nodosity in the spinal column (b), formed by an osteo-
phytic ossification isolated by a yellow ligament.

THE EPIOONUS SYMPTOM-COMPLEX IN CEREBRO¬
SPINAL SYPHILIS.

By WILLIAM G. SPILLER, M.D.,

Professor of Neuropathology, and Associate-Professor of Neurology in the
University of Pennsylvania; Neurologist to the Philadelphia General
Hospital.

Read in abstract before the Pennsylvania State Medical Society, Sept 1907.

From the Department of Neurology and the Laboratory of Neuropathology of
the University of Pennsylvania, and from the Philadelphia General
Hospital.

It is not often that the symptoms of an epiconus lesion are
caused by syphilis, and yet a case has been observed by the
anthor in which the diagnosis had to be made between syphilitic
multiple neuritis and a lesion of the epiconus or its roots. The
existence of the former condition is questionable. Remak thinks
it is not yet positively determined whether syphilis may cause
polyneuritis, although it is probable. Flatau refers to a case
studied by Oppenheim and Siemerling in which the saphenous
major and the cruralis nerves showed a slight decrease of nerve
fibres and a slight increase of the endoneurium. The radial and
peroneal nerves were intact. This is the only case with necropsy
he mentions, but he states that pathologic-anatomical findings in
a case of pure syphilitic polyneuritis have not been obtained.
Implication of the cranial nerves is common in syphilis of the
brain and is caused by the syphilitic meningitis; a similar in¬
volvement of the spinal roots from syphilis of the spinal cord
also occurs frequently.

WILLIAM G. SPILLER

Remak says that Ehrmann has observed cases of neuritis
nodosa on a syphilitic basis, and he (Remak) has seen painful
swellings of nerves, especially of the ulnar, radial, and peroneal
nerves, and swellings of the brachial plexus in cases of localised
syphilitic neuritis. In a case of brachial neuritis on a syphilitic
basis, studied with Westphal, the nerves were hard to the touch,
but Remak remarks that such swellings occur in non-syphilitic
cases and cannot always be attributed to the syphilis. In cases
in which the neuritis was supposed to be produced by syphilis,
there were other signs or history of syphilis, or improvement
from anti-syphilitic treatment. Syphilitic neuritis is rare,
whereas other manifestations of syphilis are common. A few
clinical cases of syphilitic mononeuritis are referred to by
Remak.

A brachial neuritis may be simulated by pressure on the
plexus by enlarged syphilitic glands. Bilateral symmetrical
paralysis may be caused by implication of the vertebrae or
meninges, as in a syphilitic case observed by Remak, 1 in which
the circumflex nerve was paralysed on each side and the fifth
and sixth cervical vertebrae were thickened. Primary bilateral
syphilitic brachial neuritis may occur, in Remak’s opinion, and
he refers to a clinical case of Leyden’s as an example. He refers
to clinical cases of syphilitic polyneuritis reported by Gross,
Oppenheim, Buzzard, Fordyce, Taylor, Schlossberger, Sorrentino,
Perrero, Brauer, Spillman and Etienne, Crocq, and Fry.

Some so-called cases of syphilitic neuritis may have been
caused by the mercurial treatment. In Brauer’s case 2 the treat¬
ment with mercury had been employed, and Bauer was uncertain
whether both the mercury and syphilis together caused the poly¬
neuritis, or whether other causes existed. Mercury had been
employed five weeks before the symptoms of polyneuritis ap¬
peared. Neuritis was found by microscopical examination, and
some of the cells of the anterior horn were vacuolated.

Cestan, 3 in 1900, reported two clinical cases of syphilitic
polyneuritis, and collected eleven cases he found in the literature.
In both his cases the neuritis occurred very soon after the infec-

1 Remak and Flatau, “Neuritis and Polynauritis, Nothnagel’s System.”

2 Brauer, Neurol. Cent., 1896, p. 67].

* Cestan, Nouvelle Ictmographie de la Salpttriire, 1900, p. 158.

CEREBRO-SPINAL SYPHILIS

tion. Of the cases he collected, only two were with necropsy
(Brauer, Kahler). In regard to mercury being the cause of the
polyneuritis, he refers to the fact that Lewin observed only once
symptoms of neuritis in 8000 cases of syphilis treated by injec¬
tions of the bi-chloride. Cestan’s two cases were without sensory
iuvolvement, and suggested very much the form of neuritis seen
in lead palsy, inasmuch as the symptoms were purely motor,
and in the first case the paralysis was confined to the upper
limbs and was most pronounced in the extensors of the hands.
It is possible, I think, that the symptoms in these cases were
caused by lesions of the spinal cord and not by peripheral
neuritis.

Oppenheim, in the fourth edition of his text-book, p. 537,
says that Schultze, Buzzard, and he (Oppenheim) have described
cases of syphilitic polyneuritis, and Cestan recently has also re¬
ported unquestionable cases. He acknowledges its existence, but
speaks of it as a very rare affection.

In the discussion following the report of Fry’s case of syphi¬
litic multiple neuritis before the American Neurological Associa¬
tion, 1 2 Dana, Starr, J. J. Putnam, and Leonard Weber said they had
never seen a case of syphilitic multiple neuritis. Starr, 8 in the
first edition of his text-book, published in 1903, expresses him¬
self a little more guardedly, and says there is a certain proba¬
bility that some of the cases were of syphilitic origin, but the
condition is extremely rare. At a discussion of the New York
Neurological Society it was found that no one had seen a case of
multiple neuritis undoubtedly syphilitic.

The case that forms the subject of this paper is as follows :—

The patient, a coloured man, admitted syphilitic infection.
He denied alcoholism, except that he had occasionally taken a
little beer. He entered the Philadelphia General Hospital,
July 27, 1905. About three months previously pain had been
felt in the back on the left side, low down near the os inno-
minatum. Numbness and pain were then felt in the left lower
limb, especially severely in the calf. When he entered the
hospital he moved the left lower limb in walking as in foot-

1 Dana and others, Journal of Nervous and Menial Disease, vol. xxv., 1898,
p. 598.

2 Starr, “ Organic Nervous Diseases,” Lea Bros, & Co., 1903, p. 160.

WILLIAM G. SPILLER

drop. The power of flexion of the left foot was impaired.
No tenderness was felt over the nerve trunks, and the patellar
reflexes were preserved. The voluntary movement of all the
limbs at this time was good, except in the dorsal flexion of the
foot. When the sole of the right foot was irritated, flexion of
toes was produced, but irritation of the sole of the left foot
caused no response. Ankle clonus was not obtained. The
patellar tendon, triceps and biceps tendon, cremasteric, and epi¬
gastric reflexes were preserved and equal on the two sides and
about normal, indeed, the patellar reflexes seemed a little prompter
than normal. Achilles jerks were not obtained.

The pupils were unequal, the right being the larger. Reaction
to light was absent, but contraction in convergence was preserved.
The extra-ocular muscles were normal. The tongue was not
affected. The functions of the bladder and rectum were not dis¬
turbed. Sensation, objectively tested, was normal.

Aug. 12, 1905.—An examination by Dr William Pickett on
this date revealed that the right pupil was myotic, but the light
reflex was obtained, and in a dark room the right pupil became
larger. Dorsal flexion of the feet was performed only by the
tibialis anticus muscles. Tactile anaesthesia was present on the
dorsum, outside of the foot and plantar surface on each side, and
on the lower and outer part of the legs, and was more pronounced
in the left limb, where it extended nearly to the knee. The man
complained of pain at night nearly circling the body at the level
of the iliac crests. An area of anaesthesia was found near the arm
on the left side, about 10 cm. in breadth.

Sept. 14, 1905.—Difficulty in talking was observed on this
date, and speech was unintelligible. The man was weak and
drowsy. He understood at times what was said to him, but
often failed to understand commands: for example, he raised his
upper limb when told to put out his tongue. He had more diffi¬
culty in moving his left lower limb. When he was aroused he
opened the right eye but kept the left eye closed, or opened it only
slightly and with effort. He was able to forcibly close the eye¬
lids. The muscles of the facial nerve supply were not affected.
The tongue was protruded straight. The left eyeball was not
rotated outward on voluntary movement, and moved very little in
convergence, and slightly upward and downward.

The patellar reflex was exaggerated on the right side, on the

CEREBROSPINAL SYPHILIS

left side it was not so prompt, but not diminished. Achilles
reflex was absent on each side. The plantar reflexes were pre¬
served.

Oct 22, 1905.—An examination was made on this date by
Dr William J. M'Connell in Dr Mills’ service. Ptosis of the left
upper lid was complete. The motor fifth and seventh nerve
supplies were not affected. The left pupil was dilated, the right
moderately contracted. The light reflex was obtained on the
right side but not on the left side. The left internal rectus and
superior rectus muscles were completely paralysed; the left inferior
rectus and inferior oblique muscles were weak. Looking far to
the left caused lateral nystagmoid movement.

The upper extremities were not affected as regards motion,
sensation, and the reflexes. The extensors of the leg were normal
and much stronger than the flexors of the leg. The flexors and
extensors of the thigh and the sartorius muscle on each side were
strong. In the leg the anterior tibial muscle on each side was
the only muscle contracting in voluntary action, and the left was
weaker than the right. The patellar reflex on each side was
exaggerated, the Achilles reflexes and plantar reflexes were lost.
Both lower extremities, especially below the knees, were atrophied.
Sensation was normal in the right lower limb, in the right
buttock, and in the perineum. The man had control of bladder
and rectum. Squeezing the testicles seemed to produce pain.

Dec. 16, 1905.—An examination was made on this date by
Dr William J. M'Connell, and showed that sensation was not
affected in any form in the right lower limb, but tactile sensation
was lost in the left lower extremity over the dorsum of the foot
and plantar surface as far as the second toe. The anaesthesia
extended on the outer surface of the left leg half way to the
knee. An area of anaesthesia was found on the posterior surface
of the thigh from about four inches below to one inch above the
gluteal femoral fold, and from two inches from the perineum
almost to the great trochanter. This was the first time any
anaesthesia was found in the region of the buttock. In all these
areas of anaesthesia sensations of temperature and pain also were
lost

An examination of the eyes made on Jan. 1, 1906, gave
the following results :—O.D.V., $ ; O.S.Y., f. O.D. pupil, 3
mm.; O.S. pupil, 6 mm.

WILLIAM G. SPILLER

O.D. reaction free to light and in convergence and accommo¬
dation. O.S. No reaction in any way; paresis of all ocular
muscles excepting the external rectus; slight impairment_of
levator palpebrae.

O.D. media clear, fundus negative. O.S. media clear, fundus
negative.

March 11, 1906.—Notes were made by me at the time the
patient was in my service. He was shown twice in lectures by
me chiefly because of bilateral peroneal palsy. He was weak in
both lower limbs, but the weakness was much greater in the
peroneal distribution on each side. He had a steppage gait, and
when sitting with his feet firmly on the floor could not raise the
toes well when the heels were on the ground. The case was
striking because of the peroneal palsy occurring with cerebro¬
spinal syphilis.

Condition, March 11, 1906.—He is able to pull up his right
lower limb on command, but it is impossible to get him to pull
up the left lower limb. Although his stupor is very great he
pulls up the right lower limb and probably therefore has weak¬
ness of the left lower limb. When the left lower limb is pricked
with a pin he flexes it somewhat at hip and knee, the limb there¬
fore is probably weak but not paralysed, and the test of move¬
ment is interfered with by the stupor. He has marked bilateral
foot-drop, and the lower limbs below the knees are much wasted
both in the muscles in the front and back of the legs. The soles
of the feet are also wasted. The lower limbs are abnormally
flaccid, especially the left. When either lower limb is stuck
with a pin the patient gives distinct evidence of discomfort and
puts his hand at the place stuck. The patellar reflex is present,
but not very prompt on either side, slightly more so on the left. The
Achilles jerk is lost on each side. Babinski reflex is absent on
each side, the toes not moving in either direction. The cremas¬
teric reflex is not obtained on either side. The muscles of the
ealves and the peroneal nerves are not tender to pressure. He
cannot be tested for tactile sensation because of his mental
condition.

Upper limbs : He can raise the right upper limb on com¬
mand, but cannot raise the left upper limb. He is therefore
hemiparetic. The biceps tendon reflex and triceps tendon reflex
are prompt on each side, more so on the left. He feels pin

CEEEBRO-SPINAL SYPHILIS

prick when stuck in either upper limb, but he can move the left
very feebly, The upper limbs are not wasted. The left side of
the face is paralysed and he does not close the left eyelids as
well as the right. It is impossible to get him to put his tongue
out or to test movements of his eyes. There seems to be weakness
of the right external rectus, but this is not positive.

March 17, 1906.—The man was stuporous, and breathing
was difficult. Bubbling r&les were heard over the chest The
heart was rapid and weak. He died on this date.

The necropsy revealed: pulmonary hypostasis and oedema;
chronic adhesive pleurisy, cyanotic induration of spleen, folli¬
cular enteritis, hepatic congestion, cyanotic kidney, purulent
meningitis.

The results of my microscopical examination of the nervous
tissue are as follows :—

While sections from the third lumbar region show the cells
of the anterior horns to be normal, with the exception of an
occasional diseased cell, those from the lowest lumbar and sacral
regions show these cells intensely degenerated. The nuclei are
displaced to the periphery; some of the cells contain several
vacuoles; chromatolysis is intense; the dendritic processes of
many of the cells have disappeared, and the cell bodies are
swollen. The round cell infiltration of the pia, although intense,
is not any greater at this region than elsewhere in the cord.
Both posterior columns are degenerated in the lower lumbar and
upper sacral regions, but the degeneration is much greater on
the left side, and is of long standing, although recent degenera¬
tion in both posterior columns, especially the left, is also present,
as shown by the Marchi method.

Sections from the mid-thoracic and lower cervical regions
show intense round cell infiltration of the pia, and thickening
of the pial vessels, and degeneration of the columns of Goll,
much greater on the left side, and slight degeneration of each
crossed pyramidal tract Perivascular round cell infiltration is
also found within the cord.

The round cell infiltration of the pia and the thickening of
the arteries is very intense over the medulla oblongata, cerebral
peduncles, chiasm, and optic nerves. The optic nerves are
partially degenerated.

The left third nerve is intensely degenerated, and a small

WILLIAM Gr. SPILLER

vessel accompanying the nerve is almost occluded by proliferation
of the intima.

The left seventh nerve and sensory part of the left fifth root
are also much degenerated; the motor portion of the left fifth root
is only partially degenerated. The right seventh and third
nerves and the root of the right fifth nerve are slightly degenerated.
The contrast afforded by the condition of the two third nerves is
very striking.

Right and left peroneal nerves.—Muscle attached to these
nerves shows very intense atrophy; the muscle fibres are small,
and the connective tissue is increased in amount. The Weigert
hsematoxylin stain shows considerable degeneration of the nerves.

Right and left plantar nerves.—These are partially degene¬
rated. The muscles on these nerves are also much atrophied*
and their connective tissue is much increased.

A gumma was found in the right island of Reil.

Summary.

A male, syphilitic, complained of pain in the lower part of
the back on the left side, about April 1905. This was followed
soon by numbness and pain in the left lower limb, especially in
the calf. He entered the hospital July 27, 1905. At that
time he presented foot-drop on the left side. No tenderness
was felt over the nerve trunks. The voluntary movement was
good everywhere except the dorsal flexion of the foot. It is
uncertain from the notes whether dorsal flexion of the right foot
was affected at this time. Irritation of the sole of the right
foot caused flexion of the toes; irritation of the sole of the
left foot produced no movement of the toes. The patellar
reflexes were a little prompter than normal. Achilles reflexes
were absent. The bladder and rectum functionated normally.
The pupils were unequal, and light reaction was lost. Objective
sensation was normal.

On August 12, 1905, the tibialis anticus muscles alone
contracted on attempt at dorsal flexion of the feet, the right also
being affected. Tactile anaesthesia was present on the outer
parts of the feet and legs, in the area of the first and second
sacral roots, more pronounced on the left side. Pain encircled
the lower part of the trunk.

CEREBRO-SPINAL SYPHILIS

On October 22nd the extensors of the legs were normal, the
flexors of the legs were paretic. The flexors and extensors of
the thighs were normal. The plantar reflexes were lost. Signs
of cerebral syphilis and later left hemiparesis developed. The legs
below the knees were much wasted. The lower limbs were flaccid,
the patellar reflexes later became diminished.

The remarkable features of this case were the bilateral peroneal
palsy affecting the left side before the right with the escape of the
tibialis anticus muscles, weakness of the flexors of the legs and
extensors of the foot, disturbance of objective sensation in the
distribution of the first and second sacral roots or peroneal supply,
loss of Achilles reflexes, later loss of plantar reflexes and preserva¬
tion of patellar reflexes and of the function of the bladder and
rectum, in a man clearly affected with syphilis of the nervous
system, as shown by the history and cerebral manifestations and
pathological findings.

A bilateral peroneal palsy, such as this man presented, is
most commonly caused by neuritis, and especially neuritis from
alcoholism. The absence of tenderness to pressure over the
peroneal nerves and their muscle-supply does not exclude the
diagnosis of multiple neuritis, as a purely motor neuritis may
occur. The escape of the bladder and Tectum, also, is in favour
of neuritis, but is a feature also of a lesion of the epiconus,
especially in connection with the escape of the tibialis anticus
muscles. These muscles probably have centres in the spinal
cord above those of the other muscles in the peroneal distribution,
and may escape in lesions of the spinal cord, as seen frequently
in anterior poliomyelitis. They may escape also in lead palsy
when the lower limbs are affected, just as the supinator longus
muscles often escape when the posterior interosseous distribution
is affected from lead, causing wrist-drop ; but it is still unde¬
termined whether lead palsy is primarily due to disease of the
nerve cells or of the peripheral nerves. Weakness confined to
nerve distribution is one of the most diagnostic features of
neuritis, but peroneal palsy may be caused by a lesion of the
spinal cord in the epiconus. The patient complained of pain
in at least the left lower limb, but pain in the limbs is common
in syphilitic meningo-myelitis, and probably results from irrita¬
tion of the posterior roots; it by no means indicates necessarily
peripheral neuritis. A diagnosis in this case between multiple

WILLIAM G. SP1LLER

neuritis and a lesion of the epiconus or of the roots pertaining to
this region of the spinal cord was difficult.

A lesion of the grey matter of the fifth lumbar, first and
second sacral segments of the spinal cord, a region to which Minor
has given the name epiconus, gives a very definite clinical picture
characterised by the presence of certain symptoms, as well as by
the absence of others belonging to lesions of the conus ; the conus
to be regarded as beginning with the third sacral segment and
extending to the end of the cord. There is paralysis of motion
and of sensation in the innervation of the sacral plexus, especially
in that of the peroneal nerves. These muscles are most atrophied,
and electrical reactions in these are most affected. The gait is
of the steppage type because of foot-drop. When the lesion
extends higher than the first and second sacral segments, into the
fifth lumbar segment, the flexors on the back of the thighs and
the gluteal muscles are weak, because of the implication of the
fifth lumbar segment. The Achilles tendon reflexes and the
plantar reflexes are lost. The negative signs are as important in
the diagnosis as the positive; the sphincters of bladder and
rectum and the sexual functions are not affected, because the
conus in which the centres for these muscles and functions are
situated, and the white columns above the conus, are not impli¬
cated. The patellar reflexes are preserved, and may be exaggerated,
because the lesion does not extend into the fourth lumbar seg¬
ment; the saddle-shaped anaesthesia over the buttocks is not
present because of the integrity of the conus. Minor had no
cases with necropsy when he wrote his first paper on this subject, 1
nor does he refer to any necropsy in the few cases of epiconus
lesions he quotes from the literature. These as well as his own
were all traumatic cases. Sensation may be affected in the feet
and outer part of the legs about half way to the knees, and
possibly also in a narrow strip extending up the back part of the
thighs. In his second paper, published in June 1906, Minor
reports two cases of poliomyelitis of the epiconus confined to one
side, also a traumatic case, but all without necropsy. 2 3 A
necropsy was not obtained in Bernhardt’s case, and this was not a
traumatic case. 8 The lesion was supposed to be haemorrhage or

1 Minor, Deutsche Zcitschrift fur Nervenhcilkunde , vol. xix. p. 331.

2 Minor, Deutsche Zeitschrift fur Nervenheilkunde , vol. xxx. p. 395.

3 Bernhardt, Salkoweky’s Festschrift , cited by Minor.

CEREBRO-SPINAL SYPHILIS

myelitis of the epiconus. Cestan and Babonneix’s case 4 in
their paper is regarded by Minor as one of epiconus lesion,
caused by hsematomyelia. 1 It is not stated by Minor whether or
not a necropsy was obtained, A case of Laignel-Lavastine is not
regarded by Minor as entirely typical.

A traumatic case of lesion of the epiconus was under my
observation a long time, and was reported by Weisenburg. That
also was without necropsy.

These cases referred to by Minor seem to be the only
instances in literature of lesions of the epiconus, and by far the
majority of these cases are the result of trauma. Unless Cestan
and Babonneix’s case was with necropsy all were merely clinical
cases.

In a diagnosis between lesions of the epiconus and the roots
pertaining to it, or lesion confined to these roots, the following
points are recognised: In lesions of the epiconus the deformity
of the vertebrae, if one exists, is at the first lumbar vertebra ; the
symptoms develop rapidly and rapidly extend, anaesthesia is pro¬
nounced, and the sensory disturbances are of the dissociated type;
signs of sensory irritation are absent, and the disturbances are
bilateral and symmetrical. In lesions of the cauda equina in
the roots pertaining to the epiconus, the deformity of the vertebrae,
if one exists, is lower ; the symptoms begin more slowly and
extend more slowly, pain is severe and lasts a long time, and
precedes other symptoms, and the disturbances are asymmetrical.
Tenderness to pressure is common in the peripheral lesions, but
inasmuch as hypersensitiveness is common in meningitis, probably
from irritation of the posterior roots, it does not imply neuritis
of the peripheral branches.

In ray case, the report of which has just been given, the
left leg was affected first, but the right was soon implicated;
there was no deformity, as there was no trauma; the symptoms
developed rapidly, soon reached their height, and remained
stationary some time without involving either upper limb until
cerebral hemiparesis occurred. Anaesthesia was pronounced, but
dissociation of sensation was not present, and the implication
was bilateral and symmetrical. The symptoms were therefore
suggestive of a cord lesion. Even with the microscopical study
before us it is difficult to say whether the multiple neuritis
1 Cestan and Babonneux, Case 4, cited by Minor.

WILLIAM Gr. SPILLER

occurred first and the cellular changes in the lower lumbar and
sacral regions were secondary, in the form of a reaction at dis¬
tance, or whether the roots of the peroneal nerves arising in the
epiconus were first affected, as they may have been, by the
meningomyelitis. No greater intensity of the meningitis is
present in the lower lumbar and sacral regions to explain
the implication of the roots of these regions and the escape
of roots from higher levels. It is possibly more reasonable,
therefore, to assume that the peroneal nerves were the first
affected, and that the case was one of syphilitic multiple neuritis
occurring with syphilitic meningo-myeloencephalitis. With this
explanation we can understand why the nerve-cells of the
anterior horns of the upper lumbar region afforded such a
striking contrast to those of the lower lumbar and sacral
regions.

Two other cases of the epiconus symptom-complex have come
under my observation :—

Case II.—6. Iver., aged 35 years, a patient of Dr Stengel,
was admitted to the University Hospital, April 27, 1907. In
the middle of February 1907, he was taken ill with a high
fever. When seen by a physician a few days later he had an
enlarged spleen and rose-spots. The temperature went down
to normal, and he was able to work at the end of a week. He
worked about ten days, when he again had fever, and the
symptoms indicated incipient typhoid fever, although the spleen
was not enlarged and rose spots were absent. He rapidly
grew worse, and developed meningeal symptoms, with positive
Koenig’s sign and ankle clonus. He was stuporous for two
weeks. This condition disappeared, and was followed rapidly
by pneumonia of the lower left lung, which resolved very
slowly. The pneumonia occurred about March 20th. Symp¬
toms of empyema on the same side followed the pneumonia.
About April 6th pus was obtained by needle, and soon after
this he coughed up large quantities of muco-purulent material,
and this he continued to do.

May 12, 1907.—Examination by Dr Spiller.

The lower limbs have good voluntary power except in the
peroneal distribution on each side. Bilateral foot-drop is
present, slight on the right side, but very pronounced on the

CEREBRO-SPINAL SYPHILIS

left side. He is able to dorsally flex the right foot, even to
a moderate degree of resistance, bat in attempting to dorsally
flex the left foot contraction occurs only in the anterior tibial
muscle. The muscles of the legs below the knees are wasted.
He has no fibrillary tremors. The patellar tendon reflex is
exaggerated on each side, and patellar clonus is present on each
side, ankle clonus also, but the latter is soon exhausted. Ankle
clonus with pronounced foot-drop on the left side is very
striking. Sensations of touch and pain are normal in the lower
limbs. Babinski’s sign is not obtained on either side in a
characteristic manner, but on the right side at times all the
toes except the big toe are extended. Babinski’s reflex is not
indicated on the left side by extension of any of the toes.
Cremasteric reflex is weak on the left side, prompt on the right
side. Sensations of touch and pain are normal about the anus
and in the perineum. He has no pain nor tenderness in the
lower limbs. Micturition and defecation are normal.

The grasp of the hands is good. The biceps tendon reflex
and triceps tendon reflex are exaggerated on each side. Sensa¬
tions of pain and touch are normal in the upper limbs. No
wasting of hands or forearms. Voluntary power in the upper
limbs is good.

He closes the eyelids, shows the teeth, and draws up the
corners of the mouth very well. Pupils are equal, and respond
promptly to light and in convergence. Extraocular muscles are
normal. The tongue is normal. Speech is that of a patient
weak from sickness, not from organic nervous disease.

Diagnosis ,—Lesion of epiconus, poliomyelitic in character,
following pneumonia.

Case III.— F. S., aged 42 years, male, was injured November
6, 1905, by falling and striking his back in the lumbar region.
At the present time, October 1907, sensations of pain and
temperature are diminished, but not lost, over the outside of
each leg below the knee, and on the dorsum and sole of each
foot, especially on the right side, and are normal on the inner
side of each leg and back and front of each thigh. Tactile
sensation is normal in the lower limbs. The patellar reflex is
present on each side, but much diminished, and is shown only
by contraction of the quadriceps muscles. The Achilles tendon

ABSTKACTS

reflex is nearly normal on the right side, but is very weak on
the left side. Complete foot-drop is present on each side.
Babinski’s sign is not present on either side. The flexors on
the back of the thighs are a little weak. The functions of
bladder and rectum, and of the sexual organs, are not impaired.
Sensation about the anus and down the back of each thigh is
intact.

I call attention to the preservation or even exaggeration of
the Achilles tendon reflexes in certain cases presenting the
epiconus symptom-complex. It may indicate that the centres
for these reflexes are at a higher level. Exaggeration of tendon
reflexes from a lesion below the reflex arcs I have seen
repeatedly.

abstracts

ANATOMY.

THE RETICULAR APPARATUS OF GOLGI-HOLMGREN
(54) STAINED BY NITRATE OF SILVER. (L’appareil riticu-
laire de Golgi-Holmgren colord par le nitrate d’argent.) S. K.

Cajal, Trav. du IjaJbor. de Recherches Biol., T. v., F. 3, 1907,
p. 151.

Cajal has recently, by his new silver method after previous fixation
with formalin, succeeded in staining the Golgi-Holmgren reticulum
in the cells of the ganglia of the spinal cord of the newly-born dog
or cat. The reticulum appears as a series of intercommunicating
tubes with dilated portions alternating with segments so thin as
to be almost imperceptible. The network is found fairly uniform
throughout the whole of the cell-body, and for a short distance into
the dendrites. The structure of the reticulum varies with different
kinds of cells, being specially extensive and complicated in the large
motor cells. The fibres, especially in the dilated parts of the reticu¬
lum, show a pale, almost homogeneous, slightly stained part in the
interior, with a marginal layer more deeply stained and of a granular
appearance.

Cajal interprets this as a channeled system filled with some
coagulated substance which has a faint attraction for colloid silver.
He regards the apparatus described by Golgi and that of Holmgren
as being identical.

ABSTRACTS

The reticulum is found in every kind of nerve cell, and even in
the ependymal epithelium. The differences in staining seem to
show that the chemical properties of the reticulum are not absolutely
identical in all vertebrata.

Alexander Bruoe.

ON A NEW ORIGIN OF THE PEDUNCULAR BUNDLE OF
(55) TURGK. (Sopra una nuova origins del fasdo peduncolare del
Tiirck.) Pusateri, Riv. Hal. di Neuropatol., Psichiat. ed
Elettroter ., Vol. i., F. 1, p. 29.

In the examination of a case of softening in the median, and to
some extent in the anterior part of the second and third temporal
convolutions, Pusateri found a degeneration of the bundle of Tiirck.
He argues, not very convincingly, that this case shows a wider
origin for the bundle than that given by Dejerine, viz., the median
part of the second and third temporal convolution.

Alexander Bruce.

A NEW SELECTIVE STAIN FOR THE NERVOUS SYSTEM.

(56) (Eine neue elektive Nervensystemf&rbung.) Ren£ Sand, Arb.
a. d. Neurol. Instil, a. d. Wien. Univ., Bd. 15, Teil 1,1907, p. 339.

For this modification of the silver method the author claims cer¬
tainty and constancy of results with both normal and pathological
material. The staining is not done en bloc, but on paraffin sections;
and further, the method of fixation is such that sections from the
same block can be stained by Nissl’s method, and by selective stains
for leucocytes, connective tissue or neuroglia, or by general stains
such as hsemalum, carmine, etc.

The method for impregnating the axis cylinders is as follows :—

Pieces of tissue to be obtained as fresh as possible and not over
5 mm. thick.

Fix in a mixture of pure anhydrous acetone 90 c.c. and con¬
centrated pure nitric acid 10 c.c. for forty-eight hours, the mix¬
ture being changed after one, four, and twenty-four hours.

Transfer to pure anhydrous acetone for six to eight hours,
changing three times. Then place directly in a paraffin bath at
50° C. for two hours, changing twice.

Sections of 10 fx fixed on slide with albumen, cleared successively
with xylol and acetone, and placed directly in 10 per cent, freshly
prepared silver nitrate solution for twenty-four hours, in oven at

ABSTRACTS

30°-38° C. Then prepare the following solution:—To 50 c.c. 10
per cent, fresh watery silver nitrate solution add strong ammonia
until the ppt. which is formed is just dissolved and no more. The
sections, which should be still uncoloured or only faintly yellow, are
washed for a second or two in distilled water and put in the
ammonic-silver solution for forty-eight hours, till distinctly grey-
brown in colour.

Wash thoroughly in distilled water.

Tone for five to ten minutes till steel-grey in colour in the
following bath :—3 c.c. 1 per cent, gold chloride solution, 17 c.c.
2 per cent, ammonium sulphocyanide solution, 80 c.c. aq. distill.

Wash in water.

Flush for fifteen secs, with 5 per cent. sod. hyposulphite solu¬
tion. Wash very thoroughly in distilled water, pass through aloohol
or acetone, mount in balsam in xylol.

The sections should be free from all precipitate; the axis cylinders
impregnated grey to black; glia and connective tissue slightly
greyish but transparent; elastic fibres and muscle fibres impregnated
like the axis cylinders, but not so deeply. Nuclei are faintly
stained. Nerve cells are grey, and their fibrillary reticulum is often
well brought out. The neurofibrillsB and fine unmedulla ted fibres
are not stained by this method.

The paper also gives shortly the other selective stains which may
be applied to sections fixed by this method.

J. H. Harvey Pirie.

PHYSIOLOGY.

A CONTRIBUTION TO THE STUDY OF THE RELATION
(57) BETWEEN LABYRINTH AND EYE. (Beitrag zur Lehre
von der Beziehung zwischen Labyrinth und Auge.) C. Biehl,

Arb. a. d. Neurol. Instil, a. d. Wien. Univ., Bd. 15, Teil 1, 1907.

It is now sufficiently established that various conditions of the
labyrinth, as well as stimulation of that organ, have influence on the
position and on the movements of the eyes. The question on
what special functions of the ocular muscle the influence is exerted
remains unanswered.

In the author’s own experiments, attention was chiefly directed
to a sign which should be known as the H. Hertwig Majendie squint
position. This consists of a vertical divergence and of an associated
lateral turning of the eyeballs.

The object of the investigation was to study the results of
stimulation and division of the vestibular nerve isolated at the base
of the brain, with special reference to the effects on the oculomotor

ABSTRACTS

apparatus and by means of the resulting nerve degeneration to
trace the course of the vestibular fibres.

The experiments were made on sheep. Eleven sheep were chosen
aged about four weeks. They were allowed to live for not more
than twenty-eight days after the operation.

The effects of stimulation were remarkably uniform; first,
horizontal nystagmus towards the same side was induced, followed
rapidly by an associated change in the position of both eyes, namely,
a lateral turning to the same side and also a vertical divergence,
the eye on the operated side being raised and on the other lowered.
After division of the nerve the nystagmus continued or almost dis¬
appeared, but the eyes took up an exactly opposite position—a
typical H. Hertwig Majendie squint—namely, lateral turning to
tire opposite side and vertical divergence with lowering of the eye
on the side of the operation and raising of the other eye. This
sometimes reached a very marked degree. These appearances
rapidly passed off and disappeared entirely within a week.

The results of the microscopical investigation were similar to
those obtained by Ramon y Cajal and Held.

The rest of the paper is devoted to a discussion of the physio¬
logical significance of the innervation of the labyrinth to vertical
divergence. W. G. Porter.

80MB OBSERVATIONS ON THE BEHAVIOUR OF THE AUTO-
(58) MATIC RESPIRATORY AND CARDIAC MECHANISMS
AFTER COMPLETE AND PARTIAL ISOLATION FROM
EXTRINSIC NERVE IMPULSES. B. G. N. Stewart, Armr.
Joum. Physiol., Vol. xx., 1907, p. 407.

Both vagi were divided in dogs, cats, and rabbits simultaneously or
at different times, and the effects on the cardiac and respiratory
rhythms observed. The ratio of pulse rate to respiratory rate,
which is at first much increased through quickening of the heart
and slowing of the respiration, tends to diminish as time goes on,
the change being due to a fall in the pulse rate, the rate of respiration
in the great majority of cases showing no tendency to increase.

The author believes that when all its afferent channels are cut
off, the respiratory centre discharges impulses automatically at the
rate of about four per minute. This has been studied mainly in the
cat, and it appears to be remarkably constant not only in different
individuals of the same species, but also in the different mammalian
species investigated.

The existence of accelerator fibres in the vagus of the dog was
clearly demonstrated in many of the experiments.

Sutherland Simpson.

ABSTRACTS

ON THE AFFINITY OF THE SPINAL CORD FOE STRYCHNINE
(59) AND COCAINE. (Ueber die Entgiftung von Strychnin nnd
Kokain durch das Riickenmark.) B. T. Sano, Arch. /. d.
gesam. Physiol., Bd. 120, H. 6, 7, 8, 9, 1907, S. 367.

The power of the different parts of the spinal cord to combine with
strychnine and cocaine has been investigated by the author. The
white matter possesses this property in a higher degree than the
grey matter. The anterior part of the grey substance has a greater
affinity for strychnine than the posterior part, and vice versa for
cocaine. The behaviour of the different regions of the cord in their
affinities for these substances has no relationship to the blood supply.
The general morphological and functional characters of the cell
elements of the grey matter have a chemical basis, and this chemical
differentiation probably also extends to the nerve fibres taking
origin in these cells.

Sutherland Simpson.

ACTION OF ACONITINE ON NERVE FIBRES. By A. D. Waller
(60) ( Proc. Physiol. Soc.), Joum. Physiol., Nov. 29, 1907, p. xxx.

The author finds that this substance has an action on nerve fibres
as well as on nerve endings. Even 1 in 100,000 injected sub¬
cutaneously in a frog is sufficient to abolish the negative variation
in the nerve fibres.

Sutherland Simpson.

THE RELATION OF AFFERENT IMPULSES TO FATIGUE OF
(61) THE VASOMOTOR CENTRE. By W. T. Porter, H. K.
Marks, and J. B. Swift, Amer. Joum. Physiol., Vol. xx.,
1907, p. 444.

The authors attempted to fatigue the vasomotor centre, in
anaesthetised or decerebrate cats, dogs, and rabbits, by the stimula¬
tion of afferent nerves for prolonged periods, but were not successful.
At the end of a three hours application of the interrupted current
to the posterior root of one of the lumbar nerves, e.g., there was
only a slight fall in the general blood pressure—no more than in a
control animal (cat) subjected to the same manipulations except
stimulation of the nerves.

Sutherland Simpson.

ABSTRACTS

PATHOLOGY.

DEGENERATION AND REGENERATION OF THE END-PLATES
(62) OF MUSCLE AFTER SECTION OF THE NERVES. (D4-
g&idration et R6g6n4ration des Plaques Motrices aprds la
Section des Nerfs.) Tello, Trav . du Labor , de Reeherehes Biol.,
T. v., F. 3, 1907, p. 117.

Tello has studied this question principally in the rabbit, the lizard,
and the frog, by means of the silver method after previous fixation
with ammoniated alcohol, using pyrogallic acid and formalin as
the reducing agents. The chief conclusions from his work, which
is not yet finished, are :

(1) That the peripheral part of a divided motor nerve and its
termination in the muscle begin to degenerate in twelve to fourteen
hours after section, and continue doing so until all the remains of
the degenerated fibres are absorbed. Absorption in the end-plates
is completed in two and a half days, and in the nerve fibres in from
two or three days to a month or more.

(2) The phases of the degeneration of the nerves and end-plates
are hypertrophy of the terminal arborisations and the neuro-
fibrillae, excessive staining of the interfibrillary plasmatic substance
with granular appearance of the argentophile substance, decom-

C 'tion of this into granules, and ultimately fragmentation of the
iches.

(3) All the detritus of the plaques is removed, perhaps by diges¬
tion of the granular substance and nuclei; that m the end-plates
by the cells of Schwann.

(4) Certain fibres, which may survive forty-eight hours, show in
the end-plates a return to the embryonic condition, and consequently,
instead of disintegrated branches, show a terminal sphere, which is
destroyed later.

(5) In cold-blooded animals the degeneration is more delayed.

(6) The regenerating fibres which start from the central end
commence to reach the muscle almost two and a half months after
the operation in rabbits of two to three months old, and a month
or a month and a half after section in new-born rabbits.

(7) The regenerated fibres enter the old nerve tubes, probably
attracted by the positive chimiotactic substance produced by the
cells of Schwann. These fibres always terminate in clubs.

(8) The young fibres divide at several different parts of their
course and form a large number of daughter-fibres, which sometimes
separate and continue their course in different tubes, but they
frequently follow a long course within the same sheath. Ultimately
they cease to be invested by a sheath, and come into contact with

ABSTRACTS

muscular fibre, in which they terminate by a bud, in the substance
of which the arborisation of the end-plate is produced.

(9) Each new fibre gives origin to a large number of plates,
either collateral or terminal, which confirms the fact that only a
small number of nerve tubes reach the muscle, and that this Bmall
number is supposed to innervate the whole of the muscle fibres.

(10) The nuclei and the already existing plates are conserved
with unimportant variations, and they attract by chimiotaxis
one of the newly-arrived fibres of the motor nerve. When the
terminal bud has reached the granular substance, it divides into an
increasingly complicated ramification.

(11) Some fibres, before coming into contact with the correspond¬
ing plates, turn backwards within their guiding sheaths, sometimes
within the same sheath of Henle, sometimes following a more com-

E licated course. This uncertainty of path of the fibres is explained
y the abundance and complexity of the chimiotactic currents.

Alexander Bruce.

ON PATCH? ATROPHY OF THE MEDULLARY SHEATHS IN
(63) THE CORTEX OF GENERAL PARALYTICS. (Ueber den
fleckweisen Markf&serschwund in der Himrinde bei pro-
gressiver Paralyse.) 0. Fischer (of Prague), Arb. a. d.
deutschen psych. Univ.-Klinik im Prog, 1908.

Tuczek and subsequent observers demonstrated in the cortex
of general paralytics a fairly diffuse affection of the medullary
sheaths, which is especially well marked in the outer layer. In
1899 Siemerling called attention to the presence in three cases of
general paralysis of perivascular foci of absence of the medullary
sheaths; similar communications followed. Fischer in this article
gives the results of his studies of these patches of disappearance of
the medullary sheaths in great detail; his material consisted of
forty-three cases of general paralysis, and of fifty-seven other
brains; the method of serial sections was employed. In 65
per cent, of the cases of general paralysis these patches were
present; in 35 per cent, none were found. In none of
the cases except those of general paralysis were these patches
observed. Histologically they are quite different from the light
patches seen in senile brains. They cause no secondary
degeneration, as the axis cylinder is not affected. The patches are
therefore similar to the foci in disseminated sclerosis, but present
no inflamm atory reaction and much less glia reaction than the latter.
This atrophic condition of the medullary sheaths shows no relation
to any special inflamma tory reaction; the author uses this to support
the view that the parenchymatous degeneration and the inflamma-

ABSTRACTS

tory element in the picture of general paralysis are two independent
processes. The atrophy of the medullary sheaths in the special
patches is similar in nature to the diffuse medullary atrophy in the
cortex and represents therefore merely a special localisation of the
morbid agent. There is no question of the foci being artefacts,
as they are in certain cases visible in the fresh unfixed brain.

The article is illustrated by eighteen excellent figures.

C. Macfie Campbell.

A STUDY OF THE NEUKOFIBRILS IN DEMENTIA PARA
(64) LYTIOA, DEMENTIA SENILIS, CHRONIC ALCOHOLISM,
CEREBRAL LUES, AND MIOROOEPHALIO IDIOCY. S. C.

Fuller (of Westborough, Mass.), Amer. Journ. of Insan.,
April 1907.

A careful study has been made of the cerebral cortex in fifty-
four patients dying insane at the Westborough Insane Hospital.
The paper is illustrated with thirty excellent plates. The author
emphasises the extreme importance of caution in the interpretation
of the alterations in neurofibrils in material from pathological
sources. He believes, however, that pathological changes may be
demonstrated in the neurofibrils of the cerebral cortex in all
persons dying insane.

His conclusions are:—(1) The alterations in the neurofibrils
taken alone have no more value for diagnostic purposes than the
mere disintegration of the tigroid masses in a Nissl preparation.
(2) Poverty in cell processes, the more or less universal tinging of
the nucleus, and destruction of the finer intercellular fibrils,
characterise the silver impregnation of the dementia paralytica
cortex; fair preservation of the dendrites and an equally diffuse
destruction of intercellular fibrils, but without special preference
for the finest elements, is the rule in dementia senilis. (3) The
alterations in the remaining groups of cases reported suggest that
these changes may be due to a variety of causes, such as oedema,
faulty nutrition or development, and the direct action of intoxica¬
tions introduced from without. (4) Alterations in the neurofibrils,
such as granular disintegration, fragmentation, localised swellings,
rarefaction, and complete destruction were to be found in varying
stages of intensity in all of his cases. (5) Just as the ensemble in
a Nissl preparation is of value in determining dementia paralytica,
or in distinguishing a luetic meningeal or perivascular infiltration,
in almost to the same degree may the sum of the findings in a
silver preparation for neurofibrils be employed in making an
anatomical diagnosis of dementia paralytica, or in differentiating
it from a disease with a dystrophic substratum, such as senile
dementia. C. H. Holmes,

ABSTRACTS

CLINICAL NEUROLOGY.

ALCOHOLIC NEURITIS. (NSvrite alcoolique.) Babinski (of
(65) Paris), Jour, des Prat., No. 47, Nov. 23, 1907.

A man, fifty-four years of age, waiter in a cafe, presented a series of
mental, sensory, and motor symptoms, which might possibly have
been taken as indicating the presence of tabes, complicated by
general paralysis.

Careful examination showed the incorrectness of such a diag¬
nosis, for while the patient suffered from loss of memory and intel¬
lectual weakness, with mental confusion, the disturbances of speech
peculiar to general paralysis were absent, and the wavering memory
was subject to complete returns. Further, the recollections of recent
date were alone lost, whereas these persist in general paralysis. The
psychic troubles were simply of alcoholic origin.

The patient had had syphilis: but in considering the question
of the presence of tabes one noted that such pains as the patient
suffered from were different from the lightning pains of that disease.
Further, the muscles of the calf were tender when pressed, and the
passage of an electric current through them caused sharp pains—
not as obtains in tabes, where neither pressure nor the electric
current cause pain. The disturbances of tactile and deep sensi¬
bility, frequent in tabes, were here absent. Also the muscular
force was affected. In walking the foot was raised with difficulty,
and allowed to fall in stepping on account of the muscular atrophy
on the anterior aspect of the limb. The pupils and sphincters were
unaffected.

The symptoms were purely toxic in origin, alcoholism
producing a peripheral neuritis with mental confusion. The
diagnosis in such cases is of course of great importance from the
point of view of prognosis.

A. Hill Buchan.

ANTERIOR POLIOMYELITIS IN THE ADULT, WITH ILLUS-
(66) TRATIVE OASES. G. L. Walton, Boston Med. and Surg.

Journ., Nov. 28, 1907, p. 719.

In this paper short notes are given of ten typical cases of acute or
sub-acute anterior poliomyelitis in young adults. The author
emphasizes the fact that the disease is essentially the same as in
children, although the onset of paralysis is usually more retarded,
and the extension of paralysis from one group of muscles to another
is less immediate. The real seat of infection is apt to be obscured
by temporary symptoms pointing to the meninges ; the implication

ABSTRACTS

of which, he thinks, is probably independent, not an extension from
the cord substance. The prognosis for recovery seems better than
in children ; in four of these cases it was practically complete.

J. H. Harvey Pirie.

ACUTE POLIOMYELITIS AND ALLIED DISEASES. (Akute
(67) Poliomyelitis und verwandte Krankheiten.) Harbitz and
Scheel, Deut. med. JFoch ., Nov. 28, 1907, p. 1992.

The authors of this paper have made a full anatomo-pathological
study of seventeen cases occurring in Norway, during the epidemic of
1903-6. Thirteen of these cases died during the acute stage of the
illness, four subsequently. Ten cases were children, the remainder
young adults. They did not confine their investigation to the spinal
cord, but made a comprehensive survey of the whole nervous system.
They conclude that in fatal cases inflammatory poliomyelitis is
found to extend over the whole cord, medulla and pons as well as the
greater part of the brain. Probably the same holds good for non-
fatal cases. There is always also some meningitis, and indeed this
is primary, the inflammation extending inwards from the pia along
the sheaths of the vessels. When the inflammation is marked in
various parts, then we get clinical types which are no longer classi¬
fied under acute poliomyelitis, but are really the same disease.
Transitional types may be seen between poliomyelitis and bulbar
paralysis, meningo-encephalitis and transverse myelitis. No
transition to polyneuritis or epidemic cerebro-spinal meningitis
has been observed.

The microscopic appearances described, beyond the extent over
which they occur, are familiar, and need not be detailed. No
organisms were found.

J. H. Harvey Pirie.

AMYOTROPHIC LATERAL SCLEROSIS, WITH HEMIPLEGIC
( 68 ) ONSET, IN A BOY OF SIXTEEN. (ScWrose laterals
amyotrophique, h dlbut h6mipl6gique chez un sujet de 16
ans.) Bouchaud, Joum. de Neurol ., d^c. 5, 1907, p. 465.

Author describes a case in a boy of sixteen, in which there was a
somewhat rapid development of atrophy on the left side, especially
in the upper limb, associated with an exaggeration of tendon reflexes
on the same side. As the condition is associated with some sensory
phenomena, it is doubtful if it can be regarded as a pure case.

Alexander Bruce.

100

ABSTRACTS

PRURITUS IN TABES. (Pruritus bei Tabes.) Gunzburger,

(69) Miinch. Med. JFchn, Dec. 31, 1907, p. 2642.

The recent discussion on this subject at the Soc. med. des Hop.
(v. Rev. of Neurol., Dec. 1907, p. 909) reminds Gunzburger of a case
that occurred in his own practice two years ago. His patient
suffered, especially at night, from severe pruritus, which was most
marked in the lumbar region. Treatment for scabies afforded no
relief. There were no other subjective disturbances. Examination
revealed complete absence of the knee-jerks, the presence of
Romberg’s sign and reflex iridoplegia. The patient, in fact, had
suffered from tabes for years without knowing it. Giinzburger
concludes that in every case of pruritus the reflexes as well as the
urine should be tested. J. D. Rolleston.

CASE CONTRIBUTION ON SKULL INJURIES. (Beitrag zur

(70) Kasuistik der Sch&delverletzungen - Basisfraktur, Oontusio
cerebri, traumatische Epilepsie and Demenz; aphasische
Symptome.) G. Ackermann, Moiuitsschr. f. Psychiat. u. Neur.,
Bd. 22, Erganzungsheft, S. 1.

This is a full description of a case with a few lines of comment
thereon. The main phenomena are sufficiently indicated in the
title; a transitory right hemiplegia also occurred. The accident
took place during the convalescence from a septicjemia.

Ernest Jones.

STUDIES IN MENINGOCOCCUS INFECTIONS. D. Davis, Journ.

(71) Infect. Dis., Nov. 15, 1907.

Davis has made a very thorough study of eleven cases of cerebro¬
spinal meningitis, which were apparently sporadic in nature. He
was fortunate enough to find the meningococcus in the blood of two
out of nine cases examined. The two positive cases were in the first
four days of their illness, and Davis thinks it probable that systematic
cultivation of large quantities of blood at this early period of the
disease would probably frequently give positive results. In one
of these cases the meningococcus was isolated from the nasal mucus,
the discharge from the eyes, and the cerebro-spinal fluid as well as
from the blood, yet in spite of this very marked and general in¬
fection the patient made a good recovery.

As regards the path of infection Davis is inclined to favour the
theory that the infection is taken originally into the nose and mouth.
This view does not necessitate the adoption of the opinion that
thence the meningococcus penetrates to the meninges through the

ABSTRACTS

101

base of the skull. We only have to assume it enters the lymph or
blood stream and localises itself in the cord and brain, just as the
cholera organism selects the intestine. Davis does not think the
infection is gastro-intestinal in origin, believing the micro-organism
too sensitive to acids to make such a path of infection probable.
In favour of the other route he instances cases in which the meningo¬
coccus was found in the blood before any cerebro-spinal symptoms
occurred. It is possible, then, that localisation of the organism
occasionally fails to ensue.

In 200 examinations of the nose and throat of 150 normal
persons, Davis failed to find the meningococcus. So, although
the carrying of infection by contacts is admitted, how are we to
explain sporadic cases occurring at long intervals ? Normal people
do not apparently harbour the germ when there is no epidemic, and
the difficulty is increased when we remember that the meningococcus
is short-lived and difficult to cultivate. The only suggestion, and
that a purely theoretical one, is that the Gram negative diplococci,
which superficially resemble the meningococcus, but which cultur¬
ally are distinguishable from it, and which are found in normal
noses and throats, may under certain circumstances become modified
and acquire the characteristics of the meningococcus.

Davis also made interesting experiments on the agglutinins of
the disease. Eight cases were examined. All gave positive re¬
actions with a 1-50 dilution sooner or later in the course of their
illness. The highest dilution with which a positive reaction was
obtained was 1-500, and this was at the end of the fourth week of
the disease. The phenomenon is not to be expected till the end
of the first week, when it may occur in 1-25 dilution. The
agglutinins are thermostable, resisting 65° C. for one hour. They
are not contained to an appreciable amount in the cerebro-spinal fluid.

Defibrinated meningitis blood rapidly killed meningococci
introduced into it, plates being usually sterile in three hours. The
number of leucocytes in the blood made no difference to the rapidity
of their destruction. Again, with a normal blood, in which the
meningococci rapidly multiplied, killing the leucocytes by heat
made no difference to the rapidity of their multiplication. Opposed
to these destructive processes there are other elements in the blood
which favour growth, as, while the meningococcus will not grow in
cerebro-spinal fluid, its growth is facilitated if red corpuscles are
added to the mixture.

Davis in a previous paper reported that he had found but little
opsonic activity in cerebro-spinal meningitis. He now admits
that there is more phagocytosis in meningitis blood than in normal
blood. Much would appear to depend on the strain of meningococci
employed. On the whole the patient in the fourth week of the
illness shows a marked increase m opsonic power.

ABSTRACTS

102' ‘

Further experiments were made to note the effect of the injection
of the meningococcus into animals and man. Davis, like other
observers, found that the organism has very little virulence for
animals if injected subcutaneously or intravenously. Intra-
peritoneal injections, however, killed a high proportion of small
animals in about twelve hours. Flexner’s plan of intra-lumbar
injection does not appear to have been attempted.

Two patients were injected with cultures killed by heat. The
first, treated with this vaccine in the sixth week of the illness, re¬
ceived the scrapings of several serum cultures in 3 cc. of salt solution.
No subjective symptoms followed. There was, however, some local
irritation at the seat of injection. Some days later a second injec¬
tion was given and was followed by a small sterile abscess. A
leucocyte rise occurred after each injection to fall to normal in
about three days. The reaction after the second injection was more
marked. The temperature fell about two days after this, and
remained steadily normal, the patient making an uninterrupted
recovery. The second patient received only one injection with no
immediate result but a mild local reaction. A rise of temperature
and some leucocytosis occurred two days later. Thereafter the
patient became worse and died five weeks after injection in the
tenth week of the disease.

The most striking of all the results obtained by Davis is the
effect of an injection of a similar sterilized culture administered to
himself. Immediately there was local irritation and smarting pain.
In twenty minutes he was seized with nausea and vomiting. Ten
minutes later he had a rigor lasting half an hour. Thereafter
headache, muscular pain, purging, and vomiting. In three hours
from the injection his temperature was 103° F. The vomiting
continued throughout the night, accompanied by marked prostra¬
tion. Next day there was some improvement. A diffuse rush, but
no haemorrhages, appeared all over the body. Temperature varied
from 101° to 102° F. The face was flushed and there was some
stupor. On the following day the temperature was a little lower,
the rush disappeared. On the fourth day herpes appeared on lips,
eyelids, and palate. From this point onwards there was improve¬
ment, although it was a month before the evening temperature
was steadily normal. The fever was accompanied by a steady rise
in the number of leucocytes and in the opsonic index.

Davis concludes, then, that patients suffering from cerebro¬
spinal meningitis acquire immunity slowly. If a vaccine is to be
given early in the illness only small doses should be employed, and
these may be gradually increased. Injections, judging from the
opsonic and leucocyte curves, may be given at intervals of from
six to eight days. Something is to be hoped from treatment on such
lines. Claude B. Ker.

ABSTRACTS

103

CEREBRO SPINAL MENINGITIS. Cantley, Brit. Journ. Child.

(72) Dis., Nov. 1907.

Cantley gives an interesting analysis of 125 cases of meningitis
observed by him. Of these 71 were tubercular, 36 cerebro-spinal,
11 pneumococcal, while 5 were due to ear disease. In reference to
the latter he considers that the importance of ear inflammation as
a source of meningitis in early life has been much exaggerated.
Sometimes the ear trouble found in such cases is merely a part of a
general infection and is in no sense causative. On other occasions
the ear infla mm ation may be due to extension from the inflamed
meninges. As regards mortality the tubercular cases were the most
fatal, and, as we would expect, the cerebro-spinal ones the least so.
Ten out of eleven pneumococcal cases succumbed.

Age is of some importance in diagnosis. If meningitis occurs in
the first six months of life it is probably not tubercular. In the
second six months, not more than one-third of the cases are tuber¬
cular. After the first year is over, the vast majority of the cases
are tubercular. In cerebro-spinal fever, vomiting and diarrhoea
are more common than in the tubercular type and the pulse is more
rapid.

Severe sporadic cases of cerebro-spinal meningitis may occur
with haemorrhages and other acute symptoms which render these
indistinguishable from the epidemic form. On the other hand,
during epidemics cases conforming to the post-basic type of menin¬
gitis often occur. There is no dividing line. Cantley, like Osier,
compares outbreaks of cerebro-spinal fever to those occasions where
pneumonia appears to take on an epidemic form.

Claude B. Ker.

'HERPES IN CEREBRO-SPINAL MENINGITIS IN CHILDREN.

(73) (L’erpete nella meningite cerebro-spinale nei bambini.)

Gioseffi, Riv. di Clin. Pediatr., Nov. 1907, p. 920.

A boy, aged eight months, was admitted to hospital on the third
day of an attack of cerebro-spinal meningitis. Some vesicles were
present at each internal canthus and on the left cheek. Lumbar
puncture performed the same day revealed markedly turbid fluid
containing almost exclusively polymorphic leucocytes, and many
intra- and extra-cellular diplococci which on culture proved to be
meningococci. On the following days the child got worse, and the
herpetic eruption became much more extensive. Fresh vesicles
appeared almost every day, covering the right ala nasi and bridge
of the nose, the right cheek, temple, and upper lip. The mucous
membranes were also invaded. The vesicles spread along the right
side of the tongue to the tip ar.d covered the hard and soft palate.

104

ABSTRACTS

Both eyelids were also affected. Some vesicles formed on the
cornea, and as they desiccated left small opacities. Finally the
meningeal symptoms increased, pneumonia developed, and death
took place withm ten days of the onset.

J. D. Rolleston.

THE TREATMENT OF EPIDEMIC CEREBRO SPINAL MENIN-
(74) GITI8. (Zur Therapie der Meningitis cerebro-spinalis epi-
demica.) Tobben, Miinch. Med. fVchn., No. 49, p. 2420.

Op 66 cases of epidemic cerebrospinal meningitis 31 died, a mortality
of 47 per cent. Thirty-seven of these were treated bylumbarpuncture
only with 21 deaths, a mortality of 56’7 per cent. Lumbar puncture
was adopted first for diagnostic purposes, and was afterwards
repeated for increase of pyrexia, severe headache, vomiting, or
somnolence ; 25-60 c.c. were withdrawn. The amelioration produced
by lumbar puncture was often striking, though it was difficult to
determine whether it had a curative effect on the disease. The
remaining 29 cases, which were treated with both lumbar puncture
and Kolle-Wassermann’s serum, furnished a mortality of 34'5 per
cent. (10 deaths). The earlier the serum treatment was adopted,
the better the result. Among 12 first or second day cases, there
were two deaths (16*6 per cent, mortality). Among four third or
fourth day cases, there was one death (25 per cent, mortality).
Among the 7 fifth to seventh day cases, there were three deaths (42*9
per cent, mortality). Among the six cases on which treatment was
started on the eighth day or later there were four deaths (66 6 per cent,
mortality). Serum rashes occurred in 3. Children under 3 received
5 c.c., older children 10 c.c., and adults 30 c.c. The doses were re¬
peated as occasion demanded. J. D. Rolleston.

ON THE DIAGNOSIS OF THE SYPHILOGENOUS DISEASES OF
(75) THE CENTRAL NERVOUS SYSTEM IN THE EARLY
AND ADVANCED STAGES. (Ueber die Diagnose und
Friihdiagnose der syphilogenen Erkrankungen des zentralen
Nervensystems.) W. Erb, Deutsche Zeitsch.f. Xervenheilk., 1907,
p. 425.

The intimate causal connection between syphilis and tabes is now
almost universally recognised, but there are still numerous problems
awaiting solution. Erb here discusses the diagnosis of incipient,
incomplete, or abortive forms of tabes.

Firstly, as to the significance of loss of the pupillary reflex to
light, whilst Babinski and other French authors regard it as a sign

ABSTRACTS

105

merely of antecedent syphilis, Moebius regarded it as an indication
of incipient tabes. Erb recounts a series of seven cases in which for
a long time, sometimes as long as twenty years, the Argyll-Robertson
phenomenon was the only pathological sign present, but in which
other symptoms of tabes subsequently developed. He also gives
particulars of eight cases in which the Argyll-Robertson phenomenon
has been present for periods varying up to twelve years, without any
other evidence of tabes. In two of these cases the cerebro-spinal
fluid was examined and found normal (one of them, however, had
absence of all the deep reflexes). Erb concludes that whilst the
Argyll-Robertson pupil by itself is highly suspicious of incipient
tabes, it is not conclusive, and we must be on the alert for other
evidence, such as hypsesthesia and hypalgesia of radicular distribu¬
tion, excessive sensitiveness to cold on the trunk, paraesthesise of
the genitals or in the ulnar area, etc., also various “crises,” minor
degrees of ataxia and of hypotonia, together with the condition not
merely of the knee-jerks, but also of the ankle-jerks and of the deep
reflexes of the upper limbs.

He agrees as to the immense diagnostic value of examinationof the
cerebro-spinal fluid, especially its cytological examination. Lympho¬
cytosis is present in upwards of 95 per cent, of cases of tabes. This
lymphocytosis he believes to be due to meningeal irritation, syphilitic
in origin, whether diffuse or localised. But whilst the occurrence
of lymphocytosis is strong evidence of previous syphilitic infection,
its absence does not absolutely exclude syphilitic disease of the
central nervous system.

The three clinical phenomena of Argyll-Robertson pupil, tabes,
and lymphocytosis may all co-exist, but they often occur separately
and appear at different stages, or any two of them may occur without
the third. These different combinations, he concludes, can only
be explained on the common etiological basis of antecedent syphilis.
Erb warns against the error of regarding lymphocytosis as patho¬
gnomonic of central syphilis, and recounts two cases—one of glioma
of the crus cerebri, the other of cervical carcinoma—in which lympho¬
cytosis was well marked.

Lastly, he refers to the observations of Wassermann, Neisser,
Plaut, and others on the sero-diagnosis of syphilis, by examination
of the blood-serum or cerebro-spinal fluid. In syphilitic diseases
a specific sero-diagnostic reaction is present, and specific anti-bodies,
if demonstrated in the serum or cerebro-spinal fluid, are practically
conclusive as to the syphilitic nature of the case. The almost con¬
stant presence of such anti-bodies in tabes and in general paralysis
is strong confirmatory evidence of the syphilitic origin of these two
affections. Unfortunately the technique of these observations is
very complicated.

Purves Stewart.

106

ABSTRACTS

ON THE SYMPTOMATOLOGY OF ATROPHY OF THE OCCIPITAL
(76) LOBE. (Zur Symptomatology des atrophischen Hinter-
haoptslappens.) A Pick (of Prague), Arb. a. d. deulsch. psych.
Univ.-Klinik in Prog , 1908.

The author reports the case of a man of seventy-five, with a charac¬
teristic senile mental disorder, and in whose physical condition apart
from the ordinary senile changes and well-marked impairment of
gait there was nothing to notice except a very interesting visual
disorder. Post-mortem the brain showed a simple senile atrophy,
which was especially well marked in the frontal and occipital lobes ;
there was no focal lesion in the more limited sense of the word.

The visual disorder consisted in frequent mistakes in the naming
and perception of objects. There was no diminution of visual
acuity, no disorder of colour sense, no limitation of the field of
vision, no impairment of stereoscopic perception; the sensation
of direction was also intact. There was no aphasia, but merely
a slight verbal amnesia ; no symptoms of apraxia were observed.
The patient perceived quite well the part of an object in the centre
of the field of observation, but was unable to synthetize it with the
impressions from the periphery of the field into the perception of
the total object. If the object were small the visual perception
of it was possible; but if it were large, the patient made glaring
mistakes, e.g. if shown a picture of a man’s head larger than life
size, he could name the eye or mouth correctly, but could not grasp
the picture as a whole ; if asked to point out certain features he
would be correct with some, but with others would place them
in quite absurd positions. He was very conscious of his inability,
and frequently arrived at the correct conclusion by a process of
reasoning rather than by one immediate act of perception. On the
face of a large clock he lost his bearings, although he could immedi¬
ately give a theoretical description of the position of the various
hours. A second element in his disorder of visual perception was
seen in his behaviour when an object, seen and recognised, was
removed to a further distance or replaced by another ; he persisted
in groping for the distant object and in perseverating with the
name of the first object.

The author considers that the disorder is in the function which
composes the various elements of a visual picture into a unity, the
combining faculty ; he does not think that one is entitled to look
upon it as a disorder of “ secondary identification,” a higher step
in the hierarchy of the apperceptive processes. He correlates the
disorder with the atrophy of the occipital lobe.

Probably many cases of so-called “ mind-blindness ” are really
due to a more elementary disorder than the one usually assumed.
The analysis of the psychological mechanism is interesting, and he

ABSTRACTS

107

supports his views on the anatomo-clinical correlation by the short
report of a second case with focal lesions in the occipital lobes. He
sums up his views in the statement that there exist disorders of
visual perception, which are due to an impairment of the synthesis
of the corresponding visual impressions, and which may be opposed
as a sensory ataxia to the better-recognised motor ataxia.

C. Macfie Campbell.

ON ASYMBOLIA AND APHASIA. (Ueber Asymbolie und Aphasie.)

(77) A. Pick (of Prague), Arb. a. d. deutsch. psych. Univ.-Klinik in
Prag , 1908.

In this review of the subject of asymbolia, Pick endeavours to clear
the ground for the adoption of a uniform nomenclature. Finkeln-
burg had defined asymbolia as the disorder “ owing to which the
power either of understanding or of expressing concepts by means
of acquired symbols is impaired.” Under the influence of Kant’s
psychology he gave as illustrations of asymbolia impairment of
recognition of the environment, of understanding religious and
social forms.

These, however, belong to the sphere of complex mental elabora¬
tion, and Wernicke opposed such an extension of the application
of the term. He limited the term to those disorders which affect
the primary elaboration of the impressions of signs or sense-
qualities of objects—optic, acoustic, etc.; the identification or
recognition of the name of an object he separated from the identifica¬
tion of its other qualities or signs. He thus contrasted aphasia on
the one hand with asymbolia on the other ; asymbolia, thus limited
to a receptive disorder, was practically the same as Freud’s agnosia.
Pick, calling attention to the broad biological principles of human
adaptation to environment, shows that in the mental elaboration
which is one link in any purposeful act of adjustment there may
be both on the receptive and on the emissive side a hitch at that
point, where the utilisation of symbols is a factor in the process;
such symbols may be conventional or non-conventional. On these
general grounds he gives the following classification of the dis¬
orders which may fitly be grouped under asymbolia:—

A. Emissive asymbolie disorders: 1. Motor-aphasic disorders

of speech; 2. motor-agraphic disorders of writing; 3. motor

amusia (musical expression);—(a) vocal, (b) graphic, (c) instru¬
mental ; 4. motor disorders of finger-speech (deaf and dumb

language); 5. motor disorders of gesture ; 6. disorders of ex¬
pression by means of pantomime.

B. Receptive asymbolie disorders: 1. Sensory-aphasic. dis¬

orders of speech ; 2. sensory-aphasic, alexic disorders of writing;

108

ABSTRACTS

3. sensory amusia (auditory and visual); 4. loss of the power of
understanding the deaf and dumb language (?); 5. loss of the
power of understanding gestures ; 6. loss of understanding panto¬
mimic actions.

The author fully realises the difficulty of a satisfactory classifica¬
tion in view of the many transition forms.

C. Macfib Campbell.

ON THE SIMULTANEOUS OCCURRENCE OF ACROMEGALY
(78) AND SYRINGOMYELIA, WITH A DISCUSSION OF THE
QUESTION OF THE OCCURRENCE OF ACROMEGALY
WITHOUT CHANGES IN THE HYPOPHYSIS. (Ueber das
gleichzeitige Vorkommen von Akromeg&lie und Syringomyelie.
Zugleich ein Beitrag zur Frage nach dem Vorkommen von
Akromegalie ohne Ver&nderung der Hypophysis.) Karl
Petr6n, Virchow's Arch. f. Patholog. Amt., Bd. 190, 1907.

The writer has observed a case of acromegaly which, from a
clinical point of view, was quite typical, but post-mortem
presented no sign of a growth in the pituitary fossa. The
evolution of the disease was very slow; death was due to
tubercular pericarditis.

The patient stated that both his grandfathers, as well as some
other members of his family, had shown the same signs of acro¬
megaly as he did. From a trustworthy source it was ascertained
that a brother at least certainly had acromegaly. The writer has
found from a study of the literature that a true hereditary
acromegaly has already been recorded, but this is very rare.

At the autopsy certain anatomical changes characteristic of
acromegaly were found. The bones of the cranium, however, were
almost all very thin, and the foramina of the base of the skull
were generally dilated. It is well known that in acromegaly the
bones of the cranium are generally thickened, but in some cases
the contrary condition has been found in some parts of the cranium,
though not to such an extent as in this case.

There was a very high degree of bathrycephaly. This con¬
dition has already been noted, and is assumed by Launois and
Roy to be characteristic of acromegaly; but, from an analysis of
the literature, the writer demonstrates that this is not so.

In this case the hyphosis was not enlarged, and no microscopical
changes of the gland were found, except a slight degree of sclerosis,
which might arise from the age of the patient (50). The writer,
after analysing all the published cases, finds that in a considerable

ABSTRACTS

109

number of cases in which the diagnosis of acromegaly was quite
certain, the hypophysis was not enlarged. The number of cases
in which microscopical examination of the gland yielded negative
results is not so great, but in recent years especially a number of
such cases have been published (Dallemagne, Mitchell, Huchard,
and Launois, etc.); consequently the doctrine of constant changes
of the hypophysis in acromegaly must now be abandoned.

Examination of the spinal cord revealed an unexpected syr¬
ingomyelia. This had given rise to no clinical symptoms. This
is explained by the site of the anatomical changes which occupied
the region of the central canal and the base of the anterior horns
(the posterior horns being almost entirely free from the disease).
The lesions were most extensive in the third and fourth dorsal
segments, where the anterior horns were almost completely
destroyed. (This, we know, would give rise to no clinical
symptoms).

The syringomyelia had not the usual microscopical appearance,
as a true gliomatous tissue was not found; the affected parts of
the cord contained only epithelial cells similar to those in the
central canal, and fibrous connective tissue, connected with a great
number of markedly sclerosed blood-vessels. The central canal
was enlarged throughout the greater part of the cord, usually in
the form of a narrow transverse slit. In connection with the
central canal were found regular bands of epithelial cells; but the
latter formed for the greater part an irregular mass, without any
evident tissue between the cells.

The author examined the cord from another case of acromegaly
which had Bhown typical signs of a growth in the pituitary fossa.
Operation by Horsley’s method was unsuccessful on account of
haemorrhage. Here also pathological enlargement of the central
canal was found, though slight in degree; also some sclerosis
of blood- vessels in the cord.

The author has gone thoroughly into all the published cases of
acromegaly in which the cord was examined, and has come to the
following conclusions:—

That some changes, such as a slight degree of sclerosis in the
columns of the cord, are of no importance;

That increase of the connective tissue in the cord, found in
some cases, is pathological, but may be explained, like the changes
so often found in other organs, as the result of the acromegaly
itself;

That such nervous diseases as multiple neuritis or meningo-
myelitis, present in isolated cases, must be regarded as accidentally
coinciding with the acromegaly;

That the pathological increase of the epithelial cells of the
central canal is so frequent that it cannot be regarded as merely

110

ABSTRACTS

coincident, but must have a causal connection with the acro¬
megaly. This conclusion is the more inevitable since in the cases
of the writer, of Schulz, of Bassi, of Collier, and perhaps in other
two, a true syringomyelia was present along with the acromegaly.

Schlesinger, in his remarkable work, states that true acromegaly
is never noted along with syringomyelia. The writer’s investiga¬
tions show that this opinion must evidently be abandoned, and
that in some cases there may exist a causal connection between
the acromegaly and the increase of epithelial cells in the central
canal.

The paper concludes with some theoretical considerations.
The possibility is also mentioned that as the increase of the
epithelial cells of the hypophysis may be accepted as the cause of
the enlargement of so many parts of the body in the ordinary
cases of acromegaly, so the increase of the epithelial cells in the
central canal of the cord—in spite of their different embryological
origin—may perhaps be the cause of the enlargement of the distal
parts of one or more extremities, which is so frequently observed
in syringomyelia. Author’s Abstract.

ON THE SYMPTOMATOLOGY AND ANATOMY OF TUMOURS
(79) OF THE PITUITARY DUCT. (Zur Symptomatology und
Anatomie der Hypophysenganggeschwiilste [Erdheim].) E.

Straussler, Arb. a. d. deutsch. psych. Univ.-Klinik in Prog,
1908.

The clinical and anatomical report of a case of tumour of the
hypophysis. The patient was a man of 38, who for many months
suffered from what was diagnosed as neuralgia of the fifth. After
an X-ray examination, the diagnosis of tumour of the hypophysis
was made. At this period, in addition to attacks of headache and
vomiting, there was limitation of the temporal field of vision on
one side; the knee-jerks and Achillis-jerks were absent, but on a
later examination were elicited, although feeble. Trephining
relieved the headache to a certain extent, but otherwise did not
influence the course of the disease. Mentally the patient pre¬
sented disorientation, confabulation, and impaired retention—
Korsakoff’s symptom-complex.

At the autopsy the hypophysis was found to be attached by a
short stalk to a cystic neoplasm; microscopically this consisted
of connective tissue with cavities, the walls of which were lined
with pavement epithelium. The posterior columns of the cord
showed some degeneration. C. Macfie Campbell.

ABSTRACTS

111

ACUTE ATAXIA. (Ueber acute Ataxie.) Bregman. Deutsche
(80) Zeitsch. f. Nervenheilk., 1907, p. 409.

After a discussion as to the various possible lesions in the cerebrum,
cerebellum and peripheral nerves, capable of producing acute ataxia,
Bregman records two cases of his own, the first apparently of cere¬
bellar origin, the second, he considers, due to a combination of
cerebral and peripheral disease.

Case 1.—An alcoholic woman aged sixty. Four weeks before
admission she had sudden unconsciousness lasting about half an
hour. Ever since she has been unable to walk, the speech has been
unintelligible, and the movements of all the limbs inco-ordinate.
Dry gangrene occurred in several fingers of the right hand, and the
right radial artery was markedly sclerosed. There was static
ataxia which gradually improved, though the patient retained the
tendency to fall to the left side. Voluntary movements of all the
limbs were inco-ordinate, especially on the left side, the left upper
limb being most affected. Articulation was ataxic and explosive.
There was nystagmus on lateral movement of the eyes, especially
to the left. The deep reflexes were lost. The plantar reflexes were
flexor in type.

Case 2.—A girl of fourteen. Sudden “ unconsciousness ” lasting a
few minutes and followed by pain in the neck. (The patient ran a
hair-pin into her scalp in falling.) On recovering consciousness she
had total loss of power in both upper limbs, with total ansesthesia,
the feet being well moved. There was high fever for several days,
and the patient complained of pain on passive movement of the
limbs. Speech and swallowing were unaffected. After a week she
began to recover, but reeled in a drunken fashion. Movements
reappeared in the upper limbs, commencing in the fingers. No
headache or vomiting. On examination, the upper limbs were
feeble and ataxic. There was no muscular atrophy. The patient
could not feed herself. The lower limbs were strong and devoid
of ataxia. There was slight blunting of sensation to touch in the
fingers and loss of joint-sense in the hands. The knee-jerks and
ankle-jerks were normal, and there was a pseudo-ankle-clonus.
The plantars at first appeared to be extensor, but later were in¬
definite. The cranial nerves were normal. There was tenderness
on pressure on the nerve-trunks. Bregman considers that the
above symptoms can only be explained by a combination of a lesion
of the peripheral nerves and a lesion of the brain. The diagnosis,
however, is far from convincing, the most probable explanation,
that of hysteria, not even being mentioned.

Purves Stewart.

112

ABSTRACTS

ON DISORDERS OF ORIENTATION ON ONE’S OWN BODY.

(81) (Ueber Storungen der Orientienmg am eigenen Korper.)

A. Pick (of Prague), Arb. a. d. deutsch. psych. Univ.-Klinik in
Prag, 1908.

The patient was a woman of 55, with very marked memory defect
and general mental impairment; apart from marked exaggeration
of the knee-jerks there were no neurological symptoms of import¬
ance. A peculiar disorder of orientation was present. When asked
to point out different parts of her body, she frequently was unable
to do so, or only arrived at the part as if by a sudden intuition,
after much inappropriate fumbling. When unable to point to her
left eye, she said, “I don’t know—I must have lost it.” The
author attributes her inability to localise parts of her body to
deficient power of visual representation of the body or part
specified. The fact that the patient would seek around for the
part elsewhere than on her body is explained as follows by the
author: The failure of the visual representation leaves the atten¬
tion without any definite localising guide, and fixed by the verbal
concept of the object sought. Similarly, the fact that, on seizing
the nose of the examiner, she called it her own, depended on the
absence of the visual picture of her own body.

C. Macfie Campbell.

NON-TRAUMATIO PSEUDOSPASTIO PARESIS WITH TREMOR.

(82) (Dber pseudospastische Parese mit Tremor nicht traumatischer
Atiologie.) K. Krause, Monatsschr. f. Psychiai. u. Neur., 1907,
Bd. 22, Erganzungsheft, S. 54.

Krause first reviews the previously published cases of this re¬
markable syndrome, first described by Fiirstner and Nonne in 1896,
and gives an account of the symptoms typical and atypical belonging
thereto. He then describes two cases in which the syndrome
developed from a hysterical pseudo-tabes and an alcoholic neuritis
respectively. In neither case was trauma present, whereas in only
two of the previous cases has this factor been absent. He discusses
the nosological grouping of the syndrome, reckons it as hysterical
in his two cases, but thinks it may possibly be hypochondriacal
in others. He reaches the curious conclusion that the hysteria
was of “ toxic ” origin in his two cases, and gives no psychological
analysis of them.

Ernest Jones.

ABSTRACTS

113

CONSTITUTIONAL ASTHENIA (L'AstMnie constitutionneUe.)

(83) Paul Londe, Rev. de Mid., Nov. 1907, p. 1023.

Londe gives a descriptive account of the various symptoms that
may be called asthenic, and traces their evolution into “constitutional
neurasthenia.” He attributes them, without of course giving the
least evidence for his opinion, to congenital cerebeUo-sympathetic
deficiency. The treatment advocated is as vaguely based as the
rest of the article. Ernest Jones.

ON ABASIA OE DYSBASIA (Uber Abasie reep. Dysbasie.) E.

(84) Tromner, Monatssehr. f. Psychiat. u. Neur., Bd. 22, Erganzungs-
heft, S. 132.

This is a broad discussion of functional disturbances of gait. The
author takes up Binswanger and Ziehen’s position, which is as
follows: The more restricted is the lower limb weakness to gait
alone, i.e. the more specific is the symptom, the more certain is it
to be of a functional nature. Pure abasia, i.e. disturbance confined
to gait, is probably always hysterical. The cases in which the rela¬
tion to gait predominates the disturbance, but in which weakness
is also present under other conditions, the author appropriately
terms dysbasia; this symptom occurs in hypochondria and neuras¬
thenia. Apart from this is basophobia, an instance of the obsessional
states. Four interesting cases are fully described here, and the
grouping and diagnosis of them discussed, as well as that of
“ stammering gait,” previously published by the author (see Review
of Neur. and Psychiatr., 1906, p. 770). Ernest Jones.

DIFFERENTIAL DIAGNOSIS OF ORGANIC AND FUNCTIONAL

(85) APHONIA (Die differentialdiagnostische Bedeutung der
organischen und funktionellen Aphonie.) Ernst Barth,
Deutsche Med. fPoch., Nov. 28, 1907, S. 1999.

This is a general account of the subject in a short note that contains
nothing new. The author lays stress on the frequency with which
functional aphonia develops as a sequel to organic changes.

Ernest Jones.

HYSTERICAL PURE WORD DEAFNESS. (Uber bysterische reine
(86) Worttaubheit.) A. Knapp, Monatsschr. f. Psychiat. u. Neur.,
Dec. 1907, Bd. 22, S. 5-36.

Knapp relates the case of a woman of 35, who presented at first
complete deafness on both sides, paresis of the left lower facial, with
“ hysterical ” changes in character. The facts that the paresis was
H

114

ABSTRACTS

confined to the face while no other signs of cerebral disease were
present, and that the electrical excitability was normal, led to the
diagnosis of hysterical paresis. This was confirmed by the dis¬
appearance of the symptom after a single suggestive application of
faradism. After a fortnight’s similar treatment the deafness
gradually disappeared, leaving however a pure word deafness. This
resembled subcortical sensory aphasia in that speech, reading, and
writing were unaffected, and differed from it only in the fact that
the patient could hear her own voice perfectly. The word deafness
was improved so far as hearing female voices was concerned, but
remained permanent for male voices. The treatment consisted
in painful applications of electricity and m making threats of various
punitive measures. To the author’s evident surprise and resent¬
ment the patient’s dislike of him did not diminish under treatment,
nor did her refractoriness and inaccessibility, to which he naively
attributes the failure of his treatment.

Knapp claims that this is the first case of the kind to be pub¬
lished. (The Reviewer may remark that this is far from being true ;
Calligaris, for instance, published a similar case of pure “ subcortical ”
word deafness in hysteria in the Rome Otological Clinic Records for
1905.) Mann has published a case of “ cortical ” sensory aphasia
in hysteria, and “ transcortical ” aphasia is often seen in Ganser’s
syndrome. “ Subcortical ” motor aphasia is of course well re¬
cognised in hysteria, but not the “ cortical ” type.

It is unfortunate that no psychological analysis of the origin and
nature of the syndrome was made in this important case.

Ernest Jones.

MECHANISM OF A SEVERE BRIQUET ATTACK AS OON-
(87) TRASTED WITH THAT OF PSYCHASTHENIC FITS.

E. Jones (of London), Joum. of Abn. Psych., Dec. 1907-
Jan. 1908.

Certain points in the differentiation of some of the psychoneuroses
are taken up, and the author states that many such conditions
have been, and still are, incorrectly diagnosed under the terms
psychic epilepsy, grand mal, petit mal, etc. In making a dia¬
gnosis, evidence should be gained from observation of the mechanism
initiating an individual fit, the character of the fit, and from the
examination of the patient during the interval period.

Typical hysterical fits are less frequently mistaken than the
grand or petit mal variety, for the reason that every symptom of
a grand mal attack, from the fixed pupil to sphincter relaxation,
may occur as well in functional affections; it is therefore almost
impossible to exclude hysteria from the observation of the fit
alone.

ABSTRACTS

115

Again, it is necessary to differentiate hysteria from psychas-
thenia, and the author summarises some of the aspects of this
problem by stating that “ the disaggregation of hysteria is massive,
while that of psychasthenia is molecular.”

Primary hysteria is often complicated by psychasthenic symp¬
toms ; the reverse is very rare. C. H. Holmes.

ANOREXIA NERVOSA IN CHILDREN. F. Forchheimer, Arch .
(88) of Pediat., Nov. 1907, p. 801.

The author reports four cases of the condition in children aged
respectively seven years, twelve years, one year, and three years.

He believes that all the cases can be cured provided they are
properly treated. “ Tn order that a child be cured of it there are
required a proper physician, a proper nurse, and proper surroundings. ’ ’

A. Dingwall Fordyce.

SPONDYLITIS INFECTIOSA FOLLOWING DENGUE. (Zur
(89) Kenntnis der Spondylitis infectiosa nach Dengue-Fieber.)

H. Schlesinger, Arb. a. d. Neurol. Instil, a. d. Wien. Univ., Bd.

16, Teil 2, 1907, S. 13.

This paper deals with a condition which has not hitherto been
described in connection with dengue, but which is well known as
a sequela of enteric fever under the name of “ typhoid spine.”
From a prognostic standpoint spondylitis infectiosa resembles many
other non-purulent inflammatory processes in the nervous system
following infectious disease, e.g. acute encephalitis, serous meningitis,
myelitis, and polyneuritis. In most cases there is complete or, at
least, considerable restoration of function.

A man, aged thirty-six, contracted dengue in Cairo. On the ninth
day of the disease meningeal symptoms appeared, and lasted nine¬
teen days. During convalescence weakness of the lower limbs and
ataxia developed. Walking was only possible by the help of sticks.
The muscles of both legs were considerably wasted, the knee and ankle
jerks were exaggerated, and there was patellar and ankle clonus
on both sides. Babinski’s sign was absent, and there were no super¬
ficial or deep sensory changes except for meralgia paraesthetica and
a zone of thermohyperesthesia at the level of the iliac crest. The
sphincters were unaffected. Examination of the vertebral column
showed that the normal lumbar lordosis was replaced by a kyphosis
involving all the lumbar spine, percussion of which was painful.
The part was kept rigid, and unexpected movements of the trunk
caused pain. The skin was not affected. The X-rays showed

116

ABSTRACTS

subluxation and rotation of tbe second lumbar vertebra and an
exudation between the first and second lumbar vertebrae. Tuber¬
culosis was negatived by the absence of personal or family ante¬
cedents and a negative reaction to tuberculin. Intra-muscular in¬
jections of atoxyl and hot-air baths were prescribed. Gradual
improvement took place, but the spondylitis lasted several months.

J. D. Rolleston.

THE PATHOGENESIS OF DIPHTHERITIC PARALYSIS AND
(90) HEART FAILURE IN DIPHTHERIA. (Zur P&thogenese der
postdiphtherischen Lfthmungen und des Herztodes bei Diph-
therie.) Spieler, Arb. a. d. Neurol. Instit. a. d. Wien. Unir.,
Bd. 15, Teil 1, 1907, S. 512.

After reviewing the current theories as to the nature of diphtheritic
paralysis, Spieler records the clinical history and post-mortem
findings in three cases. The first case died suddenly of cardiac
paralysis in the fourth week, three days after the occurrence of
paralysis of the neck muscles. In addition to advanced fatty
degeneration of the myocardium, histological examination revealed
no lesions in the central nervous system, but considerable changes
in the vagi and spinal accessory nerves, while the anterior crural
nerves were found to be quite normal. In the second case, which
died within the first week with symptoms of palatal and cardiac
paralysis, the central nervous system was again found to be intact,
while advanced changes were found in the palatine nerves and to a
less degree in the two vagi. In the third case, which also died within
the first week, clinically there were no premonitory cardiac symp¬
toms, and the sudden cardiac failure came as a surprise. Exam¬
ination, however, showed, in addition to degeneration of the myo¬
cardium, considerable signs of degeneration m the vagi. In all the
three cases the degree of degeneration of the myocardium would
hardly have sufficed to have produced so sudden, and in the last two
cases so early, a death, whereas the advanced degeneration of the vagi
readily explained this. The author concludes that sudden failure
of the heart in diphtheria finds its explanation in the existence of
early peripheral degeneration of the vagus. The peripheral neuritis
b due to the direct action of the local diphtheritic process on the
terminal branches of the nerves supplying the diseased area. Thb
view b supported clinically not only by the usual course of diph¬
theritic paralysis, but also by the fact that in paralysb following
cutaneous diphtheria, the structures adjacent to the diphtheritic
lesion are first affected.

J. D. Rolleston.

ABSTRACTS

117

OBSTRUCTION IN THE NOSE OR IN THE THROAT AS CAUSE

(91) OF NERVOUS AND MENTAL DISEASES IN SCHOOL
LIFE. R. H. Johnston, N.Y. Med. Journ., Nov. 30, 1907,
p. 1023.

This paper is merely a short resume of the nervous mental disease
resulting from adenoids, enlarged tonsils, deviated nasal septa, etc.,
in children, probably all more or less due to the consequent deficient
oxygenation. Aprosexia, night-terrors, nocturnal enuresis, pseudo¬
meningitis, outbursts of temper, and reflex nervous cough are
among the conditions mentioned. J. H. Harvey Pirie.

TRAUMA IN THE .ETIOLOGY OF NERVOUS DISEASES. (Der

(92) Unfall in der AStiologie der Nervenkrankheiten. ) Kurt
Mendel, Monatsschr. f. Psychiat. u. Neur., 1907, Bd. 21, S. 468,
550; Bd. 22, S. 158, 264, 373, 544.

It is impossible here to do more than indicate this remarkable con¬
tribution, eighty-four pages long, which resumes all our knowledge
on the subject. The literature is considered fully, and criticised in
detail. Only organic affections, chiefly general paralysis, tabes,
tumour, and meningitis, are dealt with, and after every section a
short list of conclusions is given. The whole article forms an
invaluable contribution to our precise knowledge of this etiological
factor. Ernest Jones.

THE OPHTH AT .MO-REACTION TO TUBERCULIN: A RECORD

(93) OF 300 OBSERVATIONS ON CHILDREN. (L’oculo-r&ction
h la tuberculins en clinique infantile, d’aprds 300 observa¬
tions.) J. Comby, Le Bulletin Midical , 20 novembre, 1907.

Professor Calmette, the Director of the Pasteur Institute of
Lille, described before the Academy of Science in June last a new
test for the diagnosis of tuberculosis.

The ophthalmo-reaction to tuberculin, as it is called, is carried
out by introducing into the eye a drop of a definite dilution of
tuberculin. If the individual is not a tuberculous subject, nothing
is noticed. On the other hand, if he is a subject of tuberculosis,
whether active or latent, from five to ten hours, or, in rare cases,
even as late as forty-eight hours, after the introduction of the drop,
the eye begins to redden, and a more or less extensive conjunctivitis
develops, which may last as long as eight or ten days.

Calmette employed small capsules, each of which contained
five milligrams of dried tuberculin. To this ten drops of boiled

118

ABSTRACTS

water are added. A single drop of this solution is introduced into
the eye.

Facts are required to determine the exact value of the method.
A number of corroborative observations have already been
reported.

Comby is of opinion that, in the case of children, it is advisable
to use a somewhat weaker dilution, and recommends a dilution of
half the strength (twenty drops of water added), for on more than
one occasion when using the dilution originally recommended
by Calmette, he has seen a somewhat intense conjunctivitis
produced.

When this dilute solution is employed three types of reaction
may, according to Comby, be recognised.

1. A slight reaction which may escape notice, if one does not
pay special attention to the angle of the eye and compare it with
that on the opposite side. This reaction rarely persists longer
than two or three days.

2. Reaction of moderate intensity. The inner half of the eye
is injected, the caruncle stands out prominently, both the palpebral
and ocular mucous membranes are congested. The reaction per¬
sists for from 5 to 7 days.

3. Intense reaction with general injection of all the con¬
junctiva. There may be oedema with occlusion of the lids,
a purulent secretion, unpleasant sensations about the eye, and
pain. At times vesicles are to be seen at the comeo-scleral
junction. With a 1 in 200 solution this reaction is rare; it is
not seen once in twenty cases and the prognosis need not cause
anxiety.

Comby has never seen the slightest general reaction, a
weighty point in favour of this test as opposed to the subcutane¬
ous injection of tuberculin. The reaction may be repeated again
and again at intervals of days or weeks, but the result re¬
mains constant. Children presenting a perfectly healthy appear¬
ance, who are affected with latent tuberculosis, give a positive
reaction, as do those affected with all forms of active tuberculosis.

Among the children who had not shown the reaction, eight
died and were examined post-mortem. In not one was there a
trace of tuberculosis. Ten of those children who gave a positive
reaction died and were examined post-mortem: tuberculosis was
present in every case.

The results of those observers who have expressed doubt as to
the value of the reaction may, Comby believes, be explained by
differences in technique.

The reaction is contra-indicated in the presence of any local
ocular condition which might be thereby intensified. The re¬
action has to be carefully looked for in slight cases, while it is

ABSTRACTS

119

necessary to remember that in some cases it takes a long time
to appear.

Comby concludes his paper with the following sentence: “ The
ophthalmo-reaction to the tuberculin is very simple, very elegant,
and very sure. It has not deceived me once among the 300
healthy and diseased children on whom I have tested it.”

Edwin Bramwell.

ARTERIOSCLEROSIS. G. L. Walton and W. E Paul (of Boston),
(94) Joum. Amer. Med. Assoc., Jan. 18, 1908.

There is a general tendency at the present time towards a reaction
from the somewhat widespread movement to attribute to arterio¬
sclerosis all sorts of nervous symptoms; in fact, given the symptoms,
it is almost conceded that arteriosclerosis must exist, although no
sign appears in those arteries which are palpable. This position
is somewhat fortified by the knowledge that arteries may he
hardened in one part of the body and not in another.

With a view to throwing more light upon this somewhat
obscure subject, the authors have examined a series of one hundred
individuals presenting marked and obvious sclerosis of palpable
arteries, to ascertain whether or not prominent nervous symptoms,
commonly attributed to this condition, were present

(1) Headache—occurred in only 22 per cent. The percentage
is lower than that found in ordinary healthy individuals, if the
young and middle-aged are included. In eye-strain, 69 per cent,
of cases suffer from headache. The authors conclude that in the
eye-strain of advancing years, headaches are sometimes relieved by
the existence of arteriosclerosis.

(2) Vertigo—was found in 65 per cent

(3) Apoplectiform attacks—were found in 34 out of the 100
cases. These may be fairly attributed to arteriosclerosis, although
it must be remembered that the question is often complicated by
the co-existence of renal involvement.

(4) Progressive loss of memory—was complained of in 48
cases.

(5) Insomnia—occurred in but 30, which would place it in the
doubtful category.

(6) Irritability, anxiety, morbid fears, etc.—were present in
40 cases. In one-half of these the symptoms had been present
throughout life, and had not increased of late.

Renal and cardiac changes were investigated, and blood pressure
noted under varying conditions.

Signs of renal degeneration were present in 36 per cent, of the
cases; cardiac enlargement in 86 per cent, of the cases in which

120

ABSTRACTS

renal involvement was present; those without renal involvement
showed 36 per cent. The average blood pressure in cases showing
neither kidney disease nor cardiac enlargement was 147, taken
with the Riva Rocci instrument; those with cardiac enlargement
alone, 168 ; with kidney disease alone, 173; with both, 195.
These facts show (1) that renal degeneration is the prominent factor
in the production of cardiac enlargement; (2) that while either
renal degeneration or cardiac enlargement is attended by mode¬
rately high blood pressure, the existence of both these conditions
is accompanied by very high blood pressure.

The authors conclude that while arteriosclerosis is directly
productive of apoplectiform attacks and of vertigo, and while it
plays a part in the loss of memory as well as in the other failing
powers of involution, it does not produce headache except as the
immediate result of apoplectiform attacks. Arteriosclerosis may
appear in elderly neurasthenics as in any other group of elderly
persons, but further study of the relationship of the two conditions
is desirable. Renal disease is a prominent factor in the cardiac
enlargement often present in cases of arteriosclerosis. Arterio¬
sclerosis without cardiac enlargement or renal disease is only
exceptionally accompanied by a very high blood pressure. If
cardiac enlargement or renal disease is present, moderately high
blood pressure; if both are present, very high blood pressure is
the rule. C. H. Holmes.

PSYCHIATRY.

A CONTRIBUTION TO THE STUDY OF HEREDITY. (Beitrag
(95) zur Lehre von der Heredit&t.) A. Pilcz, Arb. a. d. Neurol.

Instil, a. d. Wien. Univ., Bd. 15, Teil 1, 1907.

In this paper Pilcz tabulates and analyses 2000 cases of mental
disorder, taken from the registers of the Psychiatric Clinic of Vienna
University, the cases having a neuro- or psychopathic parentage
(insanity, epilepsy, migraine, organic spinal diseases, drunkenness,
suicide, apoplexy, or character anomalies), generally of pronounced
form. From his investigation the author draws the following
conclusions:—

1. The hereditarily transmitted predisposition to a mental
disorder differs according to the special clinical form, quantitatively
and qualitatively.

2. Quantitatively, cases of progressive (general) paralysis,
senile and arterio-sclerotic dementia, and also to a certain degree
the non-katatonic form of dementia praecox, show a much less
marked neuropathic heredity than the other forms of insanity.

ABSTRACTS

121

3. Qualitatively, and speaking in general terms, there are
different predispositions; i.e. the hereditary factors differ according
to the particular form of mental disorder in the descendant.

4. As to direct heredity, homogeneous heredity is the general
rule; ascendants and descendants tend to offer the same clinical
forms, a noteworthy exception to this rule being furnished by non-
katatonic dementia prsecox, in which the ascendants have not
presented the same disease but, commonly, general paralysis.
(Thus of 51 cases of non-katatonic dementia prsecox, the parents
exhibited in 7 imbecility, in 1 moral insanity, in 3 melancholia, in
2 amentia, in 3 periodic psychoses, in 1 a neurasthenic psychosis,
in 3 alcoholism, in 2 dementia prsecox, and in 25 paralytic dementia.
Rev.).

5. Besides the h&riditd similaire the following play the chief rdle
in psychotic heredity :—Alcoholic insanities in all psychoses except
the types instanced under two; the affective psychoses in melancholia
and circular insanity; senile dementia in general paralysis, and
simple weak-mindedness in dementia prsecox.

6. Epileptic and alcoholic psychoses might be quantitatively
included with the hereditary degenerative insanities but direct
psychotic heredity plays in these two psychoses a minor part.

7. As regards other hereditary factors, alcoholism in the ascend¬
ants is important in imbecility, the alcoholic psychoses and epileptic
insanity, with the latter also epilepsy and migraine. Suicide is
found most frequently in the heredity of the affective psychoses
—a further proof of the intimate connection between suicide and
melancholia. Tabes dorsalis, when it occurs, is found most
frequently in the heredity of hebephrenia and general paralysis
(as is also general paralysis itself), and apoplexy m the parents of
general paralytics, arterio-sclerotic dements and melancholics.

8. Within the group of alcoholic insanities direct psychotic

insanity is most marked in alcoholic paranoia and the so-named
states of pathological drunkenness (pathologische Rauschzustande),
a marked feature being the great frequency of epilepsy and migraine
in the parentage. R. Cunyngham Brown.

THE CEBEBEO-SPINAL FLUID IN PARESIS, WITH A SPECIAL
(96) REFERENCE TO ITS CYTOLOGY. W. B. Cornell (of Balti¬
more), Amer. Joum. of Insan., July 1907.

The author draws the following conclusions from recent literature
on the subject, and a series of twenty-five cases of his own which
were punctured thirty-seven times.

1. All cases of paresis exhibit a spinal leucocytosis and increase
of albumen. 2. This sign is also, from point of view of its con-

122

ABSTRACTS

stancy, in all probability tbe earliest. 3. The diagnostic value of
a negative puncture is often of greater value than a positive one.
4. The cell-counting method with Fuchs and Rosenthal’s slide is
more accurate and rapid than the centrifuge technique, and has the
great advantage in permitting comparative results. 5. The use
of Unna’s polychrome blue m the mixing chamber permits a
simultaneous differential count. 6. A differential count is important
in differentiating the paretic fluid from others, especially where the
cytosis is due to a small number of polynuclears. 7. The conditions
under which syphilis produces a spinal leucocytosis demand further
investigation, especially regarding the number and character of
the cells. The increase of cells in the paretic fluid is apparently
independent of any long antecedent syphilis. 8. There seems to be
a correlation, both qualitative and quantitative, between the spinal
and haemic leucocytosis, which particularly refers to the mono¬
nuclears, but includes the polymorpbonuclears, especially after
convulsions. C. H. Holmes.

FURTHER INVESTIGATION ON THE GALVANIC PHENO-
(97) MENON AND RESPIRATION IN NORMAL AND INSANE
INDIVIDUALS. C. Ricksher (of Hawthorne, Mass.) and
C. G. Jung (of Zurich). Joum. of Abn. Psych., Dec. 1907,
Jan. 1908.

The authors reach the following conclusions:—

(1) The galvanic reaction depends on the attention to the
stimulus and the ability to associate it with other previous occur¬
rences. This association may be conscious, but it is usually
subconscious.

(2) Physical stimuli as a rule cause greater galvanic fluctua¬
tions than do the psychical in the experiments. This may be due
to the fact that they occurred before the psychical, early stimuli
nearly always causing greater reactions than do later ones.

(3) While the normal reactious vary greatly in different indi¬
viduals, they are as a rule always greater than pathological
reactions.

(4) In depression and stupor the galvanic reactions are low,
because the attention is poor and associations are inhibited.

(5) In alcoholism and in the euphoric stage of general para
lysis tbe reactions are high, because of the greater excitability.

(6) In dementia the reactions are practically nil, because of
the lack of associations.

(7) The reactions show great individual variations, and within
certain rather wide limits are entirely independent of the original
bodily resistance.

ABSTRACTS

123

The pneumographic results may be summarised as follows:—

(1) The inspiratory rate varies according to the individual,
and no general rule can be given.

(2) The amplitude of the inspirations is generally decreased
during the rise of the galvanic curve.

(3) The decrease in the amplitude, however, has no relation
to the height of the galvanic curve, but varies according to
individuals.

(4) In cases of dementia, where there is no galvanic reaction,
the changes in the respirations exist, but are very slight.

C. H. Holmes.

PATHOLOGY AND TREATMENT OF OBSESSIONAL STATES.
(98) (Zur Pathologic and Therapie der Zwangsneurose.) Wolf¬
gang Ward a, Monaisschr. f. Psychiat. u. Neur., Bd. 22, Ergan-
zungsheft, S. 149.

This paper is based on some of Freud’s earlier views on the subject.
Warda maintains that obsessional states are always due to the
suppression of various sexual events in infancy, but gives no de¬
scription of the pathology of the condition beyond the simple state¬
ment of this fact. He relates four not very convincing cases, which
are poorly analysed; he seems not to be aware of Freud’s later work
on symbolisation, etc. Ernest Jones.

OLTMACTEBIO PSYCHOSES. (Ub6r die Psychosen des Klimak-

(99) terrains.) Hans Berger, Monatsschr. f. Psychiat. u. Neur.,
1907, Bd. 22, Erganzungsheft, S. 13.

After a few references to previous writings on the subject, Berger
gives a short account of the material of the Jena clinic during the
pest nine years. Of 326 female patients between the ages of 40 and
55, in only 14 had the psychosis developed actually during the
climacteric period (organic affections being excluded). Two of
these cases are briefly described, and the general conclusions of the
others given. In 10 of the 14 melancholia was the form present.
Eight cases recovered completely, two committed suicide, and four
ended in dementia. Ernest Jones.

ALCOHOLIC INSANITIES. A Gordon (of Philadelphia), Joum.

(100) Amer. Med. Ass., Nov. 16, 1907.

The author bases his paper on the study of four hundred and thirty-
seven cases, and draws the following conclusions. Alcoholic insanity
presents special characteristic features, which are not difficult as a

124

ABSTRACTS

rule to distinguish from other analogous conditions. Acute cerebral
alcoholism presents three states—delirious, confusional, and stuporous.
The intensity of these states varies according to whether a sub¬
acute form or a form with delirium tremens is dealt with.

The chronic form invariably leads to dementia. In the develop¬
ment of the latter form, delusions, hallucinations, and illusions
may or may not manifest themselves.

Symptoms of other psychoses may confuse the picture, but close
observation will make the proper interpretation possible. Symp¬
toms of cerebral alcoholism may be superimposed upon other
psychoses, but it does not follow that alcoholism causes these
psychoses.

The conception of alcoholic melancholia, mania, paranoia, or
alcoholic general paralysis is unscientific, as it is not based upon
accurate observations.

The paper contains very little that is new, and the reference to
alcoholic melancholia, mama, and paranoia is vague, for it is certain
that the depressed, excited, and delusional forms of alcoholic
psychoses are comprehensive and well recognised.

C. H. Holmes.

A OASE OF PERIODIC MELANCHOLIA, COMBINED WITH
(101) HYSTERIA AND TABES DORSALIS WITH PECULIAR
ATTACKS OF MIGRAINE. (Ueber einen Fall von periodis-
cher Melancholic, kombiniert mit Hysterie und Tabes dorsalis,
mit eigenartigen Migr&neanf&llen. Zugleich ein Fall von
aknter Veronalvergiftung. ) M. Pappenheim, Arb. a. d. deutsch.
psych. Univ.-Klinik. in Prag , 1908.

The patient, a young man with extremely bad heredity, who had
suffered from attacks of migraine since boyhood, first came under
observation at the age of 30. He had, at the age of 14, had
fainting attacks; at the age of 20, after influenza, he was languid,
sleepless, and without appetite, took pleasure in nothing. He
later had several attacks of depression, and attempted suicide.
On admission to the clinic he was a typical case of melancholia
simplex, the melancholic phase of manic-depressive insanity
(Kraepelin); in the physical condition there was nothing abnormal
to note. Ten years later, in 1905, he returned to the clinic, having
in the interval had several attacks of depression, and contracted
syphilis in 1898. He now showed tabetic symptoms—lancinating
pains, pupillary anomalies, lymphocytosis of the cerebro-spinal
fluid, bladder disorders, sensory disturbances, Romberg’s sign;
certain elements in the clinical picture appeared to be of functional
origin. The author describes in detail the attacks of migraine,

ABSTRACTS

125

which began with auditory phenomena; he considers that on the
basis of an inherited migraine were superimposed tabetic “acusticus
crises,” due to affection of the cochlear nerve. On both sides there
was evidence of organic disease of the eighth nerve of a tabetic
character. The anatomical basis of the attacks is discussed in
detail.

The patient attempted suicide by taking 8| grammes of
veronal, and the symptoms following on this attempt are recorded.

C. Macfie Campbell.

THE CRIMINAL RESPONSIBILITY OF INSANE PERSONS.

(102) Morton Prince (of Boston), Jonm. Amer. Med. Ass., Nov. 16,
1907.

The author reviews somewhat in detail the history of the laws
governing irresponsibility in crime, states that the law of to-day was
defined by English judges in 1843 in answer to inquiry by the House
of Lords, and has continued to stand both in England and America
to the present time. This law is not statute but common law. He
quotes the questions and answers upon which the law was founded,
and makes pertinent comments on conclusions drawn. For example,
one of the answers most frequently quoted is as follows:—“ To
establish a defence on the ground of insanity it must be clearly
proven that at the time of committing the act the accused was
labouring under such a defect of reason, from disease of the mind,
that he did not know the nature and quality of the act he was doing,
or, if he did know it, that he did not know that he was doing what
was wrong.” The question, to which this answer was given, referred
to the insane who were suffering from delusions, while the answer
has ever since been applied to all insane whether they suffered from
delusions or not. The phrase, “ persons who labour under partial
delusions only and are not in other respects insane,” is also well
criticised, as being a psychiatric assumption which probably has
no basis in fact.

Prince concludes that the law to properly determine responsibility
should be statutory and not common law; he approves of the
system now employed in the States of Maine, New Hampshire,
Vermont, and Massachusetts, when the defence of insanity is raised
in criminal cases. Here the accused person is committed to an
asylum and placed under the continuous observation of impartial
experts until the question of his sanity has been determined. The
Court abides by this decision, believing that medical insanity con¬
stitutes legal irresponsibility.

Some such system would be a marked improvement on the
present thoroughly rotten system of expert testimony which exists
rather universally in America. C. H. Holmes.

126

ABSTRACTS

MENTAL ALIENATION AND CRIME. (La Alien&clon Mental 7

(103) el Delito.) By Jos6 Ingegnieros, Arch, de Psiq. y Crim.,
Sept.-Oct. 1907.

Prop. Ingegnieros comments upon a case of a prisoner who had
made a homicidal assault on his wife. Prisoner was an inveterate
alcoholic with frequent crises of intoxication, followed by impulsive
and anti-social conduct. Sentenced to two and a half years’ penal
servitude, he was placed in the prison infirmary for mental observa¬
tion, where he was found to have delusions and auditory hallucina¬
tions, and was therefore transferred to the pavilion for criminal
lunatics. As in the former case, Prof. Ingegnieros argues that his
condition should have been discovered at the trial and the prisoner
sent direct to the criminal lunatic asylum as a dangerous and
irresponsible person.

R. CuNYNGHAM BROWN.

THE LIBERATION OF CRIMINAL LUNATICS. (Liberacion y
(104) Abandono de Alienados Delincuentes.) By Jos6 Ingeg¬
nieros, Arch, de Psiq. y Crim., Sept.-Oct. 1907.

In a short paper Prof. Ingegnieros of Buenos Aires University
relates the case of a man, the subject of systematized delusions of
persecution, who, under the influence of his delusions, committed
a serious crime. The account given by the author puts in a very
unfavourable light criminal procedure in Brazil. Notwithstanding
abundant evidence of insanity, the accused was sentenced to a term
of imprisonment. Whilst in prison it was discovered that the prisoner
had committed murder a year previously, and also that he was
insane. Taking a retrospective view of his crimes, the authorities
pardoned the prisoner and put him at liberty, prior to his co mmi ttal
to an asylum. Prof. Ingegnieros criticises the numerous juridical
errors in the case, and maintains :—

1. The original crime of the accused was that of a lunatic, and

ought to have suggested from the first his state of alienation.

2. Once put on trial his intense delusional manifestations ought

to have put in motion an expert inquiry, which would have
resulted m his detention permanently as a dangerous lunatic.

3. Once condemned, his insanity ought not to have brought about

his pardon but a revision of the process.

4. The pardon ought not to have been accompanied by an order

for his liberation.

R. CuNYNGHAM BROWN.

ABSTRACTS

127

THE INSANE AND THE PENAL LAW. (Los Alienados y le

(105) Ley PenaL) By Jos£ Ingegnieros, Arch de Paiq. y Crim.,
Sept.-Oct. 1907.

Prof. Ingegnieros furnishes here a still more striking example of
the inadequacy of Brazilian legal procedure with regard to insane
persons accused of crime. On the one hand, he says, lunatics who
have committed serious crimes are sent by the intermediation of the
police to ordinary asylums, and, on the other hand, insane but
inoffensive, or, at least, not dangerous prisoners, are confined in
criminal lunatic asylums or the lunatic wings of prisons—that is,
that the criminal lunatic asylum or the lunatic wing of a prison is
simply a judicial depository for the insane, and not, as he contends
they should be, houses of detention for dangerous lunatics. Under
the existing Brazilian law, he says that even homicidal lunatic
prisoners may be set at liberty to the great danger of the public.
The example given is that of a labourer who, under the influence of
delusions of persecution, killed one man and wounded several others.
Whilst in prison he received hallucinatory revelations from God
and the Virgin Mary, and had delusions of persecution and of grandeur.
Later he had visual hallucinations, and in the third stage of pro¬
gressive systematized delusional insanity, after an incarceration of
twenty months, was liberated. Shortly after this liberation,
however, he travelled to Buenos Aires, and proclaimed himself in
the Cathedral to be the Messiah. He was thereupon arrested,
though with difficulty, by the police and consigned to the asylum
under Prof. Ingegnieros, who gives bill clinical notes of the case.

R. Cunyngham Brown.

TREATMENT.

INFLUENCE OF MERCURIAL TREATMENT OF SYPHILIS
(106) ON THE OCCURRENCE OF METASYHILIS OF THE
NERVOUS SYSTEM. (Hat die Hg-Behandlung der Syphilis
Einfluss auf das Zustandekommen metasyphilistischer Nerven-
krankheiten 7). Paul Schuster, Deutsche Med. Woch., Dec.
12 , 1907, S. 2083.

Schuster gives a most valuable discussion, supplemented by im¬
portant original observations, on this question. After reviewing
the literature he states the results of personal inquiries as to previous
mercurial treatment in 235 cases of syphilis of the nervous system,
in 186 of which the presence of syphilis had been proved, and positive

128

ABSTRACTS

answers as to treatment obtained; of the 235, 90 were cases of
tabes, 45 of general paralysis, and 100 of lues cerebri. A far higher
percentage had been thoroughly treated than in Neisser’s collected
series of 445 tabetics. He concludes, on these and other grounds,
that (1) the clinical picture of metasyphilis is the same, whether
there had been previous mercurial treatment or not. (2) There is
no relation between the date of onset of these diseases, and the
question of former treatment. (3) There is no evidence that
mercurial treatment of syphilis has any preventive action in this
connection. (4) There is some reason to suppose that metasyphilis
may be due to syphilitic antibodies rather than to the syphilis
toxin itself. He further mentions that mercurial treatment has
no effect on anti-bodies present in the blood of syphilitics.

Ernest Jones.

THE SURGICAL TREATMENT OF TUMOURS OF THE SPINAL
(107) MEMBRANES. (Die chirurgische Behandlung der Riicken-
markshautgeschwtQste.) Bruns, Deutsche Zeitschr. f. Nei-ven-
heilk., Bd. 30, H. 5-6, 1907, S. 355.

In his introductory remarks the writer emphasizes the importance
of general and segmental diagnosis, knowledge of the nature of the
tumour, and its influence on the cord, its roots and coverings. Intra¬
dural tumours only are considered. These are not so common as
extradural, and are usually not so extensive, and usually primary
and benign, extradural being often metastatic and malignant.
Those of practical importance are various fibromata, fibrosarcoma,
and other forms of sarcoma, including psammoma. The majority
are situated in a lateral and posterior direction from the cord, many
directly posterior and in the median line. According to Schlesinger,
if symptoms of tumour of the cord appear in people over forty years
of age, a benign form may be assumed. He also states that benign
tumours are more frequent in the "dorsal region, whilst malignant
are more often seen in the cauda equina. Softening of the cord is
exceptional. In most instances there is only compression, with
long preservation of the axis cylinders, and a possibility of recovery of
the functions of the cord after removal of the tumour. Inflammation
of the cord and membranes is rare in true tumour, and nerve roots in
its vicinity may even remain uninjured anatomically for a long time.
This apphes especially to those originating in the cord above the
level of the tumour, distinct symptoms occurring in the region of
those involved near their exit from the cord. The bone symptoms
are in most cases limited to susceptibility to pressure on the spines
and the bones above and below them. In typical cases isolated root

ABSTRACTS

129

symptoms are first observed, then Brown-Sequard paralysis, later
paraplegic symptoms, subsequently associated with distinct bone
symptoms. In lesions of a number of anterior roots atrophic
muscular paralyses occur, but these are only distinctly recognisable
in the cervical, lumbo-sacral and lower dorsal cord, and the reaction
of degeneration may be absent. If the cord itself is involved
anaesthesia is more pronounced at the level of the lesion, and there
are symptoms of interruption of conduction in all parts below it.
In exceptional cases few of the classical symptom-complex remain,
individual symptoms being absent or very insignificant, and the
sequence varying considerably. Intermissions and disappearance
of pain, and its entire absence throughout the whole course of the
condition, have also been observed, notably in tumour of the dorsal
portion. Intermission may occur in the periods between complete
destruction of one root and involvement of another, or conduction
may be gradually interrupted owing to compression of the cord.
Total absence of pain may be due to the tumour producing complete
interruption of conduction before irritating a root, or to early
operation on a tumour, which if allowed to grow would ultimately
have caused pain. In cases in which the pain radiates into distant
nerve provinces from the beginning, it is probably projected, owing
to compression of the cord. In some cases unilateral symptoms
have not been observed in the early stage, possibly because they
were present for so short a time, or owing to ischaemic softening,
oedema or inflammation rapidly injuring the entire transverse
section of the cord. There may also be considerable variation in
the duration and sequence of the individual symptoms, but in all
doubtful cases recent experience makes it clear that there should be
no hesitation in recommending operation if the trouble is pro¬
gressive, and notably painful. As regards the diagnosis, marked
bone symptoms are in favour of caries, and also the existence of
burrowing abscess. In carcinoma and sarcoma the demonstration
of a still present or previously operated upon growth in another
situation makes the diagnosis clear, but in doubtful cases operation
should be advised, and the X-rays may be of service. The diffi¬
culties in distinguishing between intradural and intramedullary
growths may be insurmountable. In intramedullary, unilateral
root and Brown-Sequard symptoms appear simultaneously, while
in intradural the former may be isolated for a long time, though
atypical cases must be borne in mind. Intramedullary tumours also
increase rapidly in the long axis of the cord. Extensive root or cord
symptoms, with intense pain on coughing or sneezing, are in favour
of extradural tumour, though these signs cannot be absolutely
depended upon. In chronic myelitis the distinction can be made
from a syphilitic anamnesis, if present. In doubtful cases an
-exploratory operation is justified. Confusion may arise in the later
i

130

ABSTEACTS

stages of hypertrophic cervical pachymeningitis, if the course of the
case is not closely observed. Circumscribed gummatous meningitis
may exhibit all the characteristic symptoms, showing the advisa¬
bility of trying antisyphilitic treatment before having recourse to
operative procedures. In syringomyelia the symptoms are marked
in the long axis of the cord. Pronounced trophic disturbances,
severe curvature, long course and considerable remissions are in
favour of this diagnosis. In multiple sclerosis the characteristic
ocular symptoms are of material assistance, as is puncture in
meningitis serosa spinalis circumscripta. As reganls segmental
diagnosis the writer refers to the difficulty in distinguishing between
tumour of the cauda equina and lumbo-sacral region. The roots
and their segments having similar functions in these regions, it is
obvious that there can be no essential difference in the root and cord
symptoms. In tumour of the cauda the symptoms are often bi¬
lateral from the beginning, and the pain is of special intensity,
duration and extent, while reaction of degeneration is marked.
Tumour in this region is also frequently malignant and diffuse.
In addition to the segmental diagnosis it is necessary to acquire
accurate information as to the longitudinal extent of the tumour.
There may be oedema, inflammation of the cord and membranes,
possibly meningitis serosa circumscripta, around the tumour, and
if they extend above it the upper extremity of the tumour may be
assumed to lie at too high a level. Sherrington’s law is of service
in this connection. In general the highest segmental symptoms of
the tumour must be referred to the highest root region under con¬
sideration, the level of the root being taken at its exit from the cord,
and not at its exit from the column. In typical cases the general
and segmental diagnosis can usually be made with a moderate
degree of certainty when, after more or less long persistence of root
symptoms, cord symptoms appear. If the former are absent, the
segmental diagnosis cannot be made until there are symptoms of
considerable compression of the cord. In relation to the nature of
the growth, the age of the patient and the position of the growth
must be considered. The writer concludes that intradural tumours
in general are favourable objects for surgical treatment, patho¬
logically, anatomically, as regards their position, size, shape, and
influence on the cord and roots. He refers to the brilliant results
in this region as compared with those obtained in the brain, notably
that in a large proportion of cases the cord recovers after severe
injury and interference with function. He points out that although
the operation is not so dangerous as trepanation of the skull, with
extirpation of tumour, it is yet not free from risk.

Donald Armour.

ABSTRACTS

131

A BRIEF REPORT OF FURTHER EXPERIENCES IN THE USE

(108) OF PARATHYROID GLAND FOR PARALYSIS AGITAN8.

W. N. Berkeley, JS\Y. Med. Joum., Nov. 23,1907, p. 974.

Disease of the parathyroid has been put forward by the author
and others as the origin of paralysis agitans. Autopsy findings are
however, as he admits, conflicting, and give as yet little support
to the theory. He has given ox parathyroid both hypodermically
and by the mouth, in a form prepared by himself and found to be
active when tested on parathyroidectomized dogs, to a considerable
number of cases with progressive benefit. The benefit consisted
indiminished rigidity, lessened pain, salivation cured (salivation is,
he says, a common though little known symptom), shaking dim¬
inished or cured, voluntary control of muscles increased, and rest¬
lessness and insomnia nearly or quite abolished. From a week to
three months may be required for the good effects to become mani¬
fest ; even advanced cases have been very much improved. The
treatment seems to be at least as satisfactory as, and more per¬
manent than, any other yet suggested, and the “ antispasmodic ”
action of the gland substance might prove symptomatically useful
in other conditions. J. H. Harvey Pirie.

THE METHODS AND TECHNIC OF THE DEEP ALCOHOL

(109) INJECTIONS FOR TRIFACIAL NEURALGIA. D’Orsay

Hecht (Chicago). Joum. of Amer. Med. Assoc., Nov. 9, 1907.

Excision of the Gasserian ganglion is followed by brilliant and
apparently permanent results in cases of intense and persistent
facial neuralgia; but it must be admitted that the operation is a
difficult one, and even in the hands of its most skilled exponents
is attended with a definite percentage of fatalities. Obviously
any method which minimises the risk to life, if equally efficacious,
will be welcomed. Schlosser, in 1900, suggested injections of
alcohol in the treatment of neuralgia. He is at present engaged
in the preparation of a treatise which will include all his observa¬
tions. Hecht considers the subject under the following headings:—
1. Anatomic considerations; 2. Methods of (a) Schlosser, (b) Ost-
walt, (c) Levy and Baudouin; 3. Laboratory and clinical observa¬
tions (personal); 4. The needle, syringe,and solution; 5. Technic;
6. Prognosis.

The impression derived from a perusal of his paper is that
the technic in the case of the trigeminal nerve is one necessitating
very considerable manipulative dexterity and experience. The
final conclusions of Schlosser, who admits that the cure is not per¬
manent, although it persists for about a year, will be awaited with
interest. Edwin Bramwell.

132

ABSTRACTS

THE TREATMENT OF CHOREA MINOR. D’Orsay Hecht
(110) (Chicago). Illinois Med, Joum., Nov. 1907.

This is a record of the author’s personal experience and that of
others as to the treatment of chorea. He concludes from his own
material, that “cases of minor chorea of moderate severity show
no great difference in their duration, whether under a treatment
entirely expectant or strenuously medicinal,” and holds that “ the
appropriate treatment for chorea comprehends (1) rest and isola¬
tion ; (2) improved hygiene and nutrition; (3) drugs judiciously
used.”

Interesting results are those of Wall,: (1) 29 cases treated
with salicylate of soda—15 were well in less than three months,
14 in less than two months; (2) 38 cases treated with aspirin—35
were well in less than two months, and 3 in less than three months ;

(3) 165 cases treated with arsenic in various forms—114 were
well in less than three months, and 63 in less than two months;

(4) 27 cases treated with general measures and cod-liver oil—19
were well in less than three months, and 13 in less than two
months. For a child 10 to 12 years old, aspirin may be given in
doses of 15 grains, three times a day; for a child between 6 anti
8 years, a powder containing 10 grains. Wall prefers to give it
stirred up in cold milk on a full stomach.

Edwin Bramwell.

POSSIBLE PROGRESSIVE GROWTH IN MUSCULAR EFFI
(111) OIENOT AFTER FIFTY YEARS OF LIFE WITHOUT

SYSTEMATIC PHYSICAL EXERCISE. H. Fletcher, X . Y .

Med. J&um., Nov. 30, 1907, p. 1005.

In this article, Mr Fletcher recounts his personal experiences ; how,
from being a physical wreck in the early forties, he became able in
a few years to do the work of trained athletes, without marked
evidence of over-exertion. Some years later still he was put through
a series of severe tests by Professor Chittenden, when it was found
that there was a progressive improvement in his physical efficiency
and power of endurance. One does not, however, acquire much
detailed knowledge of “ Fletcherism ” from this paper, as only the
main principles of his mode of life are given. Eat what you like,
but eat it with mental calm and appreciation, and with careful and
thorough buccal treatment—this way lies the road to health,
happiness and efficiency.

J. H. Harvey Perie.

REVIEWS

133

IReviews

ABBQTEN AUS DEM NEUROLOGISOHEN INSTITUTE AN
DEB WIENER UNTVERSITAT. (Festschrift zur Feier des
25 jahrigen Bestandes des Nenrologischen Institutes.) Heraus-
gegeben von Dr Otto Marburg., Bd. xv. u. Bd. xvi, Franz
Deuticke, Leipzig und Wien, 1907, M. 25 jeder Band.

Neurologists of every country will welcome the appearance of the
Festschrift in commemoration of the twenty-fifth year of the Neuro¬
logical Institute of the University of Vienna, and the tribute of appre¬
ciation and gratitude to its director, Professor Obersteiner, by his
pupils. The editor, Dr Otto Marburg, Assistant at the Institute,
opens the volume with a contribution to the history of the Institute.
When it was founded in 1882 by Professor Obersteiner, two of his first
pupils were Dr Beevor, now President of the Neurological Society
of Great Britain, and Dr Boothe of America. The former con¬
tributes to the volume a paper on a case of pseudo-bulbar paralysis
with complete loss of voluntary respiration.

How inspiring the work of Obersteiner has been is well known
in a general way to everyone, but it is brought home to us by the
fact that more than one hundred and fifty works have been published
by his pupils, nearly all of which are substantial contributions to
the progress of neurology M

We wish the distinguished President of the Institute a long life
to continue his own investigations and to stimulate many others
to reap where he has sown.

Abstracts of a number of the papers in these volumes will appear
in this and subsequent numbers of the Revieic.

Alexander Bruce.

ARBEITEN AUS DEB DEUTSOHEN PSYOHIATRISOHEN UNI-
VERSITATS-KLINIK IN PRAG. Edited by Arnold Pick
(of Prague). Berlin, Karger, 1908. Pp. 143, with numerous
illustrations in the text and 11 plates. M. 8.

This volume contains four articles by Pick, and three articles by
other workers in the clinic; the former writes on disorders of orienta¬
tion on one’s own body, circumscribed senile brain atrophy as an
object of clinical and anatomical study, asymbolia and aphasia, the
symptomatology of atrophy of the occipital lobe. Fischer describes
a patchy atrophy of the medullated nerves in the cortex of general
paralytics ; Straussler discusses the symptomatology and anatomy

134

REVIEWS

of tumours of the hypophysis; Pappenheim reports a case of a
tabetic with periodic melancholia. The plates which illustrate the
various articles are excellent.

Abstracts of the separate contributions will be found elsewhere
in this number of the Review. C. Macfie Campbell.

DIE PROGRESSIVE ALLGEMEINE PARALYSE. 2nd Edition.

By v. Krafft-Ebing, revised and enlarged by H. Obersteiner.

Alfred Holder, Vienna, 1908, pp. 217. Price M. 5.20.

This book, although based on the presentation of the subject by
v. Krafft-Ebing in the first edition, has been so thoroughly revised
that it may be regarded almost as a new work. Especially in the
chapters dealing with the pathological anatomy and the patho¬
genesis is seen the progress of our knowledge of the subject made since
the publication of the first edition. Scarcely one quarter of the
original work has been incorporated unchanged in this edition. The
literature of the subject receives special attention, and the biblio¬
graphy at the end contains 549 references. The book is a good
example of that clearness of presentation which characterises
Obersteiner’s publications, and contains the results of his own wide
experience in addition to that of the author of the first edition.
A sober criticism is given of the numerous modem theories with
regard to the disease, and no better general presentation of the
subject could be put in the hands of the student or practitioner.

€. Macfie Campbell.

THE BORDERLAND OP EPILEPSY. Sir William R. Gowers,
M.D., F.R.S. J. «& A. Churchill, 1907. Price 4s. 6d. net.

The difficulty in diagnosis presented by anomalous cases re¬
sembling epilepsy is very great. For many years Sir William
Gowers lias kept a special list of all cases which seemed to be
on the borderland of epilepsy, “ near it, but hot of it.” In the
present volume he sums up the views he has arrived at from a
study of his very large material, and thereby adds another im¬
portant contribution to a subject which his writings have already
done so much to elucidate,

The subject-matter of the book has for the most part appeared
in a series of lectures, abstracts of which will be found in last
year’s volume of this review. Faints, vagal attacks, vertigo,
migraine, sleep symptoms, and their treatment are dealt with in
successive chapters in this volume, which will be read by all who
attempt to keep abreast of modem neurology.

Edwin Bramwell.

REVIEWS

135

NOTWENDIGE REFORMED DER UNTALLVERSIOHERUNGS-
GESETZE. (Necessary Reforms of the laws regulating
accident insurance.) A. Hoche (of Freiburg), Halle, C.
Marhold, 1907, pp. 27. Price 75 Pf.

This brochure consists essentially of the communication on the
subject made by Hoche in 1907, to the summer meeting of neurol¬
ogists and alienists in Baden-Baden. In 1891 the subject had also
come up for discussion, but at that time it was a question of defining
clinical pictures and estimating the value of symptoms; in the
present contribution the centre of interest has progressed from
questions of diagnosis to that of therapeutics. The author talks
of a popular epidemic of traumatic neuroses in obvious relation to
the laws dealing with accident insurance in Germany.

His main conclusions are as follows :—A large proportion of the
cases of traumatic neurosis are due to the accident insurance laws.
These cases, although essentially curable, owing to the existence of
the present laws very frequently do not recover. An examination
of the causes at the bottom of the development of such disorders
suggests definite means of limiting the number of such cases. The
suggested means are: (a) the elimination of all avoidable mental
irritants in the compensation proceedings; (ft) the institution of
special bureaus which would endeavour to provide suitable work
for the patient, the work being in itself a valuable therapeutic
agent; (c) the substitution, as far as possible, of the payment of a
definite sum for that of a weekly or monthly allowance.

C. Macfte Campbell.

UN MOUVEMENT MYSTIQUE OONTEMPOR AIN: Le Rdveil
rdligieux du Pays de Galles (1904-1905). J. Rogues de
Fursac. Paris: F. Alcan, 1907. Price, 2.50 fr.

The documents dealing with the psychology of religious phenomena
are often of such a date that they are difficult to use for scientific
purposes. The lives of the saints are full of interesting features, a
further analysis of which is impossible owing to insufficient data.
It is therefore extremely instructive to have a scientific account of
a contemporary religious revival from the pen of a competent
alienist. It is probable, however, that a thorough analysis of the
mental experiences of a few of those who took an active part in
the revival would have proved of more psychiatric value than the
general description of the movement en masse. The author does
not confine himself strictly to an analysis of the special phenomena

136

REVIEWS

of the revival; he takes eome pains to sketch the environment in
which the whole movement developed, of which it was an organic
manifestation. From the great upheaval of 1735 there has been a
constant series of revivals in Wales, and this spasmodic character
of their mysticism is doubtlessly deeply rooted in the Welsh
temperament. The Welsh have lived in intellectual retirement,
and as the modern spirit penetrates the mass of the people the
conditions necessary for such revivals will disappear.

The good effect of the revival was seen in a distinct elevation
of public morality, especially with regard to the use of alcohol; on
the other hand, certain unstable natures were unable to support
the mystical exaltation, and the number of cases of psychoses
with distinct religious colouring was increased.

The book is written in a pleasant style, and if it does not give
any profound analysis of the phenomena, it at least gives a useful
outline of an important contemporary movement.

C. Macfie Campbell.

AERZTLIOHES UEBEB SPREOHEN UND DENKEN. Von G.

Anton (of Halle-a-S.). Halle: C. Marhold, 1907, pp. 20.

This brochure consists of a general lecture delivered on the subject
of disorders of speech and of disorders of thought closely associated
with interference with the speech mechanism. The place which
speech plays in ordinary thought is very clearly presented, and the
subject is treated in a very suggestive manner.

C. Macfie Campbell.

BOOKS AND PAMPHLETS RECEIVED.

Frugoni. “Intomo ai Rapporti tra Pneumogastrico e Funzione Renal s.”
Soc. Tipo. Fiorentina, Firenze, 1907.

C. K. Mills and W. G. Spiller. “ Symptomatology of Lesions of Lenticular
Zone, with Some Discussion of the Pathology of Aphasia.” Reprinted from
Joitm. Kerv. and Merit. DU., Aug. and Sept. 1907.

Morton Prince. “ The Criminal Responsibility of Insane Persons.” Amer.
Med. Assoc., Chicago, 1907.

Morton Prince. “The Educational Treatment of Neurasthenia and
Certain Hysterical States. Mass. Med. Soc.

Morton Prince and Isador Coriat. “Cases illustrating the Educational
Treatment of the Psycho-neurose3.” Clinic for Nerv. DU., Boston.

IReview

fleurolog^ anb Ips^cbiatr^

Original Hrticles

ON THE SPINAL CHANGES IN A CASE OF MUSCULAR

DYSTROPHY.

By GORDON HOLMES, M.D.

The muscular dystrophies are generally described as primary muscle
diseases, in which the peripheral as well as the central nervous
system is intact. Undoubtedly in the majority of the cases in
which the nervous system has been examined, even by modem and
adequate methods, no changes have been found in the lower motor
neurons to which the muscular atrophy could be attributed, but
in a certain number degenerative or atrophic changes have been
observed in the ventral horns of the spinal cord, or in the ventral
roots and peripheral nerves. The interpretation of these patho¬
logical affections of the peripheral motor neurons will need further
discussion; it has already raised so much interest that a short
description of another case in which it was present seems advisable.
Through the kindness of Dr Beevor, under whose care the patient
was when she died in the National Hospital, I have permission to
give a short abstract of the clinical notes which were then taken.

E. S., a girl of eleven years of age, was admitted to hospital in
July 1907. Neither of her parents nor any of their relatives were
affected with similar symptoms. There were four children in the
family : the eldest, a sister, was alive and well; the patient was
the second member; the two younger children were boys, who were
apparently healthy till about the age of two years, when each began

to find difficulty in going up steps and in walking anv distance:

R. OF N. & P. VOL VI. NO. 2—K

138

GOKDON HOLMES

according to the mother they were both “ touched with paralysis.”
Both died in early childhood—the one from pneumonia, the other
in a fit. The patient started to walk at the age of fourteen months,
and got about naturally till eighteen months old. Then she began to
fall frequently; at first she was able to rise from the ground, but
later became unable to do so. She had been bedridden for a con¬
siderable time. At about the age of eight or nine years it was
noticed that her arms were affected, and from that time they
became rapidly weaker, till at the date of her admission to hospital
she was practically helpless. The muscles supplied by the cranial
nerves were unaffected, but all those of the limbs and trunk were
very weak. Owing to a large amount of subcutaneous fat there
was not much atrophy visible to the eye, but on palpation very
little muscle tissue could be felt, and even when firmly contracted
the muscles were far from firm. None of them appeared to be
enlarged at this date. Those of the neck were but little affected.
All the movements of the upper limbs were extremely feeble, even
those of the fingers, but there was no absolute loss of power in any
of the muscles except in the latissimi dorsi. The intercostals were
also very weak, and breathing was chiefly diaphragmatic; the
abdominal muscles were less affected. The condition of the lower
limbs was very similar to that of the upper; the movements at the
hip-joints were the feeblest. The limbs were very flabby, and it
was noted that “ there was no tone anywhere, but very marked
hypotonicity in all the muscles.” Sensation was unaffected. The
tendon jerks of both the upper and lower limbs were absent. The
reaction of all the affected muscles to the interrupted current was
very much diminis hed, but there was no qualitative change. When
in hospital the patient developed pleurisy and broncho-pneumonia,
and died four weeks after admission.

A post-mortem examination was made about twenty hours after
death. The muscles of the shoulder-girdle and arms were very small
and soft; they were pale in colour and evidently infiltrated by fat.
Of the pectorals and latissimi dorsi practically nothing could be
seen but a few pale strands in the fatty tissue. The condition of the
calf muscles and the glutei was very similar, the other muscles of
the legs were less affected. All the peripheral nerves which were
examined seemed to be somewhat smaller than they should be
normally. The central nervous system was well developed, and
there was no evidence of disease in it to the naked eye. The ventral

SPINAL CHANGES IN MUSCULAR DYSTROPHY 139

spinal roots were, however, remarkably small, especially those of
the cervical and lumbo-sacral enlargements; they were scarcely
one-third the size of the corresponding dorsal roots, and were, in
addition, pinkish-grey in colour.

The microscopical examination of the affected muscles revealed
in them the changes which are characteristic of the myopathies;
minute description is not necessary. In the majority of those which
were examined the apparent bulk of the muscle was largely occupied
by fat in which muscle fibres in larger or smaller bundles were con¬
tained. Some of the fibres were apparently normal; in the deltoid
and biceps the majority were so; others were very much atrophied,
and contained an excess of sarcoplastic nuclei, but their cross
striation was generally well preserved; finally, in some muscles a
variable number of fibres were hypertrophied. These enlarged
fibres often contained central nuclei, and their cross striation was
less distinct than normal. A few dividing fibres were seen. There
was a variable increase of connective tissue in the affected muscles
in addition to the fat. In the much wasted muscles there appeared
to be a relative excess of muscle spindles ; these were all intact.

No pathological changes were seen in the fore-brain or brain¬
stem. The white matter of the spinal cord also appeared intact
when stained with the Weigert-Pal method, and no definite ab¬
normality was detected in the grey matter, though in places the
myelinated network of the ventral horns appeared somewhat
rarified. The dorsal spinal roots were normal, but marked changes
were at once observed in the ventral. Their small size was striking
even to the naked eye, and under the microscope it was seen that not
only was there a reduction in the number of the fibres, but that
many of those which remained were certainly atrophied, and that
the connective tissue of the roots was increased. Owing to this
sclerosis the real atrophy of the roots was greater than the apparent.
No accurate enumeration of the root fibres was made for comparison
with the normal, but it is probable that their number was reduced to
at least half.

But the most prominent change was the reduction in number
and in size of the cells of the ventral horns of the cord. This was
observable in all segments which were examined, but it was greatest
in the cervical and lumbar enlargements. Here practically no cells
of normal size could be seen, and many of those which persisted were
atrophied and shrunken, and contained an amount of pigment

140

GORDON HOLMES

which was certainly excessive considering the early age at which
the patient died. In the more affected cells the nuclei were small
and distorted, and not distinctly visible even with Nissl’s stain. In
order to estimate the reduction in the number of the cells the whole
of the fifth and seventh cervical, and the fifth lumbar segments were
embedded in paraffin, cut in serial section, fifteen micra in thick¬
ness, and stained with thionin. The cells of the principal groups of
each segment were then counted in alternate sections, and, in order
to avoid enumerating each cell more than once, only those cells in
which the nucleus was distinctly visible were included. By dividing
the total number of cells of each group by the number of sections in
which they were contained, the average number of cells per section
in each group for the whole segment was obtained. The same
segments of a normal cord, from a boy fifteen years of age, were
treated in exactly the same way.

The results which were obtained may be given in tabular form:—

{ Ventro-mesial group
Ventro-lateral group
Dorso-lateral group

( Ventro-mesial group
C 7 -j Ventro-lateral group
( Dorso-lateral group

{ Ventro-lateral group
Central group
Dorso-lateral group

Normal
average per
section.

£. S. average
per section.

Percentage
to which
cells were
reduced.

4-8

3-9

81-2

15*8

7-6

481

17-4

10-9

62-6

2-5

62-5

6-4

25-6

8-7

3-48

21-7

10.2

1-57

15-3

From these figures it is at once evident that there has been a
considerable diminution in the number of the cells of the chief groups
of the ventral horns of these segments, and that the dimin ution was
most marked in the segment which was chosen from the lumbo-sacral
enlargements. The examination of sections from other segments
shows that these figures approximately represent the average loss
of cells which each segment of the cervical and lumbar enlargements

SPINAL CHANGES IN MUSCULAR DYSTROPHY 141

at least has suffered. The enumeration of cells is such a tedious
process, and requires so much time, that it was not attempted in more
than these three segments. The cells of the lateral and dorsal
horns and of Clarke’s column were unaffected. In the portions of
the ventral horns which had suffered most severely there was a
slight increase of neuroglia, which was undoubtedly only secondary
to the disappearance of the cells.

The atrophy and the diminution in the number of fibres of the
ventral roots evidently corresponded to this loss of the ventral
cornual cells and the atrophy of those which remained. Similar
changes were found in many of the bundles of the nerve trunks and
in the intramuscular nerves which were examined. In places there
was distinct evidence of disappearance of fibres, and a variable pro.
portion of those which remained were abnormally slender and their
myelin sheaths stained badly with hsematoxylin. In addition
there was a considerable increase of the connective tissue of the
endoneurium and perineurium of the nerves, but there were no
signs of acute degeneration of the nerve fibres or of inflammatory
or active proliferative processes in the sheaths.

There can be no doubt as to the nature of this case. The clinical
symptoms, their onset at an early age and their slow evolution, as
well as the familial nature of the disease, undoubtedly justified the
diagnosis of primary myopathy. The histological changes in the
muscles confirmed it. But as the integrity of the nervous system
is generally assumed in the primary muscular atrophies, the nature
and significance of these changes which were discovered in the lower
motor neurons must be considered.

This is not an isolated observation; similar changes have been
described by other observers. As early as 1879 Erb and Schultze
(3) recorded the disappearance of many of the larger cells of the
ventral horns, atrophy of some of those which remained, and glial
sclerosis in their place, in the spinal cord of a man who died at the
age of fifty-eight years, with muscular atrophy which had set in
two years previously. The ventral roots and peripheral nerves
were unaffected. In the original communication this case was
regarded as a myelopathic amyotrophy; but later, in his well-known
monograph on the muscular dystrophies, Erb (2) stated his opinion
that this diagnosis was probably incorrect, and that the case was
probably a muscular dystrophy of the juvenile variety.

Kahler (8) also found atrophy and pigmentation of the ventral

142

GORDON HOLMES

horn cells, but no change in the ventral roots or peripheral nerves,
of a case which was accepted by Erb as a typical example of the
juvenile form of muscular dystrophy.

Frohmaier (4) observed similar changes in another case of the
juvenile form who died at the age of fifty-eight years, but the
ventral roots were, in addition, atrophied. The symptoms probably
started at about forty.

Heubner’s (6) case belonged to the pseudo-hypertrophic form.
The symptoms began when the patient was three, and progressed
slowly till death, which occurred at twenty-one. There was a
considerable diminution in the number of the larger ventral horn
cells at all levels of the cord, but especially in the cervical and
lumbar enlargements. There was also atrophy of many of the
fibres of the peripheral nerves and of the ventral roots, with increase
of connective tissue in both. The muscle changes were typical of a
primary dystrophy.

Preisz (13) has also reported a case of pseudo-hypertrophic
paralysis, in whom the symptoms appeared at fifteen years of age,
and death took place at twenty-three. He found marked atrophy
of the ventral horn cells and some increase of neuroglia in the grey
matter. He does not mention if there was any numerical reduction
of the cells. The fibres of the nerve trunks were small, their myelin
sheaths stained badly, and the fibrous tissue of the endoneurium
and perineurium was increased.

Schutz’s case (17) also probably belonged to the pseudo-hyper¬
trophic type. The disease first showed itself at the age of seven
years, and death occurred at fifteen. There was a considerable
reduction in the number of the ventral horn cells, and those re¬
maining were atrophied. The peripheral nerves were described as
normal.

The case which Striimpell recorded (18) was rather anomalous.
The patient was a man in whom the symptoms first appeared at about
the age of twenty-eight, with atrophy of the muscles of one hand ;
for three years the disease was limited to this arm ; he died at forty.
His mother had been probably similarly affected. The ventral
horns were shrunken and had lost the majority of their larger cells,
while those which remained were atrophied. There was also a
definite loss of fibres in the ventral spinal roots and in the peripheral
nerves. The author regarded his case as one of myopathy owing
to the heredity, the absence of the reaction of degeneration and of

SPINAL CHANGES IN MUSCULAR DYSTROPHY 143

fibrillation in the affected muscles, and the character of the histo¬
logical changes in the muscles, although the early distribution of the
affection and the age of the patient at the time of its onset suggested
that it belonged to the spinal atrophies.

In a long-standing case of the facio-scapulo-humeral variety,
Sabraz&s and Breugues (15) observed simple atrophy of the ventral
horn cells, especially in the cervical enlargement, but without any
numerical reduction. The ventral roots and peripheral nerves were
normal, but probably contained an excess of small fibres.

Kollarits (9) has described atrophy, with probably reduction in
number of the ventral cornual cells, especially in the cervical and
lumbar enlargements, in an early case of pseudo-hypertrophic
paralysis.

Rocaz and Cruchet (14) found diminution in the number of the
cells, pathological changes in these persisting and glial prolifera¬
tion in the ventral horns, in the same type of muscular dystrophy.
The peripheral nerves were no rmal .

Lorenz (10) also observed a numerical diminution of the ventral
horn cells in the spinal cord of a case of the juvenile form, but the
cells which remained were normal.

Port (12), in another typical case of the juvenile variety, in
which the onset occurred in about the nineteenth year and death
took place at forty-two, also observed only a diminution in the
number of the ventral horn cells.

The most recent observation is by Ingbert (7), who carefully
examined the nervous system of a case of pseudo-hypertrophic palsy.
He found a lessened number of cells in the lateral horns (? ventro-
and doreo-lateral groups), below and including the fourth lumbar
segment, and a slight increase of neuroglia in the grey matter. He
measured the cross section of a number of the ventral roots and of the
corresponding dorsal roots, and found, by comparing the size of the
ventral roots with that of the dorsal, that the former were consider¬
ably smaller than normal. He also counted the number of fibres
in the fifth lumbar ventral root (5171), and found that it contained
leas than half the normal number (10,366).

Thus in the cases observed by Erb and Schultze, Heubner,
Schutz, Striimpell, Kollarits, Lorenz, Rocaz and Cruchet, Port, and
Ingbert, as well as in my own, there was a definite diminution in the
number of the ventral horn cells, while in those reported by Kahler,
Frohmaier, Preisz. and Sabraz&s and Breugues, these cells had only

144

GORDON HOLMES

undergone atrophy or'slow degenerative changes. In the majority
of these cases pathological changes were also observed in the ventral
roots and peripheral nerves. In other specimens vascular or
interstitial lesions were found in the cord, which were generally not
limited to, and often did not affect, the grey matter, as in the case
of Gowers and Lockhart Clarke (5). These were evidently only
adventitial changes, and were not either directly or indirectly con¬
nected with the primary disease. Eollarits also observed pallor
round the central canal and a paucity of fibres in Lissauer’s zone.

It is not easy to decide at once on the origin and significance of
the lesions which were found in the lower motor neurons in these
fourteen cases. In my case, and in the majority of the others,
there can be no doubt but that it was an acquired condition and not
a developmental defect; the nature of the cell changes, the slight
secondary gliosis of the ventral horns, the definite evidence of loss
of fibres in the ventral roots and peripheral nerves, as well as the
increase of connective tissue in the nerves, makes this certain.
There are three possible explanations which may be discussed.

In the first place it is conceivable that the nervous disease was the
primary and that the muscular atrophy was due to it—in other words,
that the disease was of neuropathic origin. That this is possible
has been put forward by Erb (2), who inclined to the view that the
so-called primary muscular dystrophies are really trophoneuroses,
and are dependent on either structural or functional changes in the
trophic cells in the ventral horns of the cord which cannot, in the
majority of the cases, be revealed by our histological methods, but
of which such cases as that reported in this paper are definite evi¬
dence. Strumpell’s view is somewhat similar ; he assumes a defect
of neurotrophic influence which first expresses itself by trophic
disturbances in the portion of the neuron which is most distant
from the cell—that is, in the intramuscular nerve endings. Some
support was offered to this hypothesis by Sacara-Tulbure (16), who
described changes in the nerve endings in a case of pseudo-hyper¬
trophic paralysis; but, as Pick has pointed out, the histological
methods which can demonstrate these structures are so imperfect
that but little weight can be laid on this isolated observation.

It is generally assumed that the clinical symptoms and the mode
of evolution of the muscular dystrophies separate them definitely
from the myelopathic atrophies, yet there is scarcely a single symp¬
tom of the one which is not occasionally met wi h in the other

SPINAL CHANGES IN MUSCULAR DYSTROPHY 145

group, and it may be difficult to draw a sharp distinction even
between the histological changes in the muscles o' the two types.
Despite these facts, it appears to me very improbable that the
myopathies have a neuropathic basis; indeed, I cannot see how this
contention can be logically sustained. In the first place, there is no
reason why the muscles of certain individuals should not possess a
morbid tendency to regressive changes quite as well as parts of the
nervous system ; and secondly, in the majority of the cases which
have been examined no histological evidence of nervous change to
which the muscular atrophy could be secondary has been found.
I have had the opportunity of investigating the nervous system of
a case of pseudo-hypertrophic paralysis which died in an advanced
stage of the disease, and I failed to find any structural alterations
in any portion of it, despite the use of modem technical methods.
Even the case reported here, and the other thirteen cases cited in
which pathological changes were found in the lower motor neurons,
do not seem to me strong evidence in favour of the hypotheses of
Erb and Striimpell. The histological changes in the ventral horns
in my case were, it seemed to me, quite distinct from the degenerative
cell changes I have found in any of the many spinal amyotrophies
which I have examined, and the muscular affection exceeded them
very much in both degree and extent.

In the second place, it is possible that the neural and muscular
changes were the result of coincident dystrophies. I admit the
possibility of this view, but I do not see any strong evidence in
support of it, though undoubtedly arguments may be raised in its
favour. If we assume that the nervous lesions in my case were due
to a primary neural dystrophy, we find that it is connected with
the most typical cases of primary myopathy, in which no nervous
changes were found, by various transition types, as by Kollarits’
ease, in which the loss of cells was very small, and by the cases of
Kahler, Frohmaier, Preisz, and Sabrazes and Breugues, in which
there was atrophy but no loss of the cornual cells. If this hypo¬
thesis be accepted, it would be necessary to further subdivide the
“ muscular dystrophies ” into the primary myopathies and the
mixed neural and myopathic atrophies.

The third possibility, and that which appears to me the most
probable explanation of these cases, is that the neural changes
are secondary to the primary muscle disease. The view has been
expressed that each lower motor neuron and the muscle fibre or

146

GORDON HOLMES

fibres in which it terminates form a biological entity, and that
when the vitality of any part of this unit is seriously disturbed,,
the rest will react to the lesion and may undergo fatal regressive
changes. It is unnecessary to refer to the atrophy of the muscle
fibres which results from a neural lesion, but the evidence of the
converse process is not so evident. It is true that reactionary
changes can be generally found in some part of the neuron when the
muscles in which it terminates have been removed by amputation,,
or destroyed by a tumour, but then part of the neuron itself ia
evidently injured. I know not of any evidence of neural degenera-
tion secondary to disease entirely limited to muscle tissue, but
it seems very probable that when muscle fibres undergo complete
atrophy and disappear, the functional, and probably secondary
thereto the nutritional, equilibrium of the neurons which terminate
in these fibres must be disturbed. And further, in this case, as
in the example of muscular dystrophy which I have described, the
terminal branches of the axiscylinder, left naked by the disappear¬
ance of the muscle fibres, will be probably injured and possibly
destroyed by the connective tissue which proliferates secondary
to the muscle disease. This is the explanation which I am inclined
to adopt of the pathological changes which have been found in the
peripheral nerves and the ventral horn cells in a considerable number
of cases which have been regarded as primary muscle diseases. At
the same time I admit the possibility of the hypothesis already put
forward, according to which the muscular and neural changes are
due to a coincident tendency to muscular and neuronic degeneration.

It remains to consider why these nervous changes, if they are
secondary to the muscle disease, occur in some cases of primary
myopathy and are absent in others. Evidently the clinical variety
of the disease is unimportant, as the cases of Heubner, Preisz, Schutz,
Eollarits, Rocaz and Cruchet, and Ingbert belonged to the pseudo-
hypertrophic form, while those of Erb and Schultze, Kahler,
Frohmaier, Striimpell, Lorenz, Port, and probably my own, were of
the juvenile type, and that recorded by Sabraz£s and Breugues was
an example of the facio-scapulo-humeral variety.

The age at the onset of the symptoms, it might be thought,
would have some influence on the occurrence of these secondary
nervous changes, as the degeneration of muscle fibres in early child¬
hood could possibly arrest or inhibit the development of the neurons
concerned in their nutrition; but an analysis of these fourteen cases

SPINAL CHANGES IN MUSCULAR DYSTROPHY 147

shows that in many instances, as in"those of Erb and Scholtze,
Frohmaier, Striimpell, and Port, the muscle disease set in relatively
late in life. The long duration of the disease does not seem to be an
essential factor. The integrity of the nervous system in some cases
of primary muscular atrophy, and the atrophy or degeneration of
some of the lower motor neurons in other cases, is parallel to the fact
that sometimes all the ventral horn motor cells disappear after
amputation of the segment of the limb which they supply, while
in other cases these cells may be practically unaffected.

Reference may be made here to a case which has been reported
by Baudouin (1) as myatonia congenita, owing to the resemblance
the pathological changes which were discovered in it bore to those
in’my case. The patient was evidently affected from birth, and died
at the age of four months. The clinical symptoms were regarded as
typical of myatonia congenita, as this disease was originally de¬
scribed by Oppenheim. The functions of the cranial nerves were
unaffected, excepting slight strabismus which may have been only
an incidental symptom, but from birth the limbs neck, and trunk
were powerless and flabby. There was practically no power of
movement in the proximal joints of the limbs, but slight of the toes
and fingers. The muscular hypotonia was very marked, and the
Faradic excitability of the muscles was very much reduced. Sen-
tion was unaffected; the tendon jerks were absent. On micro¬
scopical examination it was found that the muscles were largely
replaced by fat, and contained a considerable excess of fibrous
tissue; the majority of the fibres which remained were atrophied
and contained a large number of sarcoplastic nuclei, but others were
enormously hypertrophied and were penetrated by nuclei. Some
fibres were dividing. There was a relative excess of muscle spindles.
In fact, the muscular changes were identical, as the illustrations
show, with those which are regarded as pathognomonic of the
primary muscular dystrophies ; the author himself remarks, “ les
lesions de la regression musculaire, telles qu’on peut les voir dans les
myopathies.” But there was in addition a considerable diminution
in the volume and possibly in the number of the ventral horn cells,
a reduction of the ventral roots to less than half their normal size,
and in these and the peripheral nerves there were atrophied fibres
and secondary fibrosis. The similarity of the histological changes
in this case to those in the muscular and nervous systems of my
case needs no further mention; in fact, the morbid anatomy of

148

GORDON HOLMES

Baudouin’s myatonia congenita was identical with that of a con*
siderable number of undoubted cases of muscular dystrophy. In
origin, too, they were probably similar, for, as Baudouin points out,
the abnormal condition of the muscles could not be regarded as due
merely to an arrest of development, it must have been an acquired
condition. Owing to its intensity it could scarcely have been
secondary to the simple atrophy of the ventral horn cells, and its
nature too was quite distinct from that of the neuropathic atrophies.
It must be concluded, then, that the disease of the muscles was an
acquired regressive affection, dependent probaly on an intrinsic
developmental anomaly. Let it be remembered that till birth at
least the development of the muscles is independent of the nervous
system, as has been demonstrated by the presence of normal muscles
in cases of amyelia. From the pathological point of view, therefore,
this case can be regarded as a primary muscular dystrophy, excep¬
tional only in the fact that the disease commenced during intra¬
uterine life. The clinical symptoms of the case also resembled those
of the muscular dystrophies so closely that it seems unnecessary
to place it in a separate class. There was not only atonia, but
practically complete paralysis of the muscles, and the muscles of
the basis of the limbs were more affected than those of the distal
segments. There was quantitative, but no qualitative, change in the
electrical reactions, the deep reflexes were absent, and sensation was
not affected. From the clinical point of view, too, the case was
therefore unlike the myopathies only by the fact that the disease
started so early in life. Experience has already shown that it is
impossible to place a limit in the one direction to the age at which
the symptoms of muscular dystrophy may set in—cases have been
recorded which commenced after sixty years of age—and it seems
equally impossible to set up a limit in the other.

It may be that other cases have been included in myatonia
congenita which have been only instances of myopathy of excep¬
tionally early or congenital origin. Indeed, cases have been reported
under this title in which the origin of the disease was undoubtedly
post-natal. It is not my intention to deny the existence of that
form of disease which Oppenheim has described as a pathological
entity, but there seems to be a danger of including cases of different
nature within it. It should be recognised that muscular atonia is a
prominent symptom of the myopathies, unless the extensibility of
the muscles is restricted by the formation of fibrous tissue within

SPINAL CHANGES IN MUSCULAR DYSTROPHY lU*

them. If, on the other hand, contractures developed in some
muscles in a case of myatonia congenita, owing to the atonia of their
antagonists or to the deposition of fibrous tissue within them, as
would probably have occurred in Baudouin’s case if the child had
lived, so that the mobility of the joints was lessened and not
excessive, the case would not be, it may be assumed, immediately
rejected from Oppenheim’s group if the other symptoms conformed
to the type.

The most important and definite distinction between myatonia
congenita and the muscular dystrophies seems to be that in the
former the symptoms are not progressive and that amelioration may
occur. Even if these cases, or any of them, were congenital muscular
dystrophies, this feature would not be surprising in view of the
difference of the nutritional conditions of the individual before and
after birth, and the change in the mutual relationship of the muscular
and nervous systems in intra- and extra-uterine life.

References.

1. Baudouin, A. La Semaine midicalc, 22nd May 1907.

2. Erb, W. Deutsche Zeitschr.f. Nervenheilk., Bd. i., 1891.

3. Erb und Schultze. Archiv f. Psychiatrie, Bd. ix., S. 369, 1879.

4. Frohmaier. Deutsche Med. Wochenschr., 1896, Nr. 23 u. 24.

5. Gowers and Lockhart-Clarke. Med.-Chir. Trans. Lond ., vol. lvii.,

p. 247.

6. Heubner. Fsstschr. fur Wagner, Leipsig, 1887. (Cited by Erb).

7. Ingbert, C. E. Joum. of Nerv. and Ment. Diseases, vol. xxxiv., p. 1,
1907.

8. Eabler. Zeitschr. f. HeiUc., 1884, S. 209.

9. Kollarits. Deutsche Archiv f. klin. Med., Bd. Ixx., S. 157, 1901.

10. Lorenz. “ Die Muskelerkrankungen,” Wien, 1904. Zweite Auflage.

11. Pick, Friedel. Deutsche Zeitschr.f. Neroenheilk., Bd. xvii., S. 1, 1900.

12. Port, Fr. Zeitschr. f. klin. Med., Bd. lix., S. 464, 1906.

13. Preisz, H. Archiv f. Psychiatrie, Bd. xx., S. 417, 1889.

14. Rocaz et Cruchet. Archives de Mid. de Enfants, T. ix., no. 6 (abstracted
Neurolog. Centralbl., 1906, S. 1005).

16. Sabraz&s et Breugues. Nouvelle Iconograph. de la Salpitriere, T. xii.,
p. 48,1899.

16. Sacara-Tulbure. Revue de Midicine, 1894.

17. Schutz. Tagebl. der 62 ten Vers. Deutscher Naturf, 1889. (Cited by
Erb.)

18. Striimpell. Deutsche Zeitschr. f. Nervenheilk., Bd. iii., S. 471, 1893.

150

J. A. GUNN

THE MYASTHENIC REACTION EXPERIMENTALLY
PRODUCED IN THE FROG.

By J. A. GUNN, M.D., B.Sc., M.A.,

Assistant in the Materia Medica Department, Edinburgh University.

Ik the course of an investigation of the pharmacological action
•of yohimbine, I found that there is produced in frogs, by the
administration of large doses of this alkaloid, a condition of rapid
muscular exhaustion, the symptoms of which present a close
similarity to those which obtain in the disease in man, myasthenia
gravis. Further inquiry showed that this resemblance is not a
mere superficial one, but that the electrical reactions of the
nerves and muscles of the yohimbinised frog are identical with
those which have been generally found in myasthenia gravis,
and which are designated by the term “ myasthenic reaction,”
and associated with the name of Jolly, who first described them.

Seeing that post-mortem examinations of cases of myasthenia
gravis have as yet failed to demonstrate lesions which can ade¬
quately explain the phenomena of this disease, the experimental
production of a similar condition is not merely interesting, but
may also be of importance in so far as pharmacological experi¬
ment affords wider facilities for the exact determination of the
site of this muscular exhaustion. Though identity of result does
not of necessity mean identity of cause, still the fact that the
artificially produced effects of a toxic agent like yohimbine are
identical with the effects produced by a presumable toxin operat¬
ing in myasthenia gravis, indicates certainly the possibility, even
the probability, that the nature of the action of the causes pro-
ducing these effects is the same in the two cases.

In order to institute this comparison it is convenient, first,
to review briefly the condition known as myasthenia gravis;
■secondly, to describe the similar condition produced in the frog
by yohimbine; and, finally, to endeavour to locate as far as
possible the site of the action of yohimbine.

In myasthenia gravis “ there is weakness, sometimes amount¬
ing to complete paralysis, of some or all of the voluntary muscles
— e.g. the first thing in the morning they may respond normally to

MYASTHENIC REACTION IN THE FROG 151

the will, but they become rapidly exhausted after voluntary con¬
tractions, regaining their power again after rest. The entire
system of voluntary muscles may be affected, but those muscles
are most apt to be implicated which normally act most constantly,
such as the cervical muscles and the extrinsic muscles of the eye¬
balls. The bulbar muscles are very generally involved. Hence
the term ‘ asthenic bulbar paralysis.’ A characteristic feature of
the disease is its tendency to fluctuate in severity from day to
day, or from week to week, or even to disappear for months, to
reappear” (1).

Jolly found in a myasthenic patient that if a striped
muscle be subjected to faradic stimulation, either directly or by
way of its nerve, after a short time the muscle manifests fatigue
of the same nature as ensues after voluntary stimulation of the
muscles. If faradic stimulation be alternately applied for a few
seconds and discontinued for a few seconds, the resulting tetanus
of the muscle becomes less and less complete with each successive
stimulation, until a stage is soon reached in which only at the
entrance of the stimulation is there elicited a transient contrac¬
tion (like the contraction from making a constant current), while
during the continuance of faradisation the muscle response
becomes quite weak or eventually disappears. By either in¬
creasing the strength, or by applying the same strength, of
current after a minute’s rest, these phenomena are repeated. If,
instead of alternately applying and discontinuing the stimulations
for periods of a few seconds, the muscle be faradised continuously
for a minute, a similar diminution in the muscular response
results even to its ultimate disappearance (2).

This fatigue effect is called the “ myasthenic reaction.”
It “clearly demonstrates an extraordinary inaptitude for pro¬
longed muscular activity. The same condition is reflected in the
volitional actions of such patients ” (3).

How far are the effects produced in frogs by yohimbine
comparable with the conditions in myasthenia gravis ?

Symptoms of Muscular Exhaustion in Frogs after Subcutaneous
Injection of Yohimbine. —I have found that the minimum lethal
dose of yohimbine lactate for male frogs (Rana temporaria) is
0 05 grm. per kilo of frog weight. After similar administration
of toxic, but sublethal, doses of yohimbine lactate (e.g. 0 0 4
to 0 04 8 grm. per kilo) there occur in frogs symptoms of

152

J. A. GUNN

paralysis, due, firstly, to an action on the central nervous system ;
and, secondly, to an action on the peripheral neuro-muscular
mechanism, and respectively early and late in their cnset.

The symptoms of the former action appear in about two
hours, and may be dismissed briefly, as they are not primarily
concerned in the myasthenic reaction. They consist of paralysis
of the functions of the mid-brain, cerebellum and medulla, wit¬
nessed by inco-ordination of movement, by loss of the power of
jumping and of recovering its position when the animal is laid on
its back, and by arrest of the respiration. At this period the
voluntary muscles and their motor nerves react normally to
electrical stimulation, and there is no evidence of rapid muscular
exhaustion on the part of the frog. For example, when pinched
he responds by vigorous and sustained kicking, though he is
unable to jump away. If a hind limb be drawn down several
times, it is each time rapidly pulled up again to its usual flexed
position.

Later, however, in about four or five hours after injection,
other symptoms appear. The response to pinching, though as
prompt as heretofore, and still elicited by slight stimulation, is ill-
sustained. If a hind limb be now drawn down once it is rapidly
pulled up, but if drawn down a second time it remains extended.
A few movements, therefore, suffice to bring on fatigue. The
functions of the central nervous system are recovering so that
he may be able to give one vigorous jump, but after this effort
he is incapable of further movement. After a very short rest
this power is regained, only to disappear after renewed voluntary
movement. Substituting “intoxication” for “disease,” the de¬
scription applied to myasthenia gravis is equally applicable to
the symptoms in the frog during this stage of yohimbine poison¬
ing—“ the speedy production of muscular exhaustion constitutes
the most striking feature of the disease. Persistence in a move¬
ment causes it to become gradually weaker, and ultimately
impossible, until after a short rest, when it can again be
repeated” (4).

Generally by the end of twenty-four hours after injection
of yohimbine in the doses mentioned the frog recovers from
these symptoms of unduly rapid onset of fatigue.

One symptom is interesting, though it may be a coincidence
and not significant—namely, rise of the lower eyelids of the frog.

MYASTHENIC REACTION IN THE FROG 153

This symptom is a herald of onset of the muscular exhaustion
which later appears in the limb muscles. The lower eyelid
of the frog is depressed by muscular effort, and rises when this
effort ceases. Its rise, therefore, corresponds to ptosis in man.
In myasthenia gravis, ptosis is very frequently also one of the
earliest symptoms. It is at least an indication that myasthenia
gravis may be due to a toxin having a similar action to yohim¬
bine, the more so as there is to hand an example in cobra
poisoning of a toxin which produces ptosis in man, and in the
frog elevation of the lower eyelids (5).

There is thus manifestly a singular correspondence in the
clinical picture of myasthenia gravis and yohimbine poisoning.
The question now arises as to how far this symptomatic re¬
semblance is intimate in nature, and how is the muscular fatigue
in the latter condition to be explained.

It is convenient first to consider:

Faradic Stimulation of the Motor Nerve .—In order to in¬
vestigate this a frog was killed during the fatigue stage of
yohimbine poisoning, and a gastrocnemius muscle with its sciatic
nerve isolated immediately, and kept moistened with Ringer’s
solution. A du Bois Reymond coil with Neef’s hammer was
used to stimulate the nerve, which was laid on platinum elec¬
trodes. The femoral attachment of the gastrocnemius was fixed,
and the tendo-Achillis connected by a thread to a lever, which
recorded the muscular response on a slowly-revolving smoked
drum. The results of such an experiment are shown on Figs.
A and B.

Faradic stimulation of the sciatic nerve with the secondary
coil at 240 mm. evoked no muscular contraction (A 1).

With the secondary coil at 160 mm. a full tetanic contrac¬
tion of the muscle was obtained. Though, however, the nerve
was stimulated for twenty seconds, tetanus of the muscle lasted
only ten seconds. During the remaining ten seconds the muscle
gradually relaxed, and eventually responded by only the feeblest
contractions (A 2).

After an interval of eight seconds the nerve was again
stimulated for over ten seconds, and an incomplete and evanescent
tetanus of the muscle was elicited. During the remainder of
the stimulation no effect was produced on the muscle (A 3).

With subsequent faradisations, separated by a shorter interval

154

J. A. GUNN

of time, there resulted a contraction only at the moment of
entrance of the current, and this contraction became feebler and
feebler (A 4, 5, and 6), and eventually disappeared (A 7).

After a short interval of rest the muscle again responded,
the vigour of this response varying with the length of rest
interval elapsing between the stimulations (A 8, 9, and 10).

After a rest of three minutes there was almost complete
restoration of the nerve-muscle to its previous condition (B 1),
but subsequent repeated stimulations separated by a short
interval repeat the effects seen in Fig. A.

If the nerve of a normal gastrocnemius-sciatic preparation be
stimulated under the same conditions of experiment, complete
tetanus of the muscle lasts for many minutes.

Direct Faradic Stimulation of the Muscle (Fig. C).—As before,
a frog was killed during the fatigue stage of yohimbine poisoning,
and a gastrocnemius muscle isolated immediately. The muscle
was stimulated directly. Fig. C 1 shows the height of a single
muscle twitch under these conditions. The muscle was then
directly farad is ed continuously for seventy seconds. As the
stimulation went on, the muscular response, beginning with
complete tetanus, degenerates into irregular contractions, which
finally disappear (C 2).

Subsequent faradic stimulations, each lasting a few seconds,
and separated by an interval of a few seconds, induced a con¬
traction only at the beginning of stimulation. These resembled
a single muscle twitch (C 3 and 4). These contractions became
less and less on repetition of the stimulations, and finally dis¬
appeared (C 5, 6, and 7).

With successively longer periods of rest, the stimulations
produce a more and more effective tetanus (C 8, 9, and 10), to
become less effective when the interval of rest is made shorter
(C 11, 12, and 13).

There is therefore on direct faradisation an unduly rapid
onset of exhaustion of the yohimbinised muscle, as compared with
the behaviour of a normal muscle under the same conditions.

The electrical reactions of the yohimbinised muscles are
therefore identical with those which have been described by
Jolly in myasthenia gravis.

Faradic versus Galvanic Stimulation of the Muscles (Fig. D).—
In myasthenia gravis some importance has been ascribed to the

MYASTHENIC REACTION IN THE FROG 155

fact that the muscles are much less readily exhausted by galvanic
than by faradic stimulation. In order to determine whether
this phenomenon is also a feature of the yohimbine-poisoned
muscle, arrangements were made whereby, with the help of two
commutators and a mercury dip key, the muscle could either be
faradised or stimulated by the make or break of a galvanic
current, only such time elapsing between these stimulations as
would allow of reversing the commutators.

The results of such an experiment are shown in Fig. D,
where once more a yohimbinised muscle preparation was used.
Fig. D 1 shows three contractions obtained by making the
constant current.

The muscle was then continuously faradised for twenty
seconds. At first a good tetanic contraction of the muscle was
obtained, but as the stimulation went on the muscle soon relaxed,
and eventually ceased to respond (D 2).

A few seconds later the muscle was stimulated by making
tiie constant current for fifty seconds at the rate of about once a
second. The resulting contractions were almost as good as
before the muscle was exhausted by tetanus (D 3).

The muscle was then exhausted by repeated tetanisations
separated by increasingly short intervals of time. As has been
similarly shown in Fig. C, the muscle contracted only at the
moment of commencing stimulation. After very short intervals
of rest, the muscle refused to contract. A few seconds later,
however, the muscle still responded very well to the makes of the
galvanic current (D 7).

In regard to this test, too, the muscles react like the muscles
of a myasthenic patient.

Cause of the Myasthenic Reaction Produced by Yohimbine .—
There is, I think, nothing in these results to decide absolutely
in favour of the abnormally rapid onset of fatigue in this condi¬
tion being due to an exhaustion of the nerve alone or of the
muscle alone. As compared with a normal muscle, a yohim¬
binised muscle, whether stimulated directly or by way of its
motor nerve, is incapable of sustained tetanus. Direct stimula¬
tion of the muscle does not, however, exclude stimulation of the
intramuscular nerves.

Certain other ascertained facts of the action of yohimbine
md in a solution of this problem. Thus Tait and I have found
in regard to motor nerve that the myasthenic reaction can be

156

J. A. GUNN

produced by the direct application of a two per cent, solution of
yohimbine lactate to the nerve trunk. We have found that by
subjecting a small portion of the middle of the sciatic nerve to
such a solution, the muscular response which results from faradio
stimulation of the proximal end of the nerve varies with the
interval of time between the stimulations. At first the muscle
responds with tetanus. With a short interval of rest between
successive faradisations a contraction occurs only at the beginning
of stimulation, or there may be even no muscular response.
Faradisation of the same part of the nerve again produces tetanus,
provided a sufficient interval of rest is allowed. In this case
there can be no question of a direct effect of yohimbine either
on the nerve ends or on the muscle, for faradisation of the part
of the nerve distal to the yohimbinised portion elicits a normal
tetanus which shows no such impairment on continuous or
repeated stimulation (6).

It is therefore practically certain that the more dilute
solution of yohimbine which finds itself in the blood of the frog
after the subcutaneous injection of this drug will produce, either
by affecting the nerve trunks or more probably the finer nerve
fibres in the muscle, such effects as can in great measure at least
explain the myasthenic reaction. It is also apparent that this
action may be entirely a primary one, secondary to an affection
neither of the muscle nor of its nerve ends, nor of the motor cell
from which the nerve arises.

As to whether yohimbine also affects the nerve ends, it seems
difficult to decide. The usual tests by which the curara action
can be localised to the nerve ends fail on account of the power¬
ful action which yohimbine exerts on the nerve trunks.

There is as yet no definite consensus of opinion regarding
the site of the exhaustion in myasthenia gravis. For example.
Jolly suggests a dystrophy of the voluntary muscles, Myers a
toxic action on the nerve ends in the muscle, and Campbell and
Bramwell a toxic action on the axons. Others have supposed,
probably with less likelihood, an affection of the central nervous,
system.

With regard to pharmacological evidence, Jolly considers
that certain experiments performed on the frog with protovera-
trine by Watts-Eden support his hypothesis of a muscular
explanation.

MYASTHENIC REACTION IN THE FROG 157

Watts-Eden (7) describes symptoms of motor exhaustion
occurring in the frog after injections of protoveratrine similar to
those produced by yohimbine. He found, among other things,
that a muscle treated with a saline solution containing protovera¬
trine is rapidly fatigued by a few single induction shocks, whereas
if the nerve be soaked in a similar solution for a prolonged period
there is no such loss of excitability. Jolly took this as support¬
ing his views of a muscular explanation.

I have found that a muscle treated with a saline solution
containing yohimbine reacts in practically the same way, but
unfortunately this method of experiment does not get rid of the
intramuscular nerve fibrils, and in point of fact Waller (8), by
investigating with the galvanometer the electrical response to
stimulation, found that protoveratrine exerts a distinct effect on
the motor nerves. He found that protoveratrinised nerve, when
subjected to a series of tetanising stimulations, “ exhibits a well-
marked negative sign of action during excitation, but little or
no positive sign of reaction after excitation. And in corre¬
spondence with this failure of positive reaction, the succession of
action-effects exhibits rapidly progressing exhaustion.”

As Myers points out, this finding of Waller’s, together with
Watts-Eden’s experiments showing that protoveratrine has a
paralysing action on sensory nerves, would seem to show that
this substance has a general action on nerve fibres.

Yohimbine also paralyses sensory nerves, and its action on
motor nerves is remarkably like that of protoveratrine; and I
have further shown that this action in the case of yohimbine is
adequate to explain the myasthenic reaction. It is suggestive
that two alkaloidal substances which have been noted as pro¬
ducing effects similar to myasthenia gravis should be found on
analysis to have actions on nerve so similar to one another.

The balance of pharmacological evidence, so far as such
evidence can be translated to the interpretation of pathological
conditions in man, seems therefore to rest in favour of the
myasthenic reaction in myasthenia gravis being due, at any
rate in part, to a toxic action on the motor nerves.

References.

1. Campbell, H., and E. Bramwell. “Myasthenia Gravis,” Brain, voL
xxiiL, 1900, p. 277.

158

ABSTRACTS

2. Jolly, F. “ Ueber Myasthenia Gravis paeudoparaly tica,” Berlin Klin.
Woch., 1895, Bd. 32, p. 1.

3. Myers, C. S. “ Myasthenia Gravis,” Journal of Pathology, 1903, vol.
viii., p. 311.

4. Campbell and Bramwell, loc. cii ., p. 287.

5. Fraser and Elliott, Trane. Boy. Hoc., vol. cxcvii., 1905, p. 258.

6. Quarterly Journal of Experimental Physiology, April 1908.

7. Watts-Eden, “ Ueber die Wirkungen des Protoveratrines,” Archiv fur
Pathologic und Pharmacologic, 1892, Bd. 29, p. 440.

8. Waller, Brain, vol. xxiii., 1900.

Description op Figures.

A Faradic stimulation of sciatic nerve. The signal shows the time
during which the nerve was faradised.

B. Continuation of A, three minutes later.

C. Faradic stimulation of gastrocnemius muscle.

D. Faradic versus galvanic stimulation of the gastrocnemius muscle.

The signal (2, 4, 5, and 6) shows the time during which the muscle was

faradised. The single coutractions without signal (1, 3, and 7) are from makes
of a constant current.

Hbstracts

ANATOMY.

THE ANATOMY AND DEVELOPMENT OF THE INDU8EUM
(112) OBISEUM CORPORIS GALLOSI. (Zur Anatomic and Bnt-
wicklungsgeschichte des Indusinm grisenm corporis callosi.)

E. Zuckerandl, Arb. a. d. Neurol. Instit. Wien, Bd. 15, S. 17,
1907.

The grey matter known as the indusium griseum which covers the
dorsal surface of the corpus callosum consists of two different parts
of different origin; the lateral symmetrical portions undoubtedly
belong to the gyrus supracallosus or the dorsalward prolongation
of the cornu ammonis, while the median portion consists of fibres
some of which penetrate the corpus callosum as the fibrse perforantes
of Kolliker. This paper is devoted to the investigation of the origin
and course of these fibres of the median or intermediate portion of
the indusium griseum. It was found that this portion is probably
present in all mammals, though in some species it is so small that its
demonstration is difficult; in fact, an examination of the reptilian
Brains shows that it is one of the fundamental cerebral structures.

Plat* 13.

Platk 14 .

ABSTRACTS

159

Its fibres arise in part from the gyros supracallosus. It develops
from the septum, with a part probably from the lateral walls of the
hemispheres. It is at first a bilateral and symmetrical structure,
but during its development its two parts fuse together.

Gordon Holmes.

THE COMPARATIVE ANATOMY OF THE NUCLEUS RUBER
(113) TEOMENTI. (Zur vergleichenden Anatomie des Nucleus
ruber tegmenti.) R. Hatschek, Arb. a. d. Neurol. IrutU.
JVien, Bd. 15, S. 89, 1907.

In this paper the form, constitution and chief connections of the
nucleus ruber in' the different classes of mammals are described.
Its fundamental nature is most easily studied in one of the lower
monkeys, in which its different parts are well developed. Here it
is easily seen that the nucleus consists of two distinct parts: the
one, which contains only large cells, occupies the dorsal and caudal
portion, and is named by the author nucleus magnicellulatus; the
other is composed of much smaller cells, and forms the frontal and
ventral portion of the nucleus—nucleus parvicellulatus. In the
lower mammals the former is much the larger, in the carnivora it
forms quite two-thirds of the whole nucleus, but it becomes re¬
latively much smaller in the higher apes, and in man it is only a
rudiment represented at most by a group of eight to ten cells in a
section, at the dorsal and caudal border of the nucleus ruber proper.
As the nucleus magnicellulatus diminishes in size the nucleus
parvicellulatus increases, and in the anthropoid apes and in man
forms practically the whole of that which is generally described as
the nucleus ruber.

Hatschek has not been able to furnish any new evidence on the
efferent connections of these two parts of the nucleus ruber, but he
cites the work of Kohnstamm and Preisig, who found chromatolytic
changes only in the cells of the nucleus magnicellulatus after section
of the tractus rubro-spinalis, and who have thus proved that these
cells send their axiscylinders spinalwards. On the other hand,
Preisig has demonstrated changes in the small-celled nucleus as the
result of a section between the nucleus ruber and the optic thalamus,
thus proving that these cells send their axiscylinders forwards.
The latter nucleus seems to be an important co-ordination centre
intercalated between the cerebellum and the fore-brain.

On examining the cerebellum through the mammalian series,
Hatschek has also found that the nucleus dentatus increases in size,
step by step with the nucleus ruber parvicellulatus, while the develop¬
ment of the medial cerebellar nuclei, the embolus and globosus,
which are relatively much larger in the lower mammals, corresponds

160

ABSTRACTS

with that of the large-celled portion of the nucleus ruber. In the
lower mammals the superior cerebellar peduncle crosses the middle
line in two distinct decussations, a dorsal and a ventral. In those
species in which the dorsal decussation predominates, the nucleus
magnicellulatus is much larger than the nucleus parvicellulatus,
while in the higher mammals the majority of the fibres, and in man
practically all, cross in the ventral decussation. It therefore seems
that the fibres of the superior peduncle which arise from the embolus
and nucleus globosus cross the raphe of the mid-brain in the dorsal
decussation and are in intimate connection with the nucleus ruber
magnicellulatus, and that those from the nucleus dentatus pass
through the ventral crossing and terminate in the nucleus parvi¬
cellulatus. Gordon Holmes,

THE FIBRILS AND THE FIBRILLOGENOUS SUBSTANCE IN
(114) THE GANGLION CELLS OF VERTEBRATES. (Le fibrille
e la sostanza fibrillogena nelle cellule ganglionar! del verte-
brati.) 0. Fragnito, Annali di Nevrol., Anno xxv., Fasc. 3,
1907.

We have in this paper a further contribution to the question of
the development of the fibrils in the nerve cells of the cord of the
chick, and a reply to the criticisms of Cajal on the author’s
previous work.

In this research the author has employed the Vth method of
Donaggio for staining nerve fibrils, with slight modifications.
With this stain the chromatic substance is stained a clear blue,
while the fibrils have a reddish-violet tint, in the cells of embryos
as well as of adults. At a period of development, when the
fibrils are wanting or have just begun to appear, it is possible to
recognise constantly in the cells two substances—one, which has
assumed a blue colour and is distributed throughout the cell; and
a second, which has a reddish-violet tint and occupies the central
portion of the cell, lying usually beside the nucleus. This latter
he calls the “ fibrillogenous substance.” With the aid of a very
interesting series of illustrations, the differentiation of the fibrils
from this fibrillogenous substance and the connection of the
fibrils with the processes of the cell are clearly demonstrated.

It is evident, then, that the conducting element of the adult
nerve cell “ makes its first appearance in the protoplasm of the
ganglion cell, not in the form of neurofibrils, but of an un¬
differentiated substance, from which they develop later.” This
undifferentiated substance can be seen in most of the cells of the
cord of a chick on the tenth and eleventh days of development,

ABSTRACTS

161

and the differentiation of the fibrils can be followed in subsequent
stages of development.

In the earlier stages of development Fragnito has found that
the fibrillogenous mass has a fairly clear outline, and resembles
closely in size and shape the nucleus of the nerve cell By
examining the cord of a chick at the ninth day of development he
has seen that the nerve cells have two nuclei, each of which is
furnished with a nucleolus and a dense chromatic reticulum.
Between this condition and the appearance of the fibrillogenous
mass a series of intermediate stages have been observed, in which
the second nucleus loses its sharp outline, and the fibrillogenous
substance is seen to be derived from its nucleolus.

The author then refers to the fact that many observers have
recognised that there are substances in the cytoplasm of the nerve
cell which are of nuclear origin, and it has been suggested by them
that these substances have been secreted by the nucleus, and have
passed out from it, in the form of globules or as a fluid, to con¬
stitute the cytoplasm. Fragnito, however, is of the opinion that
the chromophile substance of the nerve cell is derived from the
nuclear substance of the secondary neuroblast.

From the more recent investigations it seems probable that, at
least in the cord of the chick, the adult nerve cell is derived from
two neuroblasts, one of which develops into the adult nucleus, and
the other undergoes certain changes and gives rise to the cytoplasm
and the fibrils. R. G. Rows.

ON THE COURSE OF THE AFFERENT PORTION OF A NUM-
(115) BER OF REFLEX ARCS, ESPECIALLY OF THE LOWER
SPINAL REFLEXES. (XJeber den radiculUren Verlauf des
centripetalen Teiles einer Anzahl von Refiexbogen, besondera
von Reflexen des untersten Ruckenmarks&bechnittea.) G.
Bikeles und W. Fromowicz, Arb. a. d. Neurol. Instil.
Wien., Bd. 15, S. 52, 1907.

A large number of skin, sphincter and tendon reflexes can be
obtained in dogs in which the spinal cord had been previously
transected in the lower thoracic or upper lumbar region; some of
these reflexes can be constantly obtained in every animal, others
are present in only some specimens. The dorsal roots through
which the afferent portions of these reflexes pass were determined by
exposing the cauda equina and cutting through a series of dorsal
roots in succession, noting when the reflex disappears.

Eighteen different reflexes were investigated in this way, but as
long descriptions of the form of each reflex and of the mode of

162

ABSTRACTS

exciting it would be necessary, only a few of the more important
can be referred to here.

All the sacral and the first coccygeal roots carry afferent fibres
concerned in the true anal reflex; reflex depression of the tail on
stroking the skin of the perineum is no longer obtained when the
second sacral to the second coccygeal roots are cut; the seventh
lumbar root contains the afferent fibres for the Achilles-tendon
reflex, and reflex flexion of the toes is lost when the sixth lumbar
root and the roots below it are cut. Gordon Holmes.

THE ORIGIN OF THE SUPERIOR FACIAL IN MAN. (L’origine
(116) du facial suplrieur chez l’homme.) C. Parhon and J. Minea,
Presse Mid., No. 66, 1907, p. 521.

The authors have been fortunate enough to have had an oppor¬
tunity of examining a case of paralysis limited to the upper facial
muscles—namely, the frontalis, the corrugator supercilii and the
orbicularis palpebrarum. The paralysis was due to the involvement
of the upper branches of the nerve by a circumscribed epithelioma.
They found an atrophy of the dorsal group of nerve cells in the
common nucleus of the facial. Further examination showed that
the nuclei of the 3rd, 4th, and 6th nerves were quite intact, as
also was the group of cells in the neighbourhood of the 3rd and
4th nuclei, which occupies a depression on the posterior longi¬
tudinal fasciculus, and which is regarded by Giannelli as the nucleus
for the upper facial muscles. They attribute the frequent escape
of the superior facial muscles in certain atrophies of nuclear origin
to the fact that the nucleus of the upper branch of the facial nerve
forms a perfectly circumscribed group quite independent of the rest
of the facial nucleus. Alexander Bruce.

PHYSIOLOGY.

IS THE UPRIGHT POSITION MAINTAINED BY SENSATIONS
(117) FROM THE JOINTS? (Wird der Stehende durch daa
Lagegefdhl der Glieder (durch die Nachricht fiber Gelenksein-
stellungen) vor dem Fallen bewahrt 1) S. Erben, Arb. a. d.
Neurol. Instit. a. d. Wien. Univ., Bd. xvi., T. 2, 1907, S. 23.

It is shown that a person in the erect attitude balances his body
and keeps himself from falling not by any information derived from
the joints of the lower limbs, but by sensory impressions conveyed
from the sole of the foot. Increased pressure on the heel, e.g., tells
the person that the vertical line from the centre of gravity of the

ABSTRACTS

163

body is about to fall outside his base of support behind. If the
pressure increases towards the ball of the foot, he knows that he
is going to fall forward if the body is not thrown backward to
prevent it.

In locomotor ataxia the patient no longer receives these sensa¬
tions from the sole of the foot, and if his eyes be closed so that he
cannot see the relative positions of objects around him, he has no
gnide at all and so cannot maintain his balance.

Sutherland Simpson.

FURTHER DATA REGARDING- THE CONDITION OF THE

( 118 ) VASO-MOTOR NEURONS IN “ SHOCK.” W. T. Porter and
W. C. Quinby, Amer. Joum. Physiol., Yol. xx., No. 4, p. hOO.

It is generally held that in “ shock ” the vasomotor cells are de¬
pressed, exhausted or inhibited by the excessive stimulation of
afferent nerves, and that the fall in blood pressure and the accom¬
panying symptoms are due to this depression.

In this paper the authors give the results of experiments which
appear to disprove this theory. They stimulated the depressor
nerve in the rabbit and noted the effect on the blood pressure before
and during shock (produced by violent peripheral excitation), and
they found that the “ percentile fall ” in the blood pressure before
and during shock was about the same. By “ percentile fall ” they
mean the difference between the blood pressure before and during
stimulation of the depressor calculated to percentages. If the
vasomotor centre is exhausted in shock, any additional afferent
stimulation ought to have little effect on the blood pressure, never¬
theless they found that the relative effect is the same.

Sutherland Simpson.

SOME COMPARISONS BETWEEN REFLEX INHIBITION AND

(119) REFLEX EXCITATION. C. S. Sherrington, Qmr. Joum.
Ezper. Physiol., Yol. i., No. 1, p. 67.

The author has succeeded in demonstrating the fact that by gradu¬
ally increasing the strength of the external stimulus the reflex
effect is proportionately increased. It used to be believed that the
“ all or none ” phenomenon held for spinal reflex arcs as well as for
cardiac muscle.

The reflex studied was the flexion-reflex in the hind limb of the
decerebrate dog. This is a reflex of simultaneous double sign (±),
contraction of the muscles which produce flexion of the knee-joint
occurring at the same moment as those which cause extension of
that joint. A single muscle of each of the opposing groups was

164

ABSTRACTS

selected to act upon the joint—the semi-tendinosus (flexor) and
vaso-crureus (extensor). The exciting stimulus was a single
induction shock obtained from a Kronecker inductorium, and it
was applied to the same afferent nerve in all the experiments, viz.,
the musculo-cutaneous branch of the peroneal, about 4 cm. below
the knee.

The reflexes obtained from the isolated semi-tendinosus show
that by increasing the strength of the stimulus both the amplitude
and the duration of the contractions increase. The same holds on
the inhibitory (relaxation) side of this reflex,—with increase in the
strength of the stimulus the amplitude and speed of the reflex
relaxation increase.

On the excitatory side of the reflex there is no superposition
unless the shocks succeed each other at intervals shorter than '15
sec. With this the inhibitory part of the reflex stands in apparent
contrast, because superposition (successive elongation) occurs when
the stimuli are applied at the rate of only four or five per second.
Thus stimuli which, taken singly, produce almost no perceptible
relaxation of the vaso-crureus, when repeated even at the above
comparatively slow rate lead to extensive relaxation by summation.

Sutherland Simpson.

OK PROTAGON: ITS CHEMICAL COMPOSITION AND PHYSICAL

(120) CONSTANTS, ITS BEHAVIOUR TOWARDS ALCOHOL
AND ITS INDIVIDUALITY. R A. Wilson and W. Cramer,

Quar. Joum. Exptr. Physiol., Vol. i., No. 1, p. 97.

Within recent years it has been asserted that the substance pre¬
pared from brain tissue known as protagon is not one but a mixture
of several substances. The authors, from the examination of many
samples prepared by different methods, conclude that it has a definite
chemical composition and constant physical properties—in other
words, that it is a definite chemical substance and not a mixture.

Sutherland Simpson.

ON THE TIME TAKEN IN TRANSMISSION OF REFLEX

(121) IMPULSES IN THE SPINAL CORD OF THE FROG.

Florence Buchanan, Quar. Joum. Exper. Physiol., Vol. i.,
No. 1, p. 1.

Non-polaris able electrodes connected with a capillary electrometer
arranged for obtaining photographic records were led off from one
gastrocnemius muscle of a decerebrate frog, and the same, or the
opposite sciatic nerve, placed on needle electrodes in the secondary
circuit of a Kronecker inductorium.

ABSTRACTS

165

When the undivided sciatic nerve of the same side is stimulated
by a single strong induction shock, two muscular responses (action
currents) are obtained, the first (maximal) beginning 0 004 sec.
after excitation of the nerve, and the second—a much feebler
response—succeeding the first at an interval of about 0'02 sec.
When the nerve is severed between the exciting electrodes and the
spinal cord, the second response cannot be obtained even by the
strongest stimulus. The first effect is due to stimulation of the
efferent fibres of the sciatic nerve, and is therefore direct; the second
is produced by excitation of the afferent fibres, and is a reflex effect.
By deducting the efferent and afferent factors outside the cord from
the whole time, it is found that the delay in the cord under normal
conditions in the same limb reflex varies in different preparations
between 0 012 sec. and 0 022 sec.

When the cord alone has been acted on by a very weak dose
of strychnine, the delay is somewhat diminished—0 009 sec. to
0-020 sec.—but when the circulation as well as the cord has been
affected by the drug it is increased. Cold applied to the strychnised
cord greatly increases the delay; it has the same effect on the
normal cord, but to a less degree. Fatigue brought on by repeated
stimulation may lengthen the delay in the normal cord.

In the normal cord the crossed reflex (response from one gastro¬
cnemius when stimulus is applied to opposite sciatic nerve) could
not be elicited, but in strychnine preparations from which this
response can be obtained the delay is about double what it is when
the nerve of the same side is stimulated.

It is inferred that in the same-limb reflex there is normally a
single synapse interposed in the conducting path, whereas in the
crossed reflex there are two such synapses within the cord.

Sutherland Simpson.

TEMPERATURE AND EXCITABILITY. Keith Lucas and G. R.
(122) Mines, Joum. Physiol., Yol. xxxvi., Nos. 4 and 5, p. 334.

The effect of temperature on the excitability of nerve and muscle
in the toad have been studied in relation to electrical currents of
long and of short duration. In summing up, the authors conclude
that alike for muscle and nerve “ the cooler tissue requires less
current-strength for its excitation when currents of long duration
are used, but when short currents are used this effect is masked,
either partially or completely, by the greater increase of current-
strength which the cooler tissue demands for a given decrease of
current duration.” Sutherland Simpson.

166

ABSTRACTS

ON THE CONTRACTION OF MUSCLE, CHIEFLY IN RELATION
(123) TO THE PRESENCE OF “ RECEPTIVE ” SUBSTANCES.

Part I. J. N. Langley, Joum. Physiol ., Yol. x xx v i ., Nos. 4
and 5, p. 347.

In a previous paper facts had been brought forward by the author
which seemed to prove that both nicotine and curari combine with
a “ receptive ” substance in muscle, i.e. with some substance which
is not the actual contractile molecule, though capable of acting upon
it, and that these poisons have no special action on motor-nerve
endings, most of the functions usually attributed to such nerve
endings being really functions of the receptive substances of the
muscle.

Subsequently, by further investigation, he brought forward
reasons for supposing that in frog’s muscle there are at least two
respective substances present in the muscle fibre capable of causing
a slow contraction—one in the region of the nerve ending, the other
in the general substance throughout the muscle fibre; and also two
receptive substances similarly related in distribution causing a quick
contraction.

In the present communication this work has been continued
on the muscles of the frog and additional facts adduced in support
of the above-mentioned hypotheses.

Sutherland Simpson.

THE FREEZING OF FROG’S NERVE, WITH SPECIAL REFER-
(124) ENCE TO ITS FATIGABILITY. John Tait, Quar. Joum.

Exper. Physiol ., Vol. i., No. 1 , p. 79.

The author froze a short length of the sciatic nerve of a frog’s
gastrocnemius nerve-muscle preparation, and observed (1) changes
during freezing, and (2) changes during thawing, including fatigue
changes.

During the process of freezing, which the author compares with
drying of the nerve, conductivity gradually disappears, the im¬
mediate onset of freezing being, however, accompanied by a tem¬
porary improvement in function. As a rule freezing of the nerve
induces convulsive twitching of the attached muscle, but not in
cases where the ordinary temperature of “ cold rigor ” of the nerve
lies above the freezing-point.

In the return of conductivity after thawing various stages can
be traced. Some considerable time elapses before the nerve func¬
tions normally again, and a tendency to “ cold rigor ” at relatively

ABSTRACTS

167

high temperatures persists for a time after thawing. In the stage
of return of conductivity the nerve is readily fatigued by rapid
rhythmical stimulation, and the fatigue thus induced may persist
for some minutes. Sutherland Simpson.

PATHOLOGY.

PATHOLOGICAL ANATOMY OF PERIPHERAL FACIAL PARA-
(125) LYSIS AND OF FACIAL HEMISPASM. (Contribution &
l’dtude de l’anatomie pathologique de la paralysis facials
pdriphdrique et de llidmispasme faciale.) Andr£ Thomas,
Rev. Neurol ., d4c. 30, 1907, p. 1273.

Thomas has examined the facial nerve and its nucleus in three
cases of peripheral facial paralysis, two of which were accompanied
by hemispasm.

In the first case the paralysis was preceded by an intercostal
herpes zoster, and was followed in eighteen days by a fatal termina¬
tion from congestion of the lungs. The nerve showed a pure
parenchymatous degeneration extending downwards from the first
bend in the aqueduct of Fallopius, below which point there was an
almost entire absence of axis cylinders. Above the geniculate
ganglion the axis cylinders reappeared, were for the most part
swollen, and gradually became more normal as the nucleus was
approached. The cells of the nucleus were swollen, showed chro-
matolysis and eccentric nuclei. The nucleus of the opposite side
was perfectly normal.

In the second case a total left facial paralysis supervened upon a
suppurative otitis media. It was accompanied by loss of hearing,
diminution of taste in the anterior part of the tongue, complete
reaction of degeneration and slight intermittent spasms of the
muscles. Examination of the nerve revealed a chronic peri¬
neuritis without interstitial inflammation of the nerve, situated just
below the first bend of the aqueduct of Fallopius. The nerve at
this level and below it showed a neuroma of regeneration. The
geniculate ganglion was somewhat atrophied. The intra-pontine
portion of the nerve and its nucleus were normal.

In the third case there was an almost complete right facial
paralysis with occasional spasms affecting all the muscles supplied.
The peripheral branches showed no degeneration, but many fine
fibres twisted and tangled amongst each other, resembling fibres in
process of regeneration. Several fine fibres might be seen within a
single sheath of Schwann. At the level of a swelling of the nerve
at the first bend of the aqueduct of Fallopius, Cajal’s silver method

168

ABSTRACTS

showed numerous fine fibres twisted on each other, suggesting a
regenerative process. Below this swelling there was neither peri*
neuritis nor endoneuritis, but the nerve showed traces of a process
of irritation as well as indications of restoration. The nucleus of the
nerve was in all respects normal.

The authors draw special attention to the fact that in these two
cases, where the paralysis was complicated with hemispasm, there
was a neuroma of regeneration in the neighbourhood of the genicu¬
late ganglion. They do not express an opinion as to whether the
hemispasm is the result of the irritation of compression produced by
the neuroma, or is due to some other cause.

It is interesting to note that in three cases of apparently different
types of facial paralysis the initial lesion was situated in the aque¬
duct of Fallopius at the point of the first bend of the facial nerve.

Alexander Bruce.

HETEROTOPIA OF THE NUCLEUS AROUATUS. (Ueber emeu

(126) frtiheren Fall von Heterotopie des Nucleus arcuatus). M.

Oeconomakis, Neurolog. Centralbl., 16 Dec. 1907, S. 1158.

The author describes a medulla oblongata in which the one pyramid
was divided up by a very large and branching arcuate nucleus,
which was normal in structure. The only interest in the case is,
that corresponding to the unusual size of the arcuate nucleus the
fibre arcuate extern© ventrales of the same side were unusually
large and seemed to be intimately connected with the nucleus.

Gordon Holmes.

ON THE FORMATION OF NEUROGLIA PENCILS AND

(127) ATROPHY OF THE ANTERIOR HORNS IN THE SPINAL
CORD OF A GENERAL PARALYTIC. (Ueber Gliastift-
bildung und Vorderhoraatrophie im Rftckenmarke eines Para-
lytikers.) E. Friedel, Monatsschr. f. Psych, u. Near., Bd. 22,
Erganzungsheft, p. 39.

The clinical and anatomo-pathological report of a case of general
paralysis with old infantile paralysis. The examination of the
cord showed marked wedges of glial hypertrophy, especially in
relation to the peripheral neuroglia in the region of Lissauer’s zone.

C. Macfie Campbell.

NOTE ON 0BLL-FINDING8 IN SOFT BRAINS. E. E. Southard

(128) and M. D. Hoskins, Amer. Joum. Insan., Yol. xxiv., Oct. 1907.

The authors call attention to a point in pathological anatomy,
viz., the occasional occurrence at autopsy of brains and cords which

ABSTRACTS

169

are unduly soft to the touch, but which have been subjected neither
to oedema nor to post-mortem autolysis. This very diffuse malacia
appears to be a phenomenon of terminal exhaustion, and is perhaps
related to such central neuritis as may occur (1) in Korsakow’s
psychosis, or (2) in other conditions, e.g. epilepsy. The histology
of the brain and cord in oedema and post-mortem autolvsis differs
from that of the general encephalo-malacia under discussion, as
the latter condition shows axonal reacting in the nerve cells and
Marchi degeneration in the nerve fibres. As an example of the
condition the case of an epileptic dying at the age of forty-two is
fully reported. D. K. Henderson.

DIFFUSE CORTICAL CHANGES IN OASES OF CEREBRAL

(129) TUMOURS. (Uber diffuse Hirnrindenver&nderungen bei Him-
tumoren.) E. Redlich, Arb. a. d. Neurol. Instit. a. d. IVien
Unit., Bd. 15, Teil 1, S. 320.

This paper deals with the psychical changes which are so frequently
met with in cases of cerebral tumour, and the question of whether
they can be correlated with changes found in the cerebral cortex.
After considering the work and opinions of other writers on the
subject, the author describes the changes seen in four cases of
cerebral tumour accompanied by marked psychical disturbances.
The four cases were respectively metastatic carcinoma, glioma,
multiple tubercle, and endothelioma of the dura mater; in all, the
changes were much alike—slight thickening of the pia mater,
with some lymphocyte infiltration, but no plasma cells, loss of
granules in the ganglion cells, increase of the satellite cells,
especially in the large pyramidal cell stratum of the cortex,
neuronophagy, some degeneration of, particularly, the short associa¬
tion fibres, and slight changes in the vessels. These changes are
very similar to those met with in senility and in various psychoses,
and cannot be regarded as characteristic of brain tumours. The
author’s opinion is that they are probably due, not to any toxaemia,
but to the increase of intracranial pressure and interference with
the circulation and nutrition of the cortex.

J. H. Harvey Pirie.

EXPERIMENTAL LESIONS AT THE BASE OF THE BRAIN.

(130) (Uber experimentelle L&sionen an der Gebirnbasis.)

A. Spitzer and J. P. Karplus, Arb. a. d. Neurol. Instil, a. d.
Wien. Univ., Bd. 16, T. 2, 1907, p. 348.

Lesions were made in the pons for the most part in cats, dogs and
monkeys, and the resulting degenerations traced by the Marchi

170

ABSTRACTS

method. The method of operating is given in great detail. They
reached the pons from in front, entering through the basisphenoid.
Sepsis followed in some of the cases. Various fibre systems, afferent
And efferent, were involved in the lesions, and it was observed that
the physiological effects of the interruption of important anatomical
bundles were often very slight. Extensive injury to the pyramidal
tracts led to no noteworthy disturbance in cate and dogs, a fact
which is in accordance with the findings of several earlier observers.
In one of the monkeys the pyramidal fibres were almost all cut
across in the pes pedunculi with the involvement of neighbouring
bundles, and there was no very evident hemiplegia as a result.
This is supplementary to the work of Rothmann and of Schuller,
who divided the pyramidal tract at the decussation and on the spinal
side of the pons respectively.

In this paper the anatomical results are given for the monkey
alone, those for the cat and dog being reserved for a subsequent
publication, in which the authors will sum up and correlate the facte
of the completed work. Sutherland Simpson.

CLINICAL NEUROLOGY.

DIPHTHERITIC PARALYSIS. (Les Paralysies diphtdriques.)

(131) Ch6nA Gas. des Hop., Jan. 18 and 25, 1908, pp. 75-82 and
111-118.

A lengthy review containing no orginal observations. Too much
importance is attached to the treatment of paralysis by antitoxin,
the value of which the writer, like many of his compatriots, wrongly
assumes is firmly established, (v. Rev. of Neur. and Psych., 1905,
p. 129, and 1907, p. 862.) A complete bibliography of recent work
is appended. J. D. Rolleston.

DIPHTHERITIC NEURITIS OF THE LEFT CIRCUMFLEX
(132) NERVE. (Ndvrite toxique d’origine diphtdrique, lo calis e au
nerf circonflexe gauche.) Esprit, Le DauphirU Medical, Dec.
1907, p. 273.

A young soldier had an attack of diphtheria in September 1907,
which was treated with antitoxin, and followed by paralysis of the
palate. At the beginning of November, he began to suffer severe
pain, especially at night, in the left shoulder. There was no joint
trouble nor any history of injury. The unusual prominence of the
acromion and head of the humerus with flattening of the shoulder

ABSTRACTS

171

simulated a forward dislocation of the head of the humerus. The
latter, however, occupied its normal position, and the phenomenon
was found to be due to atrophy of the deltoid in which the reaction
of degeneration was present. Abduction and elevation of the left
arm were impossible. The other muscles of the arm and scapulo-
thoracic region were unaffected with the exception of the pectoralis
major, which was slightly atrophied. The sensory troubles were
mainly of a subjective character. Tactile anaesthesia and thermo¬
anaesthesia were absent nor were there any vasomotor or trophic
disturbances. The issue of the case is not recorded.

J. D. Rolleston.

PERIPHERAL FACIAL PALSY. Alfred Fuchs, Arbeit a. d.
(133) Neurolog. Inslit. a. d. Wien. Univ., Bd. 16, Teil 2, S. 245.

This paper, as its sub-title states, is a comparison of the more
recent literature with the author’s personal experiences. Its
nature is such that an abstract can scarcely be made, consisting as
it does largely of brief abstracts of many cases of peripheral facial
palsy of every variety. It is valuable, if only for the literature
references. J. H. Harvey Pirie.

THE RECENT EPIDEMIC OF POLIOMYELITIS. V. P. Gibney
(134) and Charlton Wallace, Jour. Am. Med. Ass., Dec. 21, 1907,

p. 2082.

This paper is in the form of a preliminary report on cases seen at
the Hospital for Ruptured and Crippled during the epidemic in
New York last summer. It does not contain much that is new.
The occurrence of the epidemic in summer suggests infection by
the intestinal tract, and some 63 per cent, of the cases had
intestinal disturbances of some sort before the onset of paralysis.
Mild cases were seen where the paralysis cleared up practically
entirely ; others, where a considerable involvement of the meninges
had evidently occurred, a point of interest in view of the findings
of Harbitz and Scheel in the Norwegian epidemic (see this Review,
Feb. 1908, p. 99). Under treatment they lay great stress on
early orthopaedic measures for the prevention of deformities. The
limbs should be kept in normal position, no active treatment
applied till the inflammatory changes in the cord have subsided,
and even then care must be taken not to overstrain the partially
paralysed muscles, or deformities will result.

J. H. Harvey Pirie.

172

ABSTRACTS

SYRINGOMYELIA WITH BULBAR PHENOMENA AND INTENSE
(135) TROPHIO DISTURBANCES. Raymond and Lejonne, Nouv.

Icon, de la Salpetribe, July-August 1907, p. 261.

In this case the motor symptoms consisted of a spastic paraplegia
and a paresis of the right arm. The sensory symptoms were those
of a hypo-sesthesia to all forms of cutaneous sensation on the right
half of the body, as far as the neck; over the left shoulder the
temperature sense was lost. Deep sensation was much affected
over the right half of the body. Trophic disturbances consisted of
a scoliosis, an arthropathy of the right shoulder, and a hyper¬
trophy of the wrist and hand of the same side, with vasomotor
affection. The bulbar phenomena were hemiatrophy of the right
half of the tongue, paresis of the right half of the palate and of the
right vocal cord (syndrome of Hughlings Jackson). The cheiro-
megaly is of considerable interest because of its rarity. In syringo¬
myelia it is usually one limb, and in particular the peripheral
part of a limb, that is affected. If it is bilateral, one side is usually
more affected than the other. The cheiromegaly has nothing to do-
with acromegaly. It is possibly of mixed origin, a combination of
hypertrophic osteitis with overgrowth of the soft parts.

S. A. K. Wilson.

A CASE OF SYRINGOMYELIA WITH CHEIROMEGALY. Lher-
(136) mote and Artom, Nouv. Icon, de la Salpetribe, Sept.-Oct. 1907,
p. 374.

In a typical case of syringomyelia the interesting feature is tho
hypertrophy of the right hand, wrist, and lower part of the
forearm. Cheiromegaly is usually easy to distinguish from acro¬
megaly. In the former, the length of hand and fingers is not
nearly so much affected as the breadth or width; of the latter
Marie says that there is always proportion in the disproportion^
In the former there is very frequently some affection of the skin,
some callosity or fissure, or scar of a blister or whitlow, which ia
absent in the latter. Osseous change is more regular and more
common in the latter than in the former. The pathological
anatomy of cheiromegaly is not satisfactorily known. Peripheral
neuritis of the nerves supplying the hand, and a syringomyelic
cavity more developed in the right than the left half of the cord*
were found in the present case. S. A. K. Wilson.

ABSTRACTS

173

A CASE OF PARAPLEGIA DUE TO AN INTRA MEDULLARY

(137) LESION, AND TREATED WITH SOME SUC0ES8 BY THE
REMOVAL OF A LOCAL ACCUMULATION OF FLUID.

Warrington and Monsarrat, Lancet , Jan. 11, 1908, p. 94.

The salient features of this case were: injury to the lower part of
the spine in a man of twenty-two, followed by pain in the lower
limbs and trunk for two years ; a slow and slight weakness in the
legs, becoming worse after a period of rest in bed ; and, after an
attack of pneumonia, a gradual recovery; then a sudden complete
paralysis of the right leg and a gradual paralysis of the left,
leading to complete paraplegia. No evidence of syphilis or tuber¬
culosis. Clinically he presented the signs of a transverse lesion of
the cord at about the mid-dorsal region, the absolute loss of power,
great loss of sensation, and the feebleness of the reflexes showing
that conduction was greatly interfered with. The probable
diagnosis seemed to be a gliomatous growth consequent on the
trauma, with a haemorrhage into it, accounting for the sudden
accentuation of symptoms nearly four years after the injury. At
operation the laminae of the 6th to 9th vertebrae were removed, a
tough pellicle was found outside the dura, evidently of inflam¬
matory origin. The dura was adherent to the cord, which for
some distance was of a jelly-like, greyish-black colour, and pro¬
truding. Incision in the posterior mid-line allowed a few c.c.’s of
clear fluid to escape. The wound was then closed. Four months
later the patient was able to walk a little with crutches, the
reflexes were still exaggerated, sensation had greatly improved in
the right leg and thigh, but had diminished in degree over an area
corresponding to the extent of the surgical procedure.

J. H. Harvey Pirie.

PERIPHERAL SPINAL DEGENERATION REVEALED ONLY BY

(138) LONGITUDINAL SECTION OF THE CORD AND AN AXIS
CYLINDER STAIN. S. D. Ludlum, N.Y. Med . Jour., Dec.
21, 1907, p. 1167.

A woman had acute joint inflammation and, three days before
death, delirium, but no definite motor nor sensory symptoms.
Post-mortem there was found a moderate degree of meningitis,
especially of the cord, but the interest of the case lies in the fact
that although Marchi and Weigert stains gave negative results,
Bielschowski’s method applied to longitudinal sections demon¬
strated a band of degeneration and breaking up of the axones
about the entire periphery of the cord. The author thinks this
has been due to the contiguous meningitis.

J. H. Harvey Pirie.

174

ABSTRACTS

MENINGITIS FOLLOWING GONORRHtEA. (Gonocoque et menin-
(139) gocoque.) Milhit et Tanon, Press* MidicaU, Jan. 15, 1908,
p. 34.

A man, aged 21, was admitted to hospital on October 18, 1906.
Three weeks previously he had contracted gonorrhoea, which ran a
normal course till October 15, when the discharge suddenly stopped.
The next day, his legs were weak, and on the seventeenth, he was
unable to stand. At the same time he suffered from headache and
dyspnoea. On admission, though unable to stand, he could still
move his limbs. The reflexes of the lower limbs were diminished.
There were no sensory nor sphincter troubles, and no mental dis¬
turbance. There was no purulent urethral discharge, but serous
fluid expressed from the meatus showed a few extra-cellular gono¬
cocci. On lumbar puncture the cerebro-spinal fluid was found to be
normal. On October 23, the paralysis invaded the upper limbs and
the diaphragm. The headache became worse, and there was stiff¬
ness of the neck and of the whole vertebral column. The reflexes
of the upper and lower limbs were weakened but not abolished.
Temperature 102.2°. Lumbar puncture was again performed.
The cerebro-spinal fluid was now turbid, and on centrifugalisation
showed polvnuclears containing a few encapsuled diplococci, which
closely resembled Weichselbaum’s organisms. The next day coma
supervened, and complete palsy of the limbs. The sphincters were
paralysed, 20 c.c. of very turbid cerebro-spinal fluid were withdrawn
under tension. Numerous polynuclears, pus cells, and meningococci
were found. The following day there was improvement which
was subsequently maintained. On November 1, commencing
muscular atrophy was noted, starting symmetrically in the lower
limbs and invading the abdominal muscles, thorax, and upper
limbs. There was no reaction of degeneration. Massage, elec¬
tricity, and tonics were employed, and the atrophy gradually dis¬
appeared. Complete recovery took place.

J. D. Rolleston.

ACUTE SYPHILITIC MENINGITIS. (M<Sningite aigue syphilitique.)

(140) Laubry et Giroux, Tribune Medicate, Jan. 4, 1908, p. 837.

A woman, aged 24, a dancer by occupation, was admitted to
hospital on May 9, 1907, with the following history. Beyond a
miscarriage three years previously there was nothing to note in
her antecedents. Two months ago she had suffered from attacks
of violent headache and lumbar pain preceded or followed by
tinnitus, nausea and vomiting. The ordinary treatment for

ABSTRACTS

175

neuralgia was adopted, and the symptoms so far remitted as to
allow her to make a long voyage and to continue her occupation for
about a month. On May 2 she complained of vertigo, diplopia, and
dimness of vision. Walking became increasingly difficult. She also
had intense headache and backache, vomiting, and obstinate con¬
stipation. Contracture of the neck and trunk muscles, the presence
of Kemig’s and Babinski’s signs, and right ptosis, showed that the
cerebro-spinal system was involved, but the diagnosis of epidemic
cerebro-spinal meningitis was set aside by the absence of grave
general phenomena, while tuberculous meningitis was negatived
by the absence of visceral tuberculosis. Antisyphilitic treatment
consisting of mercurial injections and iodide of potassium was
adopted. On admission to hospital, the vomiting had ceased for
three days, but there was still frontal headache and obstinate
constipation. The neck was slightly extended. The knee jerks
were exaggerated, and there was slight clonus. Babinski’s sign was
present on both sides, especially on the left. Kernig’s sign was
easily obtained. Sensibility was exaggerated. Light and accom¬
modation reflexes were present but sluggish, and there was diplopia
with convergent strabismus. The abdomen was retracted. Tem¬
perature 100°. Pulse 100.

In the left frontal region was a small tender exostosis, which
had hitherto escaped notice. After one week’s antisyphilitic
treatment, the pyrexia subsided, and the pain in the back and limbs,
the strabismus and ptosis disappeared. When discharged on June
28, the patient still had exaggerated reflexes, clonus and bilateral
Babinski, but no Kemig. The exostosis had almost entirely dis¬
appeared. Lumbar puncture was performed on three occasions,
first on admission, when the fluid was clear, slightly yellow, without
hypertension, and showed a pure lymphocytosis (10-15 cells in each
field). The fluid withdrawn at the second puncture four days later
was similar. Neither the tubercle bacillus nor the spirochseta
pallida wa9 found. At the third puncture, performed forty days
after admission, the lymphocytosis was less (8-10 cells in each
field). J. D. Rolleston.

THE VALUE OF LUMBAR PUNCTURE: WITH PARTICULAR
(141) REFERENCE TO THE DIAGNOSIS OF TUBERCULOUS
MENINGITIS. Eugene P. Bernstein. Mount Sinai Hospital
Reports, VoL V., 1907, p. 491.

The conclusions arrived at are based on the examination of 617
cerebrospinal fluids.

In cases of tumour of the brain several sudden deaths have
been reported after the withdrawal of comparatively small
amounts of fluid. It is advisable to stop the flow of fluid when

176

ABSTRACTS

the pressure reaches 20-25 mm. of mercury. This, according to
Pfaundler, is the normal subarachnoid pressure in the sitting
position, about one-half of which disappears when the patient lies
down. The consensus of opinion is that in normal individuals the
cerebrospinal fluid usually measures in amount less than 10 c.c.

With regard to the presence of sugar, Comba states:—

1. In the healthy person a glucose-like reducing substance is
constantly present.

2. In tuberculous meningitis the glucose is found in small
amounts at the onset, but is absent towards the end.

3. In purulent meningitis it is always absent.

The author found in 53 tuberculous fluids that Fehling was
reduced in 12, and these reactions all occurred but a few days at
most before death. Therefore the presence of this reducing sub¬
stance does not exclude advanced tuberculous meningitis. At
leest 10 c.c. of fluid should be used when the glucose-like body is
looked for, or its presence may escape detection.

Bernstein has never found the Fehling reducing body in
purulent meningitis.

Tuberculous meningitis is almost always accompanied by a
mononuclear leucocytosis. In 102 fluids from tuberculous men¬
ingitis only 3 fluids proved exceptions to this general rule. Cryo-
scopy has been found of no value. Negative bacteriological
findings are of no importance. The author cites the various
organisms which have been met with in the cerebrospinal fluid.
In his series the diplocoecus intracellularis was the most frequent.
Following this the tubercle bacillus. In the 102 cases examined
tubercle bacilli were found in no less than 100 ( = 98 per cent.),
although in more than one case it was necessary to search for
several hours before their presence was detected. The technic in
looking for tubercle bacilli is described in detail. Langar diag¬
nosed 100 per cent, of his cases by cultivation, but unfortunately
the patient is usually dead long before the diagnosis is obtainable.
Subcutaneous or iutraperitoneal inoculation of the cerebrospinal
fluid into guinea-pigs is, according to the author, absolutely reli¬
able, his results being uniformly good, even when only one or two
c.c. were obtained for the purpose. This method is open to the
same objection, however, as cultivation, since four to six weeks
must be allowed to elapse before the animal is killed. Four cases
of recovery from tuberculous meningitis have been reported in
which the tubercle bacilli w’ere demonstrated in the cerebrospinal
fluid. All of the author’s 102 cases ended fatally.

Edwin Bramwell.

ABSTRACTS

177

THE TECHNIC OF LUMBAR PUNCTURE IN CHILDREN.

(142 )Henry Heiman. Mount Sinai Hospital Reports, Vol. V., 1007.

The author describes in detail the technic which he and Koplik
have found from a considerable experience to be most serviceable.
In forty lumbar punctures, the patients varying in age from three
months to twelve years, the highest pressure directly after inser¬
tion of the needle was 54 centimetres, the lowest 4 centimetres,
the average 26’2 centimetres. In these same cases the average of
the various quantities, which were of necessity withdrawn to
render the pressure normal, was 32 c.c., the maximum GO c.c., and
the minimum 5 c.c. In cases of hydrocephalus the author has on
three separate occasions drawn off more than 150 c.c. without any
ill effects. The causes of “dry taps” are faulty technic, propul¬
sion of the dura before the point of the needle, occlusion of the
needle with tissue, fibrin, or pus, abnormally small amount of
secretion, or closure of the foramen of Magendie or aqueduct of
Sylvius, owing to the pressure of a tumour or to inflammatory
conditions. Edwin Buamwell.

HEMIPLEGIA AS A COMPLICATION OF TYPHOID FEVER.

(143) F. Smithies, Journ. Amer. Med, Assoc., Aug. 3, 1907, ii.,
p. 389.

Hemiplegia in typhoid fever is rare. Smithies has collected only
forty-six cases from literature, including the present one. (To these
may be added the two cases of Baric and Lian, and Laignel-Lavas-
tine, v. Rev. of Neurol. 1908, p. 37. J. D. R.). It is commonest in
early adult life, doubtless owing to the greater prevalence of typhoid
fever at that age. The time of onset varied widely. In only one
did it take place in the first week. The great majority was found
in convalescence. Aphasia was noted in twenty-six cases. Right
hemiplegia occurred in twenty-one, left in ten. Twenty-three
were males, nine were females. Death occurred in about 15 per
cent. Smithies’ case was that of a farmer who twelve years pre¬
viously had suffered from syphilis, which he had left untreated.
Left hemiplegia, preceded for a few days by cramp in the fingers
of the left hand, and tremors of the jaw and upper part of the trunk,
developed on the fifteenth day. Considerable improvement took
place, but does not appear to have been complete. Severe headache
occurred in convalescence, which disappeared after the exhibition
of iodide of potassium. The gradual onset and progressive recovery

178

ABSTRACTS

point to thrombosis of one of the cerebral arteries, probably the
right middle cerebral. Syphilis is incriminated as a predisposing
cause ofthe thrombosis. J. D. Rolleston.

BRAIN TUMOUR WITH JACKSONIAN SPASM AND UNI-
044) LATERAL PARALYSIS OF THE VOCAL CORD, AND
LATE HEMIPARESIS AND A8TEREOGNOSIS. J. T.

Atlee and C. K. Mills. Joum. Amer. Med. Assoc., Dec. 28,
1907, p. 2129.

This case is of interest both from the symptomatology and the
character of the tumour. The patient was a physician of 43, who
was successfully operated on for a tumour, originating at the
lower end of the right precentral convolution, involving a large
part of it, and to some extent also the parietal lobe. The tumour
was easily shelled out, and was proved to be of the nature of a
hyperplasia of the choroid plexus. His symptoms had been
Jacksonian spasms of the left side with an initiating sensory aura,
the attacks consisting of a sensory discharge confined to the faco,
tongue, throat, and neck. Later there was weakness and astereo-
gnosis of the whole left side and failure of word memory. These
phenomena are readily explicable from the site of the tumour.
But he had also unilateral (left-sided) paralysis of the vocal cord.
This had all the characters of a peripheral recurrent laryngeal
affection, and, indeed, it cannot be positively stated that it was
not due to such disease (there was some suggestion of aneurism).
The voice recovered considerably after the operation, although the
cord still remains paralysed. It is generally believed that the
cortical laryngeal centres have bilateral control, but this case, and
a clinical one of Delavan’s, suggest the possibility of a destructive
lesion of the cortical laryngeal centre producing a persistent uni¬
lateral paralysis of the opposite vocal cord.

J. H. Harvey Pirik.

A CASE OF PSEUDO BULBAR PARALYSIS WITH COMPLETE
(145) LOSS OF VOLUNTARY RESPIRATION. Charles E
Beevor, Arb. a. d. Neurol. Instil, a. d. Wien. Univ., Bd. xv.,
Teil 1, 1907.

The clinical report of a case of paralysis of all the voluntary move¬
ments of the lower part of the face and mouth, and also of the
voluntary movements of inspiration and expiration. The condition
occurred after three attacks of hemiplegia—two affecting the left
side and one the right side—in a man who had contracted syphilis
three years previously.

ABSTRACTS

179

Though all voluntary movements of respiration were lost, the
emotional or reflex actions of laughing, crying, coughing, sneezing,
and yawning were preserved, and in addition the action of the
muscles of the trunk and of the limbs was quite good for move¬
ments which were not respiratory. The action of the latissimus
dorsi muscle is specially considered, the writer pointing out that
it acts as a strong expiratory muscle in sneezing and coughing.

The lesions are supposed to have involved the genu and
anterior one-third of the posterior segment of both internal capsules,
extending down to the anterior one-third of the crusta, and also
the regio subthalamica and the part between the crusta and the
middle line, as well as the anterior part of the internal nucleus of
the optic thalamus. D. K. Henderson.

A CASE OF PSEUDO-BULBAS PARALYSIS. (Sur un cas de
(146) paralysis pseudo-bulbaire.) F. Raymond et L. Alquier, Now.
Icon, de la Salpetrikre, Sept.-Oct. 1907, p. 371.

The symptoms in this patient, a woman of 77, were, immobility,
an almost complete mental confusion, with attacks of laughter or
weeping from time to time. In addition, a spastic paresis of all
four limbs, exaggerated reflexes with ankle clonus and Babinski
sign, and complete incontinence of the sphincters. No actual
bulbar troubles, but the speech was slow and scanning; there was
nystagmus, and the upper limbs showed an intention tremor.
The autopsy revealed the following. In the cerebrum : numerous
lacunar areas of disintegration, some as large as a small pea, in the
white matter and in the basal nuclei—they had produced a diffuse
demyelinisation in the principal association tracts, particularly
the superior longitudinal and the occipito-frontal bundles. There
were no lacunes in the internal capsule. The peduncles were also
spared. In the pons and upper part of the medulla were nume¬
rous lacunar areas, mostly very small, but four exceedingly large
ones, one of which involved part of the pyramidal tract. The
upper part of the cervical cord also showed some lacunar disin¬
tegration, similar to those recorded by Lhermitte in senile
paraplegias. One may conclude that the pseudo-bulbar syndrome
merely indicates the existence of a lesion above the bulbar nuclear;
usually cerebral, it may be pontine. This would be suggested by
symptoms such as were present in this case, nystagmus, scanning
speech, and intention tremor, the intellectual troubles pointing to
the cerebral lesion. J. H. Harvey Pirie.

180

ABSTRACTS

POST-APOPLEOTIO TREMOR. (Symmetrical Areas of Softening in
(147) both Lenticular Nuclei and External Capsules.) John H.

Rhein and Charles S. Potts, Joum. Nerv. and Ment.

Dis., Dec. 1907.

The case reported is that of a man aged 58, who, when examined
in 1906, had an almost constant movement of the right arm, which
only ceased temporarily when his attention was distracted. The
movement consisted of alternate flexion and extension at the
elbow and wrist, the hand being supinated. There was no loss of
power in the arms, but the legs were rather feeble, and the right
one somewhat stiff. There was ataxia of both arms and legs,
especially noticeable in the right arm. The deep reflexes of the
arms were diminished ; the knee-jerks, especially the left, were
brisk. The plantar reflexes were flexor. Gait was slightly ataxic,
and Rombergism was present. The reaction of the pupils to light
was sluggish.

The patient’s mental condition precluded any concise account
of the onset of illness being obtained, but the condition was of
long duration (several years), and progressive.

The pathological examination revealed softening in the putamen
on each side, more extensive on the left than on the right, also
degeneration of the fasciculus of Tiirck on the right side. There
was no degeneration of the motor fibres in the internal capsule,
the pons, medulla, or cord. On the right side “ the red nucleus
appeared to be intact”; on the left side “ the red nucleus appeared
to be normal.” The dentate nucleus on both sides “ showed an
unusual vascularity.” T. Grainger Stewart.

REPORT OF TWO FATAL CASES OF BRAIN ABSCESS.

(148) Thomson, Arch, of Otol., Vol. xxxvi., p. 576.

This is a full clinical account of two cases of brain abscess—the first
that of a large cerebellar abscess involving the entire left lobe, a
portion of the central lobe, and encroaching on the right lobe, and
yet giving rise to no characteristic signs of trouble in that region;
the second, a case of temporo-sphenoidal abscess with typical
symptoms which repeated puncture through the dural exposure in
an existing mastoid wound failed to detect. In both cases the
indications from the leucocyte count were negative. The first case
is chiefly of interest from the fact that such a large destructive lesion
could exist in the cerebellum without giving rise to more definite
signs of its presence; the second raises the question as to the

ABSTRACTS

181

relative value of puncture and exploration through the already
existing mastoid wound in cases of suspected temporo-sphenoidal
abscess, compared with that through a trephine opening over the
superior or middle convolution. Henry J. Dunbar.

A FATAL CASE OF SINUS THROMBOSIS, AFTER CHRONIC
(149) PURULENT OTITIS COMPLICATED WITH CHOLESTEA¬
TOMA ILLUSTRATING AN UNUSUAL VARIETY OF
INFECTION. Knapp, Arch, of Otol., Vol. xxxvi., p. 573.

A boy of eight years, the subject of kyphosis, who had suffered for
three years from discharge from the right ear, was admitted with a
three days’ history of headache, vomiting, cessation of discharge,
and rigors. The temperature was 105° and the pulse 140. There
was tenderness over the mastoid, and pain below the mastoid tip,
extending down into the neck. At the operation thin foetid pus
was found in the dilated antrum and cholesteatomatous masses in
the tympanum. The sigmoid sinus contained disintegrated clot,
thin serous pus, and gas smelling like an appendix abscess. Two
days later there was tenderness in the neck and enlargement of
glands. The internal jugular was ligatured; it was inflamed and
adherent, but contained fluid blood. Symptoms of septic pneu¬
monia developed, and the patient died in a few days. Clinically
and bacteriologically the infective agent belonged to the proteus-
aerogenes group, which, in sinus thrombosis secondary to mastoiditis,
has chiefly been observed in chronic purulent otitis with choles¬
teatoma. The jugular vein should have been ligated at the first
operation. Henry J. Dunbar.

BRAIN TUBERCLE IN CHILDHOOD. (Der Himtuberkel im Kin-
(150) desalter.) J. Zappert, Arbeit, a. d. Neurolog. Inst. a. d. Wien ,.

Univ., Bd. 16, Teil 2, S. 79.

This is a long article, containing notes of a large number of cases,
with comments thereon. The following is simply a translation of
the author’s own conclusions or summary:—

1. Brain tubercle in children runs, in the great majority of
cases, a latent course; the clinical diagnosis is likewise usually
not made.

2. Among those running a latent course may be cases with
tumours from the size of a hazel-nut to that of a plum, but in the
majority the tumours are small.

3. Multiple tubercular tumours are not so often latent as
single are.

182

ABSTRACTS

4. Tubercles in the cerebellum, cerebrum, and basal ganglia
are as often latent as manifest; those in the crura cerebri, pons,
and corpora quadragemina usually cause definite symptoms.

5. Latent brain tubercle may give rise to a terminal tubercular
meningitis with the onset of localising symptoms of an atypical
meningitis.

6. Latent cases may become rapidly fatal with meningeal
symptoms without any meningitis being present.

7. The course of a case may run entirely under the clinical
picture of a progressive hydrocephalus.

8. General tumour symptoms are not infrequently present
without characteristic localising symptoms.

9. In multiple tubercle one of the tumours may be localised
with more or less certainty, while the others, even large tumours,
have been unsuspected.

10. Localisable tumours are mostly large, and are found espe¬
cially in the pons, the cerebellum, and the corpora quadragemina.

11. Through the frequent onset of an end meningitis, a limit
is set to the growth of the tubercular tumours. Where there is
no meningitis, or if only late in the disease, the tumours more
often become localisable.

12. Among the initial symptoms the more important are
hemiplegia coming on with convulsions and tremor on one or both
sides, also ataxia and chorea.

13. The differential diagnosis must be from infantile cerebral
paralysis, epilepsy, meningitis, encephalitis, and hydrocephalus.

14. Little good can be looked for from operative interference.

J. H. Harvey Pirie.

OLIOTIC CYST OF THE RIGHT SUPERIOR PARIETAL LOBULE.

(151) A. N. Collins and E. E. Southard, Amer. Joum. Insan., Vol.
xxiv., Oct. 1907.

The clinical and anatomo-pathological report of a case showing
general and focal symptoms which terminated fatally after lasting
for six years. At autopsy a cyst was found 2 5 cm. in diameter
which reached to the lateral ventricle, and was only separated from
it by the ependymal lining. Fibrous bands projected in all direc¬
tions throughout the cyst, and seemed to form a more or less in¬
timate part of it. The explanation offered is that of glioma with
cystic degeneration, the condition being analogous to syringo¬
myelia. D. K. Henderson.

ABSTRACTS

183

A STUDY OF CERTAIN REFLEXES IN SCARLET FEVER

(152) C. Rolleston, Quar. Joum. of Med., Jan. 1908, p. 117.

The writer examined the plantar, abdominal, cremasteric, and knee
jerk reflexes in 175 cases of scarlet fever. 75 were male and 100
female.

The cases were divided according to their severity into three
classes. Severe (20 cases), moderate (132 cases), and mild (23 cases).

The average age of the patients was years. The reflexes in
children under two were not examined, owing to the infantile
character of the plantar and the uncertainty of the abdominal
responses. It was found that the severer the case, and the younger
the patient, the more likely were the plantar flexor responses to be
replaced by Babinski’s sign, and the abdominal reflexes to be
absent. The knee jerks were found absent in only three severe cases.
The cremasteric reflex was only absent in one case.

Of the 20 severe cases 14 exhibited an extensor plantar response,
the average duration of this phenomenon being 24 days. The
abdominal responses were absent in 13 of the 20 cases, the period
of absence extending over 14 days.

Among the 23 mild cases only 4 showed an extensor response,
the average duration being 11 days. In 8 of these 23 patients, the
epigastric and abdominal reflexes were either absent or diminished.
Sixty-six of the moderate cases exhibited Babinski’s sign, the average
duration being 10 days. In 50 of these 132 cases, the abdominal
reflexes were absent, the period of absence being 18 days. In a
large number of cases in all three groups, whatever the type of plantar
response first obtained, there was an interval of varying duration,
in which the plantar reflexes were affected, being either entirely
absent, or represented by reaction in the hip muscles alone.

The epigastric and abdominal were less frequently affected than
the plantar reflexes. The epigastric was usually affected contem¬
poraneously with the supra- and infra-umbilical responses, but
occasionally the epigastric lagged behind the others in its return to
activity. Frequently, but by no means always, the absence of the
abdominal reflexes was associated with Babinski’s sign.

The onset of complications, e.g. uraemic fits and endocarditis,
was found to alter the character of previously normal reflexes.

Author’s Abstract.

GRAPHIC STUDY OF FOOT-CLONUS AND ITS SIGNIFICANCE

(153) IN PRACTICE. (Das graphische Stadium des Fussclonus und
seine Bedeutung in der Klinik.) Ettore Levi. Arb. a. d.
Neurol. Inslit. a. d. Wien. Univ., Teil 2, 1907

The author of this paper studied the curves obtained by the
graphic registration of the movements in foot-clonus, in such

184

ABSTRACTS

conditions as ordinary hemiplegia, spastic post-puerperal para¬
paresis, pseudo-bulbar paralysis, multiple sclerosis with hysterical
complications, hystero-neurasthenia, as well as in normal indi¬
viduals after fatigue.

He found that the periodicity of the movements in the purely
organic lesions lay between 4 and 7 per second, being generally
about 6 per second. The rate was never found to be so high as
that recorded by Horsley (8-10) or MacWilliam (13 5-14), and it
did not vary during the course of an experiment, though it differed
slightly from day to day according to the state of the patient as
regarded fatigue. The extent of the organic lesion seemed to have
no influence on this rate, which was independent of the will of the
individual. The single elements of the tracings showed regularity
of form as well as of rhythm.

In cases of pseudo-clonus the periodicity was found to vary
from second to second, reaching a maximum of 5-7 per second.
The single movements showed irregularity in extent, some appear¬
ing “ half abortive.”

The author thinks that the differences between these two types
of curves are sufficiently clear to be of clinical importance. He
also found that after hard exercise of the lower extremities in
healthy individuals (e.g., after hard bicycle exeicise on hilly roads),
a foot-clonus could be induced which gave a curve like those got
in pseudo-clonus. J. Graham Brown.

OCULOMOTOR PARALYSIS WITHOUT INVOLVEMENT OP
(154) THE INTERNAL MUSCLES IN PERIPHERAL LESIONS.
(Oculomotoriusl&hmung ohne Beteiligung der Binnenmuskeln.
bei peripheren L&sionen.) Fuchs, Arb. a. d. Neurol. Instil,
a. d. Wien. Univ., Bd. 15, T. 1, 1907, S. 1.

The author states that the opinion that in a pure external ophthal¬
moplegia the lesion is to be found only in the oculo-motor nuclei,
or in the intra-cerebral course of the nerves, is not invariably true ;
that, when a typical external ophthalmoplegia is bilateral, its origin
is usually nuclear; but, on the other hand, when the ophthal¬
moplegia is unilateral it is probably not nuclear. A purely uni¬
lateral ophthalmoplegia or a paralysis of the third nerve without
involvement of the interior muscles has been recently shown to be
a possible result of a peripheral basal lesion. The author gives
references to eighteen such cases, in six of which sectio showed
compression atrophy, primary atrophy of the nerve itself, and
inflammations. He discusses in detail five clinical observations
of his own.

The power of causing a pure external paralysis is peculiar to no

ABSTBACTS

185

special land of lesion, but may be observed in trauma, such as from
fracture of the base of the skull, or from inflammation, as in neuritis,
meningitis or orbital cellulitis, or from simple atrophy or atrophy
due to compression. The writer attributes the escape of the internal
muscles to a greater resisting power of their nerves, and refers (1)
to the opposite condition of diminished resisting power in the
macular fibres of the optic nerve which, in spite of their central
position, are most easily affected in cases of a retro-bulbar neuritis,
intoxications, etc.; and (2) to the frequent escape of the centripetal
pupil fibres, where not infrequently in neuritic atrophy of the first
nerve, the light reaction of the pupils is retained after the sensi¬
bility to light is lost. These two conditions prove that different
parts of a nerve trunk may have different degrees of vulnerability,
and afford a reasonable explanation for the escape of the internal
muscles of the eye, in some cases when the peripheral part of the
oculo-motor nerve is paralysed. Alexander Bruce.

THE BACTERIOLOGICAL A8PE0TS OF THE PROBLEM OF
(155) NEUROPATHIC KERATITIS. H. Morriston Davies and
George Hall, Brit. Med. Joum., Jan. 11, 1908.

In this paper the authors call attention to the absence of bacterio¬
logical investigations in the work previously done on the causation
of neuropathic keratitis. While they do not claim that the solution
of the problem has been made out, they reached the conclusion that
this mode of attack is decidedly more hopeful than those formerly
used.

The first part of the paper consists of a detailed review and
criticism of the various existing hypotheses concerning the etiology
of the disease.

The second part deals with the bacteriological investigations.
The authors made repeated cultures from the eyes of twenty-one
patients who had had the Gasserian ganglion removed. Nine of
these were seen during an attack of neuropathic keratitis, whilst
ten patients (seen twelve days to eighteen months after the opera¬
tion) had never had any eye trouble. The organisms obtained from
the cultures were staphylococcus aureus and albus, streptococcus,
pneumococcus, xerosis and proteus, together with one other bacillus,
which belongs to the group of pseudo-diphtheria bacilli, this
organism the authors refer to as the Bacillus X. The staphylo¬
coccus aureus was obtained from every eye examined, whilst the
Bacillus X. was found in all the eyes, and in those only, which were
affected by neuropathic keratitis.

The experimental work on eight monkeys was performed by Sir
Victor Horsley. The following results were obtained:—In three
n

186

ABSTRACTS

monkeys the cornea was not perfectly anaesthetic after the opera¬
tion, and no keratitis developed either spontaneously nor after
inoculation with Bacillus X. In three others the Bacillus X.
was present, and the keratitis appeared within twenty-four hours
of opening the lids. In one no keratitis could be induced after
the operation, but within twenty-four hours of inoculation the
Bacillus X. was never recoverable, only staphylococci being found,
whilst in one rhesus well-marked neuropathic ulceration was obtained
after inoculating the conjunctiva with the discharge from the eye of
another monkey suffering from keratitis. This discharge contained
staphylococcus aureus and Bacillus X. The coccus was found to
be non-pathogenic to guinea-pigs.

Number of
cases

examined.

Presence of
staphylo¬
coccus.

Presence of
Bacillus X.

Oases with neuropathic keratitis—
Acute stage ....

Quiescent stage

1 1

Oases without neuropathic keratitis

1 The case developed another attack of keratitis later.

The investigations suggest to the authors that three factors are
necessary: (1) Removal of the Gasserian ganglion; (2) presence
of the bacillus; (3) a factor of undefined nature dependent on the
eyelids and removed by closing them. Author’s Abstract.

AMAUROTIC FAMILY IDIOCY. (Tay Sachs Disease.) (LTdiotie
(156) amaurotique familiale.) M. E. Apert, Semaine Mid., jan. 15,
1908.

Being led to study amaurotic family idiocy by the observation of
a case, the first published in France, the author in this article arrives
at the following conclusions :—

1. Amaurotic family idiocy is a well-defined morbid entity,
almost identical in the great majority of published cases, and
characterised by the following peculiarities—onset during the first
six months of life, with a progressive apathy; gradual enfeeble-
ment of the power of sight; pathognomonic alteration of the fundus
of the eye consisting in a regularly circular white spot situated in
the macular region, with a cherry-red point in the centre ; emacia¬
tion ; paralysis; idiocy ; marasmus; death generally before the
age of two. On autopsy, no maoroscopical alteration of the nervous

ABSTRACTS

187

centres. On histological examination, a special translucent,
globular degeneration of the cells of the nervous centres and of the
ganglion cells of the retina. The disease has a very distinct family
character; in numerous families about half of the children are
affected one after the other. The predilection of the disease for
the Jewish race is remarkable; taking into account only cases
which present in a typical way the characteristic picture described
above, out of eighty-two observations two only are those of non-
Jewish children.

2. Besides the typical form characterised by such special lesions
of the macula, there exist some near varieties, in which the morbid
picture is almost the same, but in which there is no white macular
spot, but simply variable alterations of the fundus of the eye,
usually with lines of pigment. These abnormal forms are less
peculiar to the Jewish race than the typical form, since out of nine
cases, two only were Jews. Tn the absence of autopsy, it is difficult
to say if these atypical varieties should be identified with the Tay-
Sachs disease.

3. Vogt has also recently allied to the Tay-Sacha disease a
certain number of observations of family diplegia with amaurosis,
for which he proposes the name of “ juvenile form of amaurotic
family idiocy.” But these observations, which for that matter
are not all comparable to each other, differ from Tay-Sachs’ disease
in numerous ways: onset during the second period of childhood,
spasmodic paraplegia, absence of the pathognomonic alterations in
the fundus of the eye, and, in the rare cases in which there was
autopsy, granular and pigmentary alteration of the brain cells quite
different from the globular infiltration by a translucent substance
which is constant in Tay-Sachs’ disease. We must therefore con¬
tinue to class these cases apart under the name of family diplegia
with amaurosis (Higier). By doing so we shall retain for amaurotic
family idiocy the character of a morbid entity, so well defined by
its constant pathognomic characters and its precise limits, as they
have been traced by the first observers of the disease.

Author’s Abstract.

OTALGIA CONSIDERED AS AN AFFECTION OF THE SENSORY
(157) SYSTEM OF THE SEVENTH CRANIAL NERVE. Hunt,
Arch, of Otol VoL xxxvi., p. 543.

The distribution of the pain in herpes zoster auris, which is de¬
pendent on a specific inflammation of the geniculate ganglion, first
drew the author’s attention to the connection between otalgia and
the sensory system of the facial nerve. The pain in these cases is
variously referred to the surface of the auricle, the auditory canal
or tile depths of the ear—the same, approximately, as in idiopathic

188

ABSTRACTS

and reflex otalgia. Developmentally there is a most intimate
relationship between the facial nerve and its ganglion, the ganglia
of the acoustic nerve, and all those structures which go to form the
auditory mechanism. Anatomically the facial is a mixed nerve,
the geniculate ganglion, which is the homologue of the Gasserian
ganglion, having as its sensory root the nerve of Wrisberg, and as
its peripheral branches the two superficial petrosal nerves, the
external petrosal nerve, and other filaments, by means of which
the 7th nerve establishes sensory relationships with the internal,
the middle and the external ear. In reflex otalgia the lesion
giving rise to the condition is observed to be in the distribution of the
second or third divisions of the trifacial nerve, which are both
anatomically connected with the geniculate ganglion by means of
the great superficial petrosal nerve which passes to Meckel’s ganglion
and the small superficial petrosal which passes to the otic ganglion.
Because of the complexity and overlapping of the auditory innerva¬
tion, certain mixed forms of otalgia occur. These belong rather to
the auriculo-temporal neuralgia of the trigeminus, or are occipito¬
cervical otalgias; not, however, otalgia in the pure sense of the term.
The writer concludes by saying that, owing to the numerous and
intimate central and peripheral connections of the 5th, 7th,
8th, 9th, and 10th nerves, many careful clinical analyses will
be required before deciding the exact role played by any one of
them in otalgia ; but that it seems clear that while the facial nerve
may be by no means the sole factor, it is the preponderating one in
the production of otalgia. Henry J. Dunbar.

THE PSYCHICAL DISTURBANCES IN 8YDENHAMS CHOREA.

(158) (TJher die psychischen Sttirungen bei der Chorea minor.)

Kleist, Allg. Zeitschr. f. Psych., lxiv., 1907, p. 769.

The author has observed 154 cases of chorea minor (including
chorea gravidarum) occurring in the University Clinic at Halle,
and has paid special attention to the relation of the chorea to
psychical disturbance.

As far as the physical symptomatology of chorea minor is
concerned, emphasis is laid on the clonic nature of the movements,
their sudden rise and fall: sometimes they are of abrupt onset,
but persevere in a tonic way before slowly disappearing. The
curve of this type of involuntary movement shows a sudden rise,
with a plateau and a gradual subsidence. The distribution of the
movements is highly variable; in severe cases the extensors of the
back are commonly involved, and a condition not at all unlike the
“ arc de cercle ” of hysteria is frequently seen. Inco-ordination,
apart from the involuntary element in the disturbance of motility.

ABSTRACTS

189

is interesting. It is to be observed chiefly in the fingers; in some
severe cases there may be general inco-ordination in standing,
walking, sitting, etc. Speaking, eating, swallowiug may be im¬
paired. There is no necessary parallelism between the inco¬
ordination and the twitching; the former may persist after the
disappearance of the latter. The inco-ordinate cases are a link
between ordinary chorea and so-called “acute ataxia,” in which
isolated choreic movements may occur. There is much evidence
to suggest that functional disturbance of the cerebellum (inco¬
ordination and involvement of trunk musculature) plays its part
in chorea.

Forster distinguishes between affection of the prime-movers
(agonists) and affection of the synergic and antergic muscles in
chorea. According to him the former are less impaired than the
latter. Kleist finds that the inco-ordinate cases reveal a disturb¬
ance chiefly of the prime-movers; their innervation is fleeting,
nnsteady, sometimes slow, sometimes feeble. Thus there is a link
here with cases of “ paralytic ” chorea Many of the cases
observed exhibited general weakness of one-half of the body. In
two cases of almost complete right-sided paralysis the left side
showed great defect in agonist-innervation. The akinesis of severe
cases of chorea is not a paresis in the ordinary sense, inasmuch as
certain movements may be possible one minute and impossible
the next; nor is it directly proportional to the weakness of the
musculature, nor attributable to asynergy. In cases of akinesis
there is great diminution of spontaneity, which may persist after
the twitching phase is over: automatic movements, movements of
expression and mimicry, are often reduced; there is a curious
poverty of expression sometimes. Choreic patients tire readily
with muscular effort.

Hypotonia of the muscles is a constant feature. Again, no
parallelism between the hypotonia and the involuntary movements
is discoverable. The former frequently persists after movements
cease. On the other hand, hypotonia and inco-ordination are
closely associated. The tendon reflexes are absent, or normal, or
increased. Tonic perseveration of the reflex is not infrequent:
it has been observed at elbow and ankle as well as at knea
There is sometimes disturbance of sensation, either in the form of
pains and paraesthesise, or (rarely) in the form of objective change.
The muscular sense is always intact. Sometimes nerve trunks
are sensitive to pressure. Cutaneous reflexes are frequently
elicited with minimal stimuli. In two cases Babinski’s extensor
response was present

In 13 per cent of the 154 cases no obvious psychical impair¬
ment was discoverable. In 92 cases there was some mild psychical
disturbance, which took the shape of an easily excited anxiety or

190

ABSTRACTS

timidity, or of childishness, or of diminution of spontaneity.
Some of the patients were almost stuporose. In most instances
the actual choreic phenomena and the altered psychical states ran
a more or less parallel course. Apart from affective changes,
inattention, forgetfulness, and fatigability were often noticeable.

Of still more severe mental disturbance instances occurred, in
the form of hallucinations, ideas of persecution, etc. Some of the
cases of hallucinatory disturbance were very severe, with dis¬
orientation in time and space. According to Mobius, the specific
chorea psychoses are characterised by hallucinations and dis¬
orientation. Seven of the patients exhibited symptoms allied to
the motility psychosis (Motilitatspsychose) of Wernicke. They
made purposeful movements for no obvious reason whatever; one
sang, whistled, danced, talked; others made movements of ex¬
pression ; one fastened her quilt round her, beat and struck herself,
etc. The behaviour of some was alternately hyperkinetic and
akinetic, so to speak. Stereotyped movements, theatrical poses
and gestures, monotonous singing, verbigeration, etc., were ob¬
served, associated with or followed by negativism, flexibilitas cerea,
or akinesia in general.

The localisation of choreic movements, inco-ordination, hypo¬
tonia, etc., is still a difficult question.

Anton considers the condition explicable by a functional dis¬
turbance of the optic thalamus, Bonhoffer of cerebello-thalamic
paths. In the view of the latter, the phenomena are due to the
absence of centripetal impulses which normally pass by this route
to the basal ganglia and the cortex. Clinically, some cases are
more cerebellar in type, others tegmental, others thalamic. Many
of the symptoms (pain, parsesthesise, disturbances of skin, and
mucous membrane reflexes, of vessel innervation, sweat secretion,
etc.) can be explained by disturbance in basal ganglia and internal
capsule. Disease of the former is frequently associated with the
occurrence of involuntary movements of expression, such as are
seen in chorea. The influence of subcortical disease on the func¬
tions of the cortex is important; psycho-sensory symptoms may be
due to the arrival of sensory stimuli, impaired and altered in the
sensory part of the internal capsule, at the sensory cortex ; psycho-
motor symptoms to the effect of an impaired subcortical co-ordina¬
tion centre on the motor cortex. But there must in addition, in
chorea, be some disturbance of transcortical systems.

S. A. K. Wilson.

ABSTRACTS

193

A NOTE ON CERTAIN PUPILLARY SIGNS IN CHOREA

(159) F. Langmead, Lancet , Jan. 18, 1908, p. 154.

Thb following phenomena are stated by Dr Langmead to be of
fairly common occurrence in chorea, but to bear no relation to any
particular form of that disease, viz., hippus, peculiarities of move¬
ment of accommodation, contraction, varying inequality of the
pupils, and eccentric pupils. Mere inequality is of little signifi¬
cance in children, but the other signs do not appear to occur in
other general conditions except articular or cardiac rheumatism,
which is of interest with regard to the etiology of these diseases.

J. H. Harvey Pirie.

CERVICAL RIBS AND THEIR RELATION TO ATROPHY OF THE
(160) INTRINSIC MUSCLES OF THE HAND. H. Lewis Jones,
Quarterly Joum. of Med., Jan. 1908.

The author draws attention to the gradual stages by which a cervical
rib has been recognised as a cause of a definite type of muscular
atrophy, which chiefly affects the small muscles of the hand.

He describes a series of such cases in St Bartholomew’s Hospital
Reports for 1893, but the cause of the atrophy was unrecognised.

Buzzard {Brain, 1902) described a series of cases under the title
uniradicular palsies of the brachial plexus—in some of which at
all events a cervical rib was a probable factor. He demonstrated
the root distribution of the sensory and muscular affection, but
did not recognise a cervical rib as a possible cause of the 1st dorsal
root palsy.

Thorbum recognised this association in a paper in which two
cases of muscular atrophy of the type in question were described
{Med. Chir. Trans., 1905). The author found cervical ribs present
in ten out of fourteen cases in which he suspected their presence.
He points out that cervical ribs may exist which cause no symptoms.
Whether they will do this or not depends on the direction of
their growth. He quotes two papers from the Journal of the
Anatomical Society for 1892 and 1900, in which dissections of the
neck were described showing cervical ribs crossed by the 1st dorsal
root, and a similar relation has been recognised at operation.

The author refers to a paper by Hinds Howell, with a full report
of sixteen cases in the Lancet, 1907. Operation on these cases is
difficult, but has been successful on several occasions in relief of
symptoms.

Reproductions of excellent X-ray photographs illustrating the
common types of cervical ribs are included in this paper.

C. M. Hinds Howell.

192

ABSTRACTS

HYSTERICAL PSEUDO TETANY WITH PECULIAR VASOMOTOR
(161) DISTURBANCES. (Ueber hysterische Pseudotetauie mit
eigenartigen vasomotorischen Stdnmgen.) A. Westphal,
Berl. klin. Woch., 9 Dez. 1907, S. 1567.

This most interesting article should be read in the original, not only
on account of the two important cases there detailed, but for the
clearness with which the diagnosis is expounded. In both cases
hysterical tetany occurred in relation to peculiar vasomotor dis¬
turbances, a connection not previously described. These were
local syncope and asphyxia, which, however, never went on to
gangrene. Most peculiar were the arterial changes, that exactly
resembled those met with in intermittent claudication except that
the vessel walls were healthy. Repeatedly in the attacks in one
case it was carefully noticed that the pulsation in the dorsalis pedis
artery ceased completely. Ernest Jones.

CONTRIBUTION TO FREUD’S SEXUAL THEORY OF THE
(162) NEUROSES. (Em Beitrag zur Freudschen Sexualtheorie der
Neurosen.) Ernst Bloch, Wien. klin. Woch., Dez. 26, 1907,
8. 1647.

Bloch relates a case which tends to support Freud’s aetiological
theory. It concerns a man of 28 who complained of total impotence.
Psycho-analysis revealed that when attempting to rape his sister
at the age of five his father had caught him and mercilessly punished
him. He had forgotten (verdrangt) the incident until the age of
thirteen, when he repeatedly failed to perform onanie, each time the

E icture of his father thrashing him rising to his consciousness and
eing followed by an end of his erection. Bloch traces his adult
impotence to the suppressing action of the painful memory.

Some discursive remarks on Freud’s theory are then added.
Bloch is convinced of its truth, but not enthusiastic about the
practical side of psycho-analysis in therapeutics on account of the
extremely great technical difficulties, which he confesses baulk him
in ninety-nine cases out of every hundred. He admits, however,
the total hopelessness of the older psycho-therapeutics (consolation,
reassurance, etc.), and emphasises the superficiality and temporari¬
ness of any changes produced thereby. Ernest Jones.

ABSTRACTS

193

ON HYSTERIA AND FREUD’S PSYCHO ANALYTIC TREAT-

(163) MENT. (Ueber Hysteria nnd die Frendsche psychoanalytische
Behandlung derselben.) A. Friedlandkr (of Hohe Mark),
Monaisschr. f. Psych, u. Neur., Bd. 22, Erganzungsheft, p. 45.

The author reports briefly seven cases of hysteria treated success¬
fully by him without the employment of Freud’s psycho-analytic
method, which involves a rather searching investigation of the
intimate details of the patient’s history. He emphatically dis¬
countenances such a method in the case of young female patients.
One of the patients treated by him had been confined to bed for over
twenty years, but recovered completely after treatment lasting
over a year.

The author promises a fuller report of the cases, with further
therapeutic details. C. Macfie Campbell.

GONORRHOEAL SPONDYLITIS. (Spondylose blennorhagique.)

(164) Crouzon et Doury, Bull, el mim. de la Soc. mid des Hdp. de Paris,
1907, p. 1585.

Although the r61e of gonorrhoea in the production of spondylitis
is well established, there are relatively few cases where this aetiology
is incontestable. In most of the cases chronic rheumatism, the
arthritic diathesis, or tuberculosis can be incriminated. None of
these factors can be invoked in the present case. The patient in
question had contracted gonorrhoea four years ago. The acute stage
lasted three weeks, and was replaced by a persistent gleet. Sub¬
sequently pains in the knees developed. A year after the onset
of gonorrhoea the patient, who was working in the fields, began to
feel pain in the lumbo-sacral region, which spread to the sides of the
trunk, the hips, and upper part of the thigh. Simultaneously he
developed a stoop. A few weeks before admission he had an attack
of gonorrhoeal cystitis. On admission the vertebral column showed
a considerable curvature, which it was impossible to straighten.
Pain in it was spontaneous, and could also be caused by pressure,
especially in the lumbo-sacral region. The larger joints were intact.
Matutinal gleet was still present. J. D. Rolleston.

POLYARTERITIS ACUTA NODOSA AND PERIARTERITIS
(165) NODOSA. W. E. Carnegie Dickson, Joum. Path. Bad.
Carhb., 1907, Yol. xii., p. 31.

The writer of this paper endeavours to distinguish between the
two above-named conditions. Both are exceedingly rare, only twelve

194

ABSTKACTS

undoubted cases of the latter and eighteen cases of the former
disease having been previously recorded. The author’s case of
polyarteritis acuta nodosa appears to be the first published in this
country, and he therefore deals somewhat fully with the literature
of the subject. The case was that of a message boy, set. 14J
years, whose illness commenced, about a month before admission
to hospital, with general weakness, severe epigastric pain, fever and
vomiting. Later, convulsions supervened, great emaciation, and
ultimately coma and death ten weeks after onset of illness.

RisurrU of Post-mortem Examination.—Numerous small, very
hard, pale greyish-white nodules, rounded or somewhat spindle-
shaped in outline, and varying in size from those just visible to the
naked eye up to about the size of small peas, were found on the
smaller and medium-sized arteries of the heart, liver, spleen, kidneys,
mesentery, brain and spinal cord. The majority of these nodules
were about the size of hemp-seeds, and they were evidently situated
on or around the arteries, involving their walls, which were at parts
distended into minute saccular or spindle-shaped aneurismal dilata¬
tions, the majority of which were thrombosed. The latter condi¬
tion gave rise to numerous small areas of infarction in the lungs and
in the kidneys, which also showed evidence of acute or sub-acute
inflammatory changes.

The clinical symptom-complex depends largely on interference
with the functions of the organs, the vessels of which are selected
by the disease. The heart and kidneys are most frequently attacked,
and then, in order of frequency, the mesentery and liver, stomach
and intestines, muscles, spleen, diaphragm, genital organs, sub¬
cutaneous tissue, omentum, peritoneum—more rarely the brain,
(e.g. in the present case), and, in only one recorded case, the lungs.

General Conclusions. — (1) Under the general term “ peri¬
arteritis nodosa ” two entirely distinct diseases have been hitherto
described. These should be differentiated from one another, and
classified under different names, (a) Periarteritis nodosa .—A true
periarteritis, nodular in its distribution, the majority, if not all,
of the cases of which are syphilitic in nature. (6) Polyarteritis
acuta nodosa .—Characterised by the formation upon the smaller
and medium-sized arteries of small localised nodules.

(2) In the case of the latter disease the earliest discoverable
changes are found in the outer coat. The process rapidly spreads
inwards, so that the most complete destructive lesions produced by
the disease are to be found in the muscular coat. These are
accompanied by local inflammatory changes, and are followed by
the giving way of the internal elastic lamina and the other coats of
the vessel wall. Thrombosis of the contents of the lumen and of its
aneurismal dilatation is an almost constant accompaniment of the
lesion, as are also proliferative changes in the outer and inner coats

ABSTRACTS

195

of the vessel. Secondary changes, such as infarction, necrosis,
hemorrhage, etc., may occur in the organ or tisane supplied by the
affected artery.

(3) The channels by which the infection reaches the vessel wall
are possibly the vasa vasorum, or, perhaps, the perivascular
lymphatics.

(4) The etiology of the condition is obscure. The cause is
almost certainly some bacterial or other infective organism or its
toxin. No positive evidence as to the nature of this is afforded by
the present case, staining for all the ordinary pathogenic bacteria
(including tbe tubercle bacillus) and for the spirochsete pallida,
having given entirely negative results.

Author’s Abstract.

PSYCHIATRY.

ON THE CLASSIFICATION OF THE PSY0H08E8. (Beitrag zur
(166) Methodik der Statistik und der Klasslflkation der Psychosen.)

Th. Ziehen (of Berlin), Monatsschr. f. Psych, u. Neurol., Bd. 22,

Erganzungsheft, p. 161.

For a satisfactory clinical-symptomatological classification the
symptoms of each case of mental disorder have to be studied, not
only in their momentary combination and succession, but in their
mutual relationship. Each physician has to analyse carefully his
own material, to keep to the actual facts of observation, and not
to pare down and distort the actual symptoms in order to bring
the individual case under a one-word diagnosis. Such a diagnosis
is of absolutely no value, and the worthlessness of statistics
accumulated on such a basis must be recognised before progress
can be made in the classification of the psychoses. Cases should
not be forced into antiquated groups, but groups themselves should
be formed naturally out of the cases, with full descriptive diagnoses,
which do justice to the actual clinical facts. Ziehen illustrates
his method of using his clinical material by giving an extract of
the entries for four consecutive days in the book containing the
record of the diagnoses made. In Ziehen’s clinic a provisional
diagnosis is entered as soon as the case has been thoroughly
examined, and on succeeding visits the diagnosis is reconsidered,
and, if necessary, revised. The manner of grouping cases thus
analysed is illustrated by giving the results during the first half
of 1906. The author does not press the advantages of the classifica¬
tion adopted in his own text-book; he pleads for consideration

196

ABSTRACTS

of the individual cases unprejudiced by existing descriptions of
hard and fast diagnostic groups. In this connection one has to
keep in mind the distinction between symptom, syndrome (symp¬
tom-complex), clinical picture, and nosological entity.

C. Macfib Campbell.

A COMPARATIVE STATISTICAL STUDY OF GENERAL PAR-

(167) ALYSIS. Charles Ricksher, M.D., Amer. Joum. Insan.,
Vol. lxiv., Oct. 1907.

The tabulation of the results of the examination of the histories
of the 108 cases of general paralysis received in the Shephard-Pratt
Hospital since its opening in 1891. D. K. Henderson.

CHANGES IN THE CLINICAL COURSE OF GENERAL PAR-

(168) ALYSIS. (Wandlungen im klinischen Verlaufe der progressiven
Paralyse.) R. Fels, Monatsschr. f. Psych, u. New., Bd. 22,
Erganzungaheft, p. 34.

The author went over the case-records of 403 general paralytics to
see whether they confirmed Mendel’s view that the clinical picture
of general paralysis has somewhat changed in the last few decades.
The special points to which attention was paid were the social
position of the patients, the clinical symptom-picture, the number
of paralytic attacks, their nature, period of origin, and relation to
clinical symptom-picture, age of onset of the disease; the results
are tabulated in a convenient manner.

C. Macfie Campbell.

CONTRIBUTION TO THE CASE LITERATURE OF THE OCOUR-

(169) RENCE OF PARANOID S7MPT0M-00MPLEXES IN DE¬
GENERATES. (Easuistlscher Beitrag zur Lehrs von dem
Aufbreten paranoider Symptomenkomplexe bei Degenerierten.)

Eduard Reiss (Tubingen), Centralbl. f. Nervenh. «. Psych.,
December 1, 1907.

Reiss discusses in this paper a form of acute or sub-acute mental
illness which appears in criminal cases, and during sentence, and
which generally disappears quickly and surely when the prisoner
is released.

This form of mental illness is the first of the three well-defined
forms described by Bonhoeffer in his work on the “ Psychoses of
Degeneration.” Siefert has lately given examples of it in his

ABSTRACTS

197

“ Mental Diseases of Prisoners ” under the heading “ Hallucinatory
Paranoiac Form.” Neither Bonhoeffer nor Siefert give an ex¬
planation of the origin of the disease. They agree in emphasising
the fact that it is not due to dementia prsecox.

Reiss has seen eight cases. Of this number only three present
detailed and complete histories. In all the cases the psychosis
had been present for a long time and in most for quite a number
of years. The periods of sanity between the outbreaks of illness
were from one to eight years’ duration. The greater number of
cases appeared during imprisonment (generally seclusion). Fear,
ideas of reference, delusions of ill-treatment, single hallucinations,
irritability and ill-humour, and a tendency to morbid recapitulation
of past events are the principal signs. Clearness of mind and
orientation remain. Exceptional symptoms in the form of excite¬
ment, accompanied by violent outbursts of temper, during which
clearness of mind is lost, occur in several cases, but as outbreaks of
excitement occurred during the periods of sanity in the several cases,
these exceptional symptoms could not be reckoned on as peculiar
to the psychosis. The duration of illness was always from a few
weeks to several months, and only in one case did it last for over a
year. In all cases a complete and unaided recovery was made on the
patients being released from the unfavourable surroundings of the
prison. The influence of surrounding objects in exciting the
psychosis is shown by four of the seven patients suflering a relapse
when put into the same conditions as before, and recovering again
as soon and as quickly as when released formerly.

The case of an artist, 31 years of age, with a very bad
family history in regard to insanity, is gone into in detail. The
relationship and diagnosis of the form of insanity in this patient
are fully discussed. It is compared with hebephrenia, running an
episodic course, true paranoia and manic-depressvie insanity, and
the conclusion is reached that it is a case of paranoiac illness founded
on a basis of degeneration. The history of the patient’s illness
shows that he was not a criminal. It brings out very clearly the
exciting elements of the insanity, viz., outside influences. In the
case in question unaccustomed surroundings aroused numerous
fears in a timid and mistrustful mind. The mental confusion was
aggravated by the repeated and over-anxious warnings of the
mother of the patient, who could never emphasise enough the
dangers of large towns. With these warnings and with a feeling
of irremediable solitude, the patient found himself for the first time
in Paris, and felt constrained to leave the city in all haste. The
second attack occurred in Madrid, where he quarrelled with the
landlord, and the emotional excitement which followed made him
an easy prey. The cause of the outbreak in the third instance was
very dear. For years he cultivated the idea that he was an anarchist.

198

ABSTRACTS

and at every opportunity he tried to make himself noticeable by
giving vent to revolutionary ideas. Suddenly a strike broke out
in his native town, and the arrest of anarchists was a daily topic
of conversation. The mother could not warn her son sufficiently
against talking of his political ideas, as she knew that he had
already made himself noticeable in more ways than one, and, besides
this, he was suspected by other people. In this state of mind he
arrived in the Balearic Islands, where he had had unpleasantness
in the previous year on account of his socialism. For several days
his thoughts worried him; then all at once a sharp paranoiac attack
of excitement set in which was confined solely to apprehensive
conceptions working on his mind, and when he returned home and
the disturbing outside influences were removed, he became quite
well in a short time. After six months the whole psychosis suddenly
returned as a result of his unhappy boasting about his political
views. He became excited, quarrelsome, and the former events in
the Balearic Islands returned vividly to his mind. Since then the
socialistic ideas have been less marked, and during later periods of
fear and apprehension he has not had delusions. In this patient
there is a peculiar pathological reaction in a degenerate, the form
it takes depending on his constitutional peculiarities, its frequency
and severity depending for the most part on external circumstances;
in many respects, therefore, there was a close relationship to the
hysterical psychoses. The psychogenetic phenomena are a wide¬
spread property of degeneration. In this psychosis and in all the
cases, the complete recoveries made, and the dependence of the
affection on outside influences as exciting causes, are noteworthy
features. Hamilton C. Marr.

A CASE OF DEMENTIA PRjEOOX, CATATONIC FORM
(170) (KRAEPELIN), WITH RECOVERY AFTER FIFTEEN
YEARS; REMARKS ON THE DIFFERENTIAL DIAG¬
NOSIS. (Ein Fall von Dementia praecox catatonischer Form
(Kraepelin) der nach 15. j&hrigen Daner in Genesung ausging,
nebst differentiell-diagnostischen Bemerkungen.) Schaefer
(of Roda), Monatssckr. f. Psych, u. Neur., Bd. 22, Erganzungs-
heft, p. 72.

The patient was a well-educated physician of thirty, with a good
family history, who developed severe neurasthenia after prolonged
overwork; two years later after typhoid fever, and a return of the
neurasthenic symptoms, he became acutely insane. At first he
showed deep depression, anxiety, weariness of life, suicidal trend;
these symptoms were soon followed by a condition of marked con¬
fusion with excitement. During the following years various phases

ABSTRACTS

199

of the disorder were observed; sometimes the condition was one
of profound depression with a suicidal tendency, delusions of sinful¬
ness and of having an incurable disease (tabes, etc.), sometimes he
was dominated by hallucinations of a depressing nature, sometimes
his state was that of catatonic stupor with episodes of violent
behaviour.

After many years the symptoms became less marked, and ap¬
peared to be succeeded by an apathetic dementia with catatonic
traits. After passing through a phase of slight exhilaration the
patient, after the uninterrupted duration of the disorder for fourteen
years, made a complete recovery. At the time of writing he had
for two years been carrying on a large practice, had complete insight
into the true nature of his previous disorder, and profound thank¬
fulness for his recovery.

After reporting the case the author makes some pertinent
criticisms of Kraepelin’s extremely large group of dementia praecox,
under which name the latter has brought together various different
disease pictures which have in common a termination in a certain
form of dementia. Kraepelin himself admits that a certain number
of cases do recover—in fact, about 13 per cent, of the cases of this
catatonic variety.

In view of this fact, and in face of the case reported, Schaefer
considers it not advisable to make a large and somewhat hetero¬
geneous group of which the termination in dementia is to be one of
the main characteristics. It would be better to retain the smaller
groups and also the conception of secondary dementia for a certain
group of cases.

Such a discussion of the question of dementia praecox shows
how valuable it would be if Kraepelin or one of his pupils were to
publish his dementia praecox material from the Heidelberg Clinic
with the histories of the patients up to date.

C. Macfie Campbell.

PROGNOSIS IN OASES OF MENTAL DISEASE, SHOWING THE
(171) FEELING OF UNREALITY. F. H. Packard, M.D., Amer.

Joum. Insan., Yol. lxiv., Oct. 1907.

The writer has worked out the practical significance of the symptom
“ feeling of unreality ” in regard to prognosis and diagnosis. Under
the head “ feeling of unreality ” are included all those symptoms
anting from the Toss of the feeling of reality which Wernicke has
divided into the allopsychic, the somatopsychic, and the auto¬
psychic fields. In the allopsychic field such expressions as “ The
trees seem changed,” “ People are not real,” are common. In the
somatopsychic field patients use expressions to the effect that their

200

ABSTRACTS

stomach or other organs have gone, or that they have no bodies at
all, and similarly in the autopsychic field we hear them say, “ I am
dead,” “ I cannot die.” This symptom was first described by
Esquirol, and later, by Cotard who described it almost wholly in
connection with cases which Kraepelin called involution melan¬
cholia, a condition that had a bad prognosis. Further observation,
however, has shown that, although the feeling of unreality occurs
very frequently in involution melancholia, it is not an essential
symptom, and occurs also in manic-depressive insanity, general
paralysis, and some psychoses, which superficially resemble dementia
praecox; it has not as yet been recorded, in cases of classical
dementia praecox. Formerly cases in which this symptom occurred,
were thought to have a bad prognosis, but the writer shows by a
number of cases of involution melancholia, manic-depressive insanity,
and cases resembling dementia praecox, which recovered or im¬
proved, that one may give a fairly good prognosis.

He concludes by saying that the feeling of unreality is not a
fundamental symptom, nor a pathognomonic symptom, and not
of bad prognostic significance. He emphasises the fact, that the
diagnosis and prognosis of cases should be made on the more funda¬
mental symptoms. D. K. Henderson.

DELIRIUM TREMENS. Statistical Study of One Hundred and
(172) Fifty-six Oases. L. Napoleon Boston, Lancet , Jan. 4, 1908.

This paper gives an analysis of 140 cases of delirium tremens treated
at the Philadelphia Hospital (Blocley), between January 1, 1904,
and March 1,1907. There were in all 156 cases treated during this
period. But sixteen have been omitted in the analysis on account
of incomplete records.

Age was seen to be a predisposing factor to the disease, as well
as exercising an influence on its gravity. The greatest number of
cases occur between the ages of thirty and fifty, but the death-rate
remains almost the same during the second, third, and fourth
decades. The prognosis is unfavourable after the age of fifty.
Many patients were admitted to hospital for the disease several
times: one individual reached a total of forty-two admissions.
The popular idea that the disease proves fatal during the second or
third attack was not corroborated by the author’s experience.

The largest number of cases developed in August; the death-
rate during this month was 46*7 per cent., as against the average
death-rate 37*1 per cent. December and January showed a death-
rate of 72 7 per cent, and 50 per cent, respectively. In spring,
when the disease is fairly common, the death-rate is only 7‘1 and 10
per cent.

ABSTRACTS

201

Of twenty-two cases with pre-existing or accompanying complica¬
tions, ten showed kidney and lung involvement, seven heart and
lung, two kidney and heart, three heart and stomach. Thirty-
eight cases were uncomplicated, and all of these recovered. All the
fifteen cases having renal complications died. Pre-existing cardiac
disease gave a mortality of 84’6 per cent., acute cardiac complica¬
tions being hardly less serious. Cases with bronchitis and broncho¬
pneumonia had a death-rate of 60 per cent.

A. Hill Buchan.

ACUTE TRAUMATIC PSYCHOSES. (Zur Kenntnis der akuten

(173) trauxnatischen Psychosen.) M. Sommer (of Bendorf), Monatsschr.
/. Psych, u. Neur., Bd. 22, Erganzungsheft.

The report of two cases. The first patient presented Korsakow’6
symptom-complex, with explosive mood and ideas of greatness,
and became definitely demented. The second case was a boy
of 13, who, after a severe fall on the occiput, showed complete
change of character without any intellectual defect; he was rude,
gluttonous, irritable, obscene, and shameless. After a few weeks
these morbid symptoms disappeared, and the patient made a
complete recovery. The author describes the psychosis as a moral
autopsychosis in the sense of Wernicke.

C. Macfie Campbell.

TREATMENT.

THE FAVOURABLE INFLUENCE OF OCCUPATION IN CEB

(174) TAIN NERVOUS DISORDERS. Atwood, N.Y. Med. Journ.,
Dec. 14, 1907.

The great value of occupations and diversions in psychotherapeutics
is due not only to improvement of general nutrition and metabolism,
but to re-education and development of the motor brain centres
and increased flow of blood to the parts adjacent to these centres.
At first only passive participation on the part of the patient may
be available, but this, though of less help than active work, should
never be neglected as a means of treatment. Excellent practical
results have been obtained in epileptic colonies from outdoor forms
of work, suited to the individual requirements and capabilities of the
patients. In selecting the occupation suitable for abnormal mental
conditions, attention must be paid not only to the actual state of the
patient but also to his previous history, so that the work chosen
may recall pleasant and not painful or harmful associations. The
effects of music depend more on the instrument employed than on
o

202

ABSTRACTS

the nature of the musical production; thus, the soothing strings
and horns, the stirring wind instruments of wood, the even more
enlivening brass instruments, and the agitating and thrilling drum
and piccolo, have each their own peculiar place in treatment, and
are not to be indiscriminately exhibited to all types of disease. As
regards amusements, games of various kinds (especially golf, the
dosage of which is easily regulated), calisthemc drills, whist, dancing,
and even the study of geography, arithmetic, etc., assist in breaking
up the continuity of morbid ideas and mischievous acts. Handi¬
crafts, such as clay modelling, cabinet-making, and wood-carving,
preceded, if necessary, by a period of complete rest, hasten the
restoration to health and self-confidence. Such methods of treat¬
ment are most easily carried out in hospitals, but in private practice
the adoption by the patient of some fad has frequently a most
beneficial effect. Henry J. Dunbar.

THE CURABILITY OF A RARE FORM OF NOCTURNAL PETIT
(175) MAL BY THE USB OF LARGE DOSES OF BROMIDE.

L. Pierce Clark, Amer. Joum. of Med. Sc., Jan. 1908, p. 94.

In this rare form of epilepsy, which has often been stated to be a
form of hysteria, the attacks invariably occur while the patient
sleeps, usually beginning as soon as the patient falls asleep. There
may be as many as three hundred separate attacks per night. The
patients usually awaken from deep sleep. The eyes open widely,
while the pupils are dilated and unresponsive to light. The face
is either very congested or very pale. In a few seconds the patient
executes some incredibly rapid movements of the hands or feet,
movements without any intent or purpose. Then, unless dis¬
turbed, he soon passes into normal sleep again.

In this type of case bromides in ordinary doses increase the
frequency and severity of the attacks, but the writer here records
four cases which he has treated with large doses (130-400 grs.
daily) in which there has been immunity from paroxysms for
several years. Great care and attention are needed during the
period of what is, really, bromide poisoning; the details of the
treatment are given. J. H. Harvey Pirir.

THE TREATMENT OF TRIGEMINAL NEURALGIA BY INJEO-
(176) TIONS OF ALCOHOL. BRissAUDand SlCARD, Rev. nnirologique,
Nov. 30, 1907, p. 1157.

Thirty-three cases of right trigeminal neuralgia, and eleven of
left, were treated by injections of alcohol. A fine needle, 4, 5, or

ABSTRACTS

203

6 centimetres long, with a diameter of seven-tenths of a millimetre,
is employed. The strength of the alcohol used is 80 per cent, and
the amount injected is a half or one cubic centimetre. Reference
must be made to the original for the description of the various
foramina of exit of branches of the trigeminal and its divisions,
and how to reach them with the needle. Stovaine is used by the
authors as a local anaesthetic, and the injection is always made with
the patient in the horizontal positiou.

The pain of the injection usually passes off after a short
time, sometimes almost immediately. Sometimes the part treated
becomes oedematous for a time. If the injection is successful the
area of distribution of the branch concerned ought to be anaesthetic.
This anaesthesia persists, as a rule, from four to eight months,
sometimes much longer. Sometimes there is myosis, if the
sympathetic filaments of Haeckel’s ganglion are reached by the
alcohol. Paraesthesiae in the anaesthetic area are not infrequent

The authors have had excellent results in their cases, some of
which have been followed for as long as eighteen months. Any
return of pain after a time has been treated successfully with
reinjection.

They recommend this form of treatment not merely for idio¬
pathic trigeminal neuralgia, but for any secondary facial neuralgia.

S. A. K. Wilson.

THE INDICATION FOB TENDON OPERATIONS IN SPINAL AND
(177) CEREBRAL PALSIES. (Die Indikation zu Sdmenoperationen
bei spinalen und cerebralen L&hmungen.) P. Bade (of Hanover),
Wien. wed. Wochensehr., Nov. 9, 1907.

The author defines more precisely than has previously been done
the indications for tendon operations in the above conditions. It
is inadvisable to operate until two years after the onset of the
palsy, as even in the second year there may be some regeneration
of muscle ; extensive tendon operations should not be carried out
in children under six, owing to the nature of the tendinous structures,
the difficulty of putting up the limb in good position, and of carry¬
ing out satisfactorily the after-treatment. Operations in Little’s
disease may with advantage be carried out after the third year.

Tendon operations are only indicated when the muscular
equilibrium is considerably disturbed ; the greater the contracture
and the deformity, the clearer is the indication for the operation.
The aim of the operation is not to give the limb merely its normal
form, but to restore to it approximately normal function. The author
refers in more detail to a few definite deformities.

C. Maofie Campbell.

204

ABSTRACTS

ON SPINAL ANAESTHESIA. (Ueber Ruckenmarksanfisthesienmg.)

(178) A. Remenar, Wien. klin. Wochenschr., Nov. 7, 1907.

The author gives the results of his use of spinal anaesthesia in surgical
operations, the various drugs employed being stovaine (40 cases),
tropacocaine (36 cases), novocaine (4 cases). The more poisonous
the preparation, the more complete the anaesthesia. With novocaine
the anaesthesia is complete, the motor paralysis almost complete ;
with tropacocaine some sensibility may remain, the patient occasion¬
ally feels a dull pressure but no pain; stovaine was given up, as
cases had been reported with nuclear pareses, myelitis, death due
to respiratory paralysis. The author in only one of the cases
where stovaine was used saw slight collapse.

His method is to inject 1 c.cm. of a 4 per cent, solution of tropa¬
cocaine in pure water into the spinal canal. The puncture is made
with the patient in the sitting posture, leaning well forward; by
means of the Trendelenburg position the anaesthesia may be made
to reach even the costal margin. Bier, by making the patient take
deep inspirations with mouth and nostrils closed, was able to
anaesthetise the whole trunk, axilla, and upper extremities.

In two of the thirty-six cases treated with tropacocaine
anaesthesia was incomplete, but narcosis was not necessary; in
two other cases slight narcosis was necessary.

The operations included Whitehead’s operation for haemorrhoids,
resection of the knee and of the ankle joint, amputation of the leg.
The age of the patient is no contra-indication, the method having
been used with children of ten and patients of eighty. The merits
and contra-indications of the method are discussed.

C. Macfie Campbell.

THE TREATMENT OF OHOEEA MINOR, WITH E8PE0IAL

(179) REFERENCE TO THE DANGERS OF THE ARSENIC
THERAPY. Koplik, Med. Bee., 18th Jan. 1908.

Although chorea has come to be recognised as an infection pure
and simple, the therapy of the disease has, generally speaking, not
been altered to meet the indications of improved pathological
knowledge. The application of routine empirical treatment to all
forms and degrees of chorea is especially irrational, cases with
associated endocarditis or paralytic phenomena requiring entirely
different hygienic and medicinal measures from chose free from
such complications. The administration of arsenic is, in the
writer’s opinion, exceedingly dangerous in this disease in the large
doses in which it is usually administered. The commonly recog¬
nised symptoms of arsenical poisoning, such as neuritis, gastric
disturbance, oedema, and skin eruptions, are by no means in¬
frequent ; but the toxic action on the kidneys is a much earlier

REVIEWS

205

and more constant symptom of poisoning. As a result of careful
investigation in a series of cases, the writer has formed the opinion
that the appearance of albumin, casts, and even blood in the urine
is a frequent phenomenon during the treatment of chorea by
arsenic, and that the examination of the urine gives the most
delicate test for the point of tolerance of the drug. Sunshine,
fresh air, gentle recreation, and the society of other children
are beneficial in ordinary mild cases. When endocarditis is
present as a complication the treatment will have to be modified
so as to secure almost complete rest, and in the severer types with
paralytic symptoms isolation will be indicated. Arsenic should
only be given in the simple cases, and then only in tonic doses.
In cases with mental instability, or with cardiac involvement,
strychnine as a bitter tonic is very useful, and hydrotherapy is
frequently of great service. Trional, chlorotone, and the bromides,
all in small doses, are the most suitable sedatives to employ should
occasion arise. Henry J. Dunbar.

LUMBAR PUNCTURE IN OPTIC NEURITIS. Stephenson, Med.

(180) Press and Circ., 12th Feb. 1908.

This is a summary of a paper with reports of cases by Babinski
and Chaillons. An abstract of the leading facts of seven cases
where improvement followed the operation is given. These
writers “ conclude that lumbar puncture may be considered as a
curative method in optic neuritis due to intra-cranial effusion.
On the other hand, it is merely palliative in neuritis due to intra¬
cranial tumour. The operation, under any circumstances, should
be performed with care, and the amount of fluid evacuated should
be in inverse proportion to the severity of the symptoms of
compression. It is better to renew the puncture as often as
necessary rather than to do too much at one time.”

Henry J. Dunbar.

IReriew.

LB ALTERAZTONI DEL SANGUE IN RAPPORTO SPEOIALMENTE
ALLE MALATTIE MENTALI. Raff able Galdi, Nocera
Inferiors , 1907.

This work is an interesting and important compilation of the
results which ha've been obtained by a large series of investiga¬
tions into the changes in the blood in the various insanities.

In the earlier part of the work the coagulability, density, and
alkalinity of the blood, and the qualitative and quantitative
changes of the various blood corpuscles, are dealt with,
p

206

REVIEWS

It is evident, from the divergent and even contradictory
results obtained, that the subject is one of considerable diffi¬
culty, and that the methods of investigation must be improved,
and more uniformity of technique established, before we can
expect much reliable information with regard to these changes.
It must be remembered, also, that the connection between the
condition of the blood and the mental disturbance is often an
indirect one, and that there are various factors which may be
active in some cases and not in others.

More interesting is the second portion of the work, which
deals with the hemolytic and bactericidal power of the blood,
with serum therapy in some mental diseases, and with the presence
of bacteria in the blood in cases of acute delirious mania, dementia
prsecox, epilepsy, and general paralysis. But in all these branches
of the subject the discrepancies are too marked to allow of any
definite statement.

The chapter on serum therapy is devoted chiefly to an account
of the serum inoculations of epileptics by Ceni.

With regard to the finding of bacteria in the blood of the
insane, the author is of the opinion that although several varieties
of micro-organisms have been isolated from the blood in different
forms of insanity, it is not yet settled whether these can be con¬
sidered as the cause of the insanity, or whether they have invaded
the tissues during the last stages of life. He does not admit that
a specific organism has yet been found for any mental disease.

Such a work as this was wanted, and Dr Galdi has rendered
a great service by bringing together in what he calls a “ Synthetic
Review” the results which have been so far obtained in this
important branch of the subject of insanity.

R. G. Rows.

BOOKS AND PAMPHLETS RECEIVED.

Georg Lomer. “ Bismarck im Lichte der Naturwissenschaft.” Carl Marhold,
Halle, 1907, M. 3.

Paul Guerrier. “l£tude M6dico-Paychologique sur Thomas de Quincey.”
A. Rey, Lyon, 1908.

A. Hoche. “ Moderne Analyse psychischer Eracheinungen.” Fischer,
Jena, 1907, M. —60.

Paul Kronthal. “ Uber den Seelenbegriff.” Fischer, Jena, 1906, M. —60.
Ivar Wickman. “ Beitrage zur Kenntnis der Heine-Medinschen Krankheit
(Poliomyelitis acuta und verwandter Erkrankungen).” Karger, Berlin, 1907,
M. 6.

Merzbach. “ Zur Psychologie des Falles Moltke." Holder, Wien, 1908.
“Psychiatrie Contemporaine,” No. 1, 1908. Soukhanoff, Moscow.

■Review

Yteurologp anb fltepcbiatrp

Original Reticles

THE OTTOLOOIOAL STUDY OF THE CEREBRO SPINAL
FLUID BY ALZHEIMER’S METHOD, AND ITS
DIAGNOSTIC VALUE IN PSYCHIATRY . 1

By HENRY A. COTTON, M.D.,

Medical Director, N.J. State Hospital at Trenton ; formerly of Danvers
Insane Hospital, Hathorne, Mass.; and

J. B. AYER, Jr., M.D.,

Assistant Pathologist, Danvers Insane Hospital.

Methods.

The value of lumbar puncture as a diagnostic aid in psychiatry
and neurology has been nullified to some extent by the defects
of technique rather than by a lack of specific changes in the fluid
due to pathological causes.

Prior to the year 1904, the centrifuge method of Widal and
Ravaut was practically the only method for studying the cytology
of the oerebro-spinal fluid. It answered a certain purpose very well,
but the inaccuracies were soon apparent; and while clinicians made
use of the method for diagnosticating general paralysis, the pathol¬
ogists generally severely criticised it, and doubted if it had any
diagnostic value.

In the first place the cells were so very poorly stained that one

1 Read at the semi-annual meeting of the New England Society of Psychiatry
at the Colony of the Worcester Insane Asylnm (Grafton, Mass.), Sept. 19, 1907.

K. OF N. & P. VOL. VI. NO. 4—Q

208

HENRY A. COTTON and J. B. AYER

could not distinguish the various types, and the only value was in
finding an increase in the number of nuclei seen, without any regard
to what cells were present to account for the increase. The cells
were usually spoken of as lymphocytes, and the increase called
a lymphocytosis. It is true that in certain cases of general paralysis
there is a great increase in the number of cells, but the protean
character of the disease, its extent and intensity, allows of many
anatomical types. Hence we should look for some pronounced
variation in the number and character of cells found in the cerebro¬
spinal fluid. It is often difficult, by the above method, with a
small count of cells, to decide whether to call the results positive
or negative. Nissl (1) called attention to the fact that by this
method a large count per field—8 or 10 cells—could occur in fluids
without being of any pathological significance. The difficulty
of comparing the results of various observers was also apparent,
as one must necessarily perfect one’s own technique and draw
conclusions from experience—establishing one’s own standards.
Pomeroy (2) uses this method and reveals the inaccuracies of the
same when he concludes that all the clinical facts must be con¬
sidered before an opinion as to the cell count can be given. He also
states that it is impossible to differentiate various cell types .because
of their poor staining qualities. It is very easy to see that in a
clinically well-marked case of general paralysis lumbar puncture
is superfluous as a means of diagnosis. But in very doubtful
cases, where the physical signs are either absent or not sufficiently
pronounced to warrant a diagnosis of general paralysis, lumbar
puncture should be of the utmost value in aiding us to arrive at a
positive diagnosis.

Fuchs and Rosenthal (3), in 1904, in order to overcome the in¬
accuracies of the centrifuge method, and establish some standard
for comparison, utilised the ordinary hematological technique,
the pipette and blood-counting chamber. The fluid was not centri-
fugalised, but drawn directly into the pipette, and a diluent used
that would stain the cells. Knowing the degree of dilution, one
could count the cells present in so many c.c. of fluid. Here at last
a constant unit could be employed, and with a large number of
cells per c.c., the method was fairly accurate. But with a small
number of cells, the errors would vary from 30 to 90 per cent.

Jones (4) has shown how the inaccuracies could occur in counting
a small number of cells. He proposes another method of utilising

CYTOLOGICAL STUDY OF CEREBRO-SPINAL FLUID 209

the same principle, but we fail to see the advantages of his method
over that of Fuchs and Rosenthal.

Cornell (5) utilises the last-mentioned method and obtains some
good results. It must be admitted that the method is far in advance
of the centrifuge method of old, as it allows to some extent a differ¬
ential count (just how accurate will be discussed later). Cornell was
able to differentiate the following cells:—

1. Small lymphocytes. 4. Epithelioid.

2. Large lymphocytes. 5. Plasma cells.

3. Polymorphonuclears. 6. Degenerated cells.

The lack of illustrations is a serious defect of this work, as one is in
doubt as to the character of the cells from the description alone.
This is especially true of the epithelioid cells. He was able to
distinguish plasma cells, which were first described in the fluid
by Fischer; the latter’s results, however, were doubted by Nissl
and others, because they were unable to distinguish these cells.
One serious objection to the method is the fact that the cells are
not fixed in the usual manner, and that in staining the fresh cells,
they appear necessarily distorted and swollen. The inability to
compare these cells with cells in the tissue, fixed and stained by the
common methods, is a serious obstacle in accounting for their
origin. We will also show later that Cornell failed to observe other
calls that are of considerable importance in diagnosis. The lack
of anatomical confirmation of his diagnosis is also to be regretted,
as we cannot always be satisfied with the diagnosis of general
paralysis made from the clinical picture alone.

Realising the importance of lumbar puncture, and the defects
of the methods in use, Alzheimer (6), after much experimentation,
finally evolved a method by which the cells are fixed with alcohol,
after which they can be stained by the usual methods used in study¬
ing the histopathology of the cortex. This is accomplished by
adding 96 per cent, alcohol to the cerebro-spinal fluid, which pre¬
cipitates the proteid, and by centrifugalisation the cells are thrown
down with the proteid in the form of a coagulum at the bottom of
the tube. By his method a very clear differentiation of the various
types of cells can be made, due to the excellent staining qualities
of the oells thus treated.

In detail, the method of Alzheimer as used by os is as follows :—

1. Lumbar puncture in the usual manner.

210

HENRY A. COTTON and J. B. AYER

2. 96 per cent, alcohol, in proportion to twice the amount of

cerebrospinal fluid, is added drop by drop and well mixed.

3. Centrifuge the mixture for one hour at high speed in a

glass tube with conical end. (An ordinary electric
urinary centrifuge apparatus can be employed, tube to be
well stoppered to prevent evaporation.)

4. The supernatant fluid is poured off, leaving a small coagulum

in the bottom of the tube.

5. Add absolute alcohol—alcohol and ether—ether, each sepa¬

rately for one hour, to dehydrate and harden coagulum.

6. The coagulum can now be gently loosened from the bottom

of the tube by a long needle. The tube is then inverted,
and the coagulum allowed to fall into the hand by a quick
tap on the end of the tube. Care must be taken not to
squeeze or handle the coagulum. The hand is placed over
a small homeopathic vial, containing thin celloidin, and
the coagulum allowed to drop into the celloidin, where it
remains over night (12 hours usually).

7. Coagulum placed in thick celloidin, which is allowed to

evaporate slowly.

8. Then mounted on blocks, and cut at 14 m.

9. Sections stained. (Celloidin should be removed from section

by alcohol and ether before staining.)

The stains used by Alzheimer and by us were Unna’s polychrome
methylene blue and Pappenheim’s pyronin-methyl green. 1 The

1 Pyronin Stain —

Methyl green 0*30.

Pyronin, 0*25.

Alcohol, 90°/ e 2-50.

Glycerin 20.

5% aqueous sol* carbolic acid, 100.

Procedure —

1. Remove celloidin by abs. ale. and ether,

2. 80% ale.

3. Water.

4. Sections are carried on glass or platinum needle into dish of above sol.

kept in a water bath at 40° 0., 5-7 mins.

5. Quickly cool dish in running water.

6. Wash all superfluous stain in plain water.

7. Absolute aloohol to differentiate—until no’Jmore stain comes away from

section.

8. Clear in Bergamot oil.

9. Mount in balsam.

OYTOLOGICAL STUDY OF CEREBRO-SPINAL FLUID 211

latter was found to be the most satisfactory ^routine stain, as it gives
excellent nuclear piotures, a slight tint to the protoplasm in most
cells, and is considered specific for plasma cells, staining the proto*
plasm a deep red. Toluidin blue was also used with success when
especially dear nuclear figures were desired; Scharlach R. was used
to demonstrate the fat found in “ Ebmchen ” cells. Instead of
oelloidin imbedding, paraffin may be used, with alcohol or Zenker
fixation. This was tried by us, but the results did not seem to be as
satisfactory as with the technique outlined above, the only ad van*
tage of the method being that sections could be cut a little thinner.

As to the method described by Alzheimer, we can say that it is
the most satisfactory one yet devised. Because of the fixation,
cells are stained in a manner easy of differentiation, and these cells
can be compared with cells in the pia and cortex (stained in a similar
manner), an interesting point when the origin of the cells has to be
considered. The contrast between this method of treating the
cerebro-spinal fluid and others in vogue before its publication can
only be appreciated by one who has attempted to overcome the
difficulties and inaccuracies of the latter, and to Alzheimer belongs
the credit of devising a method that allows an accurate study of
the cytology of the cerebro-spinal fluid in normal and morbid
conditions.

The cells are caught in the coagulum and are found to be nearly
evenly distributed throughout (see Fig. 6, Plate 16). It is possible
that the very topmost layers of the coagulum may not contain as
many cells as the bottom layer, but this is only true when a very
small number of cells are present. But by cutting the coagulum
in cross section', and staining at least six sections from various levels,
and averaging the counts from these various sections, very little
error as to character and number of cells is made. While the
method is not a bedside one and requires some little time, yet the
advantages are so great that one is amply repaid for the extra time
spent upon the procedure. When the cells were present in sufficient
numbers a differential count was made from 200 cells, using about
six sections for the purpose. The unit for comparison of the counts
in various fluids was the number found in 100 fields, as it was found
that, in conditions other than general paralysis, the cells were so
scarce it would be ridiculous to speak in fractions of a cell to one
field, and the error would be greater. On the other hand, in general
paralysis the number becomes large, up to 3400 cells in some cases

212

HENRY A. COTTON and J. B. AYER

to 100 fields, but it is only neoeesary to count 200 oells, and keep
track of the number”of fields counted, and by simple multiplication
to get tiie totals for 100 fields. Here the differential count is of the
utmost importance.

Material and Scope of Investigation.

We have been fortunate enough to have at our disposal a large
amount of material, both living and post mortem, and thus we have
been able to study the cerebro-spinal fluid in both conditions ;
also to confirm our diagnosis and correlate our findings in the fluid
by studying the cortex and pia in a number of cases. This cor¬
relation of the findings in the fluid with the cortical histopathology
has been of great value, not only in confirming the clinical diagnosis,
but also in establishing the identity of the various cell types.

Our cases total 82, and in some instances two punctures during
life were made. In 3 cases of general paralysis, and 3 cases of
organic dementia, both ante-mortem and post-mortem punctures
were made, and in 2 cases of each of the above series autopsies were
made. A detailed summary of all fluids will be found in Chart I.
The number of fluids in various psychoses are as follows :—

19 cases General Paralysis, A.M.

12 „ General Paralysis, P.M. (Three punctured A.M., and

autopsies in two of these, and also in five other cases.)

10 „ Organic Dementia (arteriosclerotic, etc.), A.M.

8 „ Organic Dementia. (Three punctured A.M. Autopsies

in five cases, including two punctured A.M. and P.M.)

3 „ Senile Dementia, A.M.

3 „ Senile Dementia, P.M.

2 „ Polyneuritic Delirium, A.M.

1 „ Chronic Alcoholic Insanity, A.M.

1 „ Chronic Alcoholic Insanity, P.M.

4 „ Epilepsy, A.M.

4 „ Manic-depressive Insanity, A.M.

1 „ Manic-depressive Insanity, P.M.

1 „ Involution Melancholia, A.M.

9 „ Dementia Praecox, A.M.

1 „ Dementia Praecox, P.M.

1 „ Paralysis Agitans, P.M.

1 „ Paranoia (?), P.M.

CYTOLOGICAL STUDY OF CEREBRO-SPINAL FLUID 213

2 cases Idiocy (Spastic paraplegia) P.M. Died of cerebral
softening.

1 „ Morphinism, P.M.

1 „ Toxic Delirium, P.M.

1 „ Cerebral Lues, AM.

1 „ Neurasthenia, A.M.

Doubtful Gases.

2 „ Organic Dementia (?) (1 A.M., 1 P.M. no autopsy).

2 „ General Paralysis (?) (1 A.M., 1 P.M. no autopsy).

The primary object of the investigation was to compare the fluid
of various psychoses, especially those psychoses that would be
confused with general paralysis clinically, and we believe that by
this method facts have been obtained that warrant the statement
that changes occur in the cells of the cerebro-spinal fluid that are
pathognomonic of general paralysis, so that from the fluid alone a
positive diagnosis should usually be possible. (Of course this refers
only to patients suffering from mental diseases.)

In order to substantiate our claims, we have utilised the
anatomical material at our disposal, both to confirm the clinical
diagnosis and establish the origin of the various cells. We have not
taken up other conditions outside of the realm of psychiatry from
lack of time and material, so that our conclusions refer entirely to
this field.

In such conditions as organic dementia, dementia pnecox,
alcoholic insanity (acute and chronic), senile dementia and epilepsy,
we have compared the findings with those of general paralysis and
have come to definite conclusions. Many interesting points re¬
lating to the changes in post-mortem fluids have arisen, but we will
only be able to mention them and their relation to acute toxic
conditions, and we hope that, aside from obtaining facts for diag¬
nostic purposes, this work will stimulate investigation in other fields
of medicine, especially the post-mortem fluids in general diseases.

Cytology.

As we have stated above, no method previously in vogue has
allowed such a perfect differentiation of the cells of the cerebro¬
spinal fluid. Consequently, we not only have been able to dis¬
tinguish cells found by other observers, but have found cells

214

HENRY A. COTTON and J. B. AYER

that we believe have not been described previously in the cerebro¬
spinal fluid.

It is no doubt true that certain cells have been inoorrectly
classified before, because of poor staining qualities due to the
methods used. We can be reasonably sure of the identity of
lymphocytes, plasma cells, endothelial cells, phagocytes (endothelial
class with lymphocytic inclusions), polymorphonuclear leucocytes,
and “ Komchen ” cells. Other cells are found in small numbers,
and have been put in the unclassified list. They may be degenerated
types of cells already mentioned. Some cells resemble fibroblasts
and ependymal cells, but it is’difficult to come to any definite con¬
clusions as to their identity.

Nissl doubted if the cells of the cerebro-spinal fluid could oome
from the pia, because he found plasma cells in the pia in general
paralysis, but was unable to demonstrate these cells in the fluid of
patients with this disease, an error doubtless due to the technique
employed. Alzheimer, in describing his method, mentions that
plasma cells can be clearly seen by this method, and we can confirm
his statements. It is also difficult at times to distinguish between
large mononuclear leucocytes and endothelial cells in the fluid, but
the presence of the former in a fluid with practically no poly¬
morphonuclear cells would not be in harmony with our knowledge of
the relation of mononuclears to the polymorphonuclears in the
blood. And as contamination of the fluid with blood is in a large
measure responsible for any excess of polymorphonuclears, the
identity of such cells can be easily established. In most cases,
then, where polymorphonuclear cells are absent, mononuclear cells,
not lymphocytes, are better classed as endothelial.

1. Lymphocytes.

{Fig. 1, Plate 17.) {A, Fig. 1, Plate 16.)

We include both the large and small forms as differentiated by
Cornell, also altered and transitional forms. The ordinary lympho¬
cytes are found in all fluids, but aside from fluids of general paralysis
they occur in very small numbers. The nucleus is small and round ;
sometimes oval, and slightly indented. The chromophilic granules
are arranged in “ clock-face ” form around the periphery, and take
a deep blue stain (pyronin stain). The protoplasm in unaltered
forms is found as a thin line around the nucleus, and stains a faint

CYTOLOGICAL STUDY OF CEREBRO-SPINAL FLUID 215

pink. It is usually wider on one side. The altered and transitional
forms show a somewhat larger and deeper staining nucleus, and
more protoplasm (Fig. 10, Plate 17). These altered forms are very
common in general paralysis, and it is in harmony with the view
regarding the origin of plasma cells to consider these altered forms
as transitional states between lymphocytes and plasma cells. The
lymphocytes come from the pia, and their excess in the fluids of
general paralysis is easily explained by the fact that in this disease
the pia is infiltrated by them in large numbers, especially in the
adventitial sheaths of the blood vessels.

In general paralysis the differential count shows that they are
the principal cells that are increased, varying from 33 to 94 per cent.,
and averaging 73 per cent, of the total count. The total count in
general paralysis averages 450 to 100 fields, so that it is easy to see
the actual and relative increase in the number of lymphocytes in
this condition. In other conditions the total number^present does
not reach nearly the count in general paralysis. In cerebral arterio¬
sclerosis (organic dementia) the average is only 23 to*100 fields, so
that it is hardly possible that the two conditions would be confused
from the lymphocyte count. The lymphocyte count is small in all
other conditions examined, being highest in cerebral lues, i.e. 36
to 100 fields (see Chart II.). In dementia prsecox, the average
lymphocyte count is larger than in manic-depressive insanity, but
the difference is slight, and at present must be left unexplained, as
not enough cases have been examined to allow us to come to definite
conclusions. In post-mortem fluids, generally, there is an actual
increase in the number of lymphocytes, especially in general
paralysis and cerebral arteriosclerosis, but in the former the per¬
centage is lowered from 73 to 62.

2. Endothelial Cells.

(Figs. 4 and 5, Plate 17.) (B, Fig. 1, Plate 15.)

These cells are also a constant finding in all fluids examined
(except one case of neurasthenia), but vary in number in the different
diseases. They vary considerably in size and shape, often they are
the largest cells found in the fluid. The nucleus is usually eccen¬
trically placed, and is oval or “ horse-shoe ” in shape according to
the various stages of its activity. The nucleus stains a faint blue

216

HENKY A, COTTON and J. B. AYEK

with pyronin stain and has very few chromatophilic granules. The
protoplasm stains a homogeneous light pink and varies in amount.
These cells, even when very small, are easily distinguished from
lymphocytes, because of lack of chromatophilic granules and shape
of nucleus : as they appear in so many forms they may be taken for
new types of cells or resemble other familiar cells. Under certain
pathological conditions they become phagocytic for lymphocytes
and occasionally for their own type. They undoubtedly come from
the lymph spaces in the pia, and are easily affected by pathological
conditions. The average count of these cells in general paralysis
is only 13 per cent, in the living fluid, but they increase to 24 per
cent, in post-mortem fluids. They are only present 28 to 100 fields
in organic dementia during life, but post-mortem fluids show an
increase of these cells to 68 per cent, in this disease. As they show
an increase post-mortem in other conditions where small numbers
were found during life, it may be possible that the acute diseases
which are the cause of death in these conditions may be responsible
for this increase. Especially is this seen in organic dementia. In
other cases where the post-mortem fluids have shown a relative
and actual increase in these cells, the patients have died of some
acute disease. This may be accounted for by the fact that at the
time of death some changes occur which allow or cause desquama¬
tion of these cells so that they appear in large numbers in the fluid.
There is apparently no relation between the length of time post¬
mortem fluid is taken and the number of the cells found, as in the
case that showed the largest number the fluid was withdrawn one
half-hour post-mortem. The reason for this increase will have to
be left in doubt at present, as sufficient proof is not at hand for
conclusive statements.

3. Phagocytes.

(Figs. 1, 2, 3, Plate 17.) (Fig. 2, Plate 15.)

Under certain pathological conditions endothelial cells become
phagocytic. They have been described by Mallory in certain toxic
conditions, such as typhoid fever. Here, of course, they are found
in the tissues. They have also been described as occurring in the
pia in epidemic cerebro-spinal meningitis (7), lately by Stuart
M'Donald (8), and in tubercular meningitis they are numerous.
But we have not as yet seen any description of these cells as occurring

t’YTOLOGICAL STUDY OF CEREBRO-SPINAL FLUID 217

in the cerebrospinal fluid. M‘Donald describes these cells and
shows drawings of the same in the pia, but says nothing about their
occurrence in the fluid. In cerebrospinal meningitis these endo¬
thelial cells become phagocytic for polymorphonuclear leucocytes.
Those found by us are phagocytic chiefly for lymphocytes. This
difference in phagocytosis is readily harmonized when the acuteness
and chronicity of the processes in which phagocytosis in each*case
occurs is considered. The nucleus is pushed towards the periphery,
somewhat elongated and flattened, and the protoplasm is swelled
to enormous proportions.

The lymphocyte is centrally placed and surrounded by a light
area or court. The outline of the protoplasm is only seen as a faint
line outside of the lighter court. Often the lymphocytes are under¬
going degeneration or digestion by the phagocyte, and consequently
present various forms of karyorrhexis.

In some cases we have seen these phagocytes with endothelial
inclusions, but it is difficult to distinguish between these types and
degenerated lymphocytes (see Plate 17, Fig. 2).

Phagocytes were found in the fluid in very small numbers in four
cases (living) in a series of nineteen general paralytic fluids, but were
found in eight out of twelve cases of general paralysis, and in larger
numbers, post-mortem. They are found in the pia in cases of general
paralysis and organic dementia, but in small numbers. They
evidently become phagocytic in situ. From the fact that they are
so numerous post-mortem, one would infer that it was entirely a
post-mortem phenomenon, but their occurrence during life is against
this view. And as in the case of the endothelial cells, the length of
time post-mortem seems to have no influence on their quantitative
occurrence. The cause of death seems to have no relation to the
number found.

4. Plasma Cells.

{Figs. 6, 7, 8, 9, Plate 17.) {Fig. 3, Plate 15.)

These cells have a nucleus similar to that of the lymphocytes,
except that in most cases the clock-like arrangement of the chromato-
philic granules is more pronounced ; the remainder of the nucleus
is stained a deeper blue. The nucleus is oval or round, and eccen¬
trically placed. Frequently plasma cells are found with two or more
nuclei, and are considered as degenerate types, the same as de-

218

HENRY A. COTTON and J. B. AYER

scribed by Alzheimer in the cortex of general paralysis. Fig. 4,
Plate 15, and Fig. 12, Plate 17, show a cell with a mitotic figure,
whether a plasma cell or not cannot be determined. These
mitotic figures are frequently seen in fluids of general paralysis.
The protoplasm, by the pyronin, stains a deep red or pink (according
to the extent of differentiation), and as the pyronin stain is supposed
to be specific for the cells, it can be seen how important this stain is
for the purpose of differentiation. Around the nucleus is usually
seen a lighter area with the protoplasm on the periphery deeply
stained. The protoplasm varies in form presumably according to
the stage of cell-growth, and many young forms are hard to differ¬
entiate from lymphocytes. They differ but little from the cells
found in the cortex and pia of brain and cord. So far in our series
we have found them only in paralytic dementia, and have found
them in all of these cases. Cornell found them in twenty-seven out
of thirty-two cases, presumably in general paralysis, but does not
mention their significance from a diagnostic standpoint. He also
finds them in from 01 to 15 per cent., averaging 1*5 per cent. We
were unable to find such a high percentage of plasma cells in general
paralysis in our series; they vary from 1 per cent, to 6 per cent., and
average 2 per cent., or, better described, one seldom sees over one
or two plasma cells in a whole section. At present we believe that
they are pathognomonic of general paralysis and are of equal value
as a diagnostic factor with lymphocytosis. In one of our cases con¬
firmed by autopsy (No. 26), there were only 110 cells seen in 100
fields, and 94 per cent, of these were lymphocytes and two plasma
cells. When the fluid was obtained after death the plasma cells had
increased to 8 per cent. The diagnosis of general paralysis was not
only confirmed by a study of the cortex, but plasma cells were found
in abundance in the pia of the cortex and cord. In all the cases of
fluid taken P.M., there is a decided increase in plasma cells, varying
in twelve cases from two to nine, averaging 5 per cent., a 3 per cent,
increase over the cells during life. As to their occurrence in other
syphilitic conditions, we have had but one case diagnosed as
cerebral lues, and in this case they were absent. In two cases of
organic dementia, post-mortem cells resembling plasma cells were
found in the fluid, but only one seen in each case, and their identity
was questionable. As they were not found in the pia of these cases,
their presence in the fluid, if these are classed as plasma cells, cannot
be explained.

CYTOLOGICAL STUDY OF CEREBRO-SPINAL FLUID 219

5. “ Kornchen ” Cells.

(Fig. 13, Plate 17.) (Fig. 5, Plate 16.)

This is another type of phagocyte cell, filled with numerous fat
droplets or fatty pigment. They were not found in the fluid of any
living case. In one case of arterioeclerotio, brain disease (No. 65),
with a focal softening in the first temporal convolution, the fluid
taken post-mortem from the ventricles (lumbar puncture was un¬
satisfactory) showed a large number of these cells. As the brain
had been handled, it may be possible that the softened area was
damaged so that these cells escaped. The finding of such cells in
the fluid is important from the fact that they can be identified and
may help to locate the softening that has broken into the ventricle.
One “ Kornchen ” cell was found in the case of an idiot (No. 83) (also
ventricular fluid), who was subsequently found to have extensive
cerebral softening. Hence we shall give them some attention. By
pyronin, the nuclei of the cells show up darkly stained, about the
sue of a lymphocyte nucleus. It is eccentrically placed, and the
protoplasm is bulged out, usually round or oval, the fat droplets
taking a variety of shades of brown. With Scharlach R. they can
easily be identified, as they stain a dark red, and although the
material is hardly suitable for such a stain, still these granules can
be definitely identified as fat. These cells were found in the pia
in both cases of arteriosclerotic brain disease.

6. Polymorphonuclear Leucocytes.

(Fig. 15, Plate 17.)

From the observation of others, these cells have been given
special importance when found in the fluid of general paralytics.
Cornell lays special stress on increase of polymorphonuclear cells
after epileptiform seizures in general paralysis. With the pyronin
stain, the nuclei only are stained. No protoplasm is visible, and
they are easily differentiated.

We found that they occurred in nearly all of our cases of general
paralysis, varying from 1 to 39 per cent., even in clear fluids, and
that they were present also in other conditions (also in clear fluids),
but in very small numbers. Wherever we have found these cells in
large numbers, however, it has been, with few exceptions, in fluids
that were contaminated with blood at time of puncture.

In two cases of general paralysis (Nos. 22 and 71), irrespective of

220

HENRY A. COTTON and J. B. AYER

seizures, the count was 30 per cent, and 39 per cent, respectively,
but it was distinctly noted at the time that the fluid was “ bloody.”
In one case (No. 35), however, without seizures and apparently a clear
fluid, they were present to the number of 39 per cent. The average
in general paralysis, in the living cases, was 9 per cent., and in post¬
mortem cases only ] per ceDt. This is difficult to explain, but
apparently they are more constant in general paralysis than in other
conditions. We feel satisfied that the presence of polymorpho-
nuclears in any large numbers can usually be accounted for by
blood contamination, and can therefore attach no definite signifi¬
cance to their presence. In arteriosclerotic dementia they were
present in nine fluids, varying from one to five to a count. One case
of “ cloudy ” fluid showed 4 cells. The average for ten cases was
2*5. In one case, marked “ bloody,” they were present to the number
of 64 per cent., and the count was 120 cells. In post-mortem fluids
of arteriosclerotic they were absent in three fluids that were clear,
and 16 per cent, were present in one count where the fluid was
“ bloody.” They were absent in three cases of senile dementia,
all “ clear.” In alcoholic (acute) condition they were absent in one
case, “ clear,” present in two cases,—8 and 12 respectively,—
the former “ turbid ” and the latter “ clear.” Their presence in
such small numbers can have no special significance. It is possible
with a poorly stained specimen to confuse these cells with endo¬
thelial cells, and that probably accounts for the fact that Cornell
gave them such an importance in paralytic dementia. The question
of mononuclears has been previously discussed, and we would
emphasize the fact that where so few polymorphonuclears are found,
still fewer mononuclears are to be found, and one must be suspicious
of counting them as such; Cornell speaks constantly of mono¬
nuclear increase and is not clear in regard to the same.

7. Undifferentiated Cells.

In this class we have placed cells that we found, that did not
conform to the types above described. In some instances they may
be altered forms of the cells described, or degenerate forms, and in
some cases we have found cells that resembled the fibroblasts
(Plate 17, Fig. 14) found in the pia. These cells in the fluid are
distinguished by their large oval or spindle-shaped nuclei with
sparse and faintly-staining chromatic granules, but relatively slight
amount of faintly pink-stained protoplasm, often only seen at the

CYTOLOGICAL STUDY OF CEREBRO-SPINAL FLUID 221

poles of the cell. They were present in small numbers in almost
all of our cases of general paraylsis and organic dementia post¬
mortem, and in some cases of general paralysis ante-mortem. Their
significance at present is not clear; they seem to be of no great
importance in diagnosis. They seem to take part in the general
oeH increase in the fluid post-mortem. Cells possibly ependymal
in origin are also here included.

Differential Counts in Various Psychoses.

(Charts I. and II.)

Differential counts were made in all cases where the total cell
count was over 50 to 100 fields. We will consider here the fluids
of living cases only, as the value of the count for diagnostic purposes
is the most important feature of the work. As would be expected
from what we have said, the count is most important in general
paralysis. Here we get positive findings; in all other conditions
examined by us the cell findings can be considered negative. The
great difference between the counts in general paralysis and other
psychoses can be seen at a glance on Chart II. The total count in
general paralysis varies from 110 to 1500 (the average being 450).
The following proportions are taken from the average of nineteen
cases:—

Lymphocytes, 73 per cent.

Endothelial cells, 13 per cent.

Plasma cells, 2 per cent.

Phagocytes (in four cases), 1 per cent.

Polymorphonuclears, 9 per cent.

Unclassified, 2 per cent.

So we see that the total number of cells is due in a large measure
to a true lymphocytosis.

From our work so far, we can say that a lymphocytosis always
occurs in general paralysis, and as a diagnostic factor is of the utmost
importance. When the total count is over 100 per 100 fields, and
contamination by blood eliminated, it is almost safe to say that the
puncture is diagnostic of general paralysis. The presence of plasma
cells even in so small amount as 1 per cent, is the strongest evidence
of general paralysis, and confirms the evidence of the lymphocytosis,
so that the lymphocytosis and presence of plasma cells together
establish the diagnosis. In other conditions we found often a high

222

HENRY A. COTTON and J. B. AYER

cell count, but the differential count showed that the large count
was due to some other cause than a lymphocytosis.

In case No. 43 the count was 120, but only 31 per oent. lympho¬
cytes, 5 per cent, endothelial, and 64 per cent, polymorphonudears.
Here a suspicious plasma cell was found, but the fluid was extremely
bloody, so that we considered the puncture negative. The clinical
diagnosis was organic dementia (hemiplegic). In another case (No. 34),
with a clinical diagnosis of general paralysis (?), the total count was
only 80, and differential count as follows: lymphocytes, 37 per oent.;
endothelial cells, 30 per cent.; polymorphonuclear, 30 per cent. In
this case the fluid was bloody. As these two cases have not come to
autopsy, we cannot justify our diagnosis made upon the evidence of
the findings in cerebro-spinal fluid, but from the findings in our other
cases of general paralysis, four of which were confirmed at autopsy,
we feel reasonably sure of calling the above two cases negative.

It is surprising to see the difference between the total cell count
in other conditions and that in general paralysis. In no other series
of cases did the count approaeh that in general paralysis, except
where the fluid was bloody and the large cell count could be explained
by an increase in polymorphonudears. By consulting Chart II. the
counts in the various conditions can be easily compared with those
in general paralysis. In dementia procox there is apparently an
increase of lymphocytes, not to the same extent as in general
paralysis, and we are unable to explain this fact. Especially is this
true of the catatonic forms and in cases of many years duration.
Thus in one case (No. 66), of fourteen years duration—a profoundly
demented person—the total count was 160 cells for 100 fields : 74
per cent, lymphocytes, 22 per cent, endothelial, and 4 per cent,
unclassified. In another case (No. 29), of six years duration—in
a catatonic stupor—the cell count was 290 : 84 per cent,

lymphocytes, 12 per cent, endothelial, and 4 per cent, polymorpho-
nuclears (clear fluid). The absence of plasma cells differentiates
these fluids from that of general paralysis. In early cases of
dementia procox, however, where the lumbar puncture would be
of importance as an aid to diagnosis, there seems to be no increase
in lymphocytes.

Correlation with Autopsy Findings.

Chart III. shows in a general way the proportion of cells found in
the pia compared with the same elements as found in the cerebro-

y.B .—Note the uniform increase in the total namber of cells in the postmortem fluids In the majority of psychoses.

CHAKT III.

Correlation of Cells in Fluids and Pia.

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(1) Fluid Examined.

(2) Pia Examined.

Fluid, No. 1

Autopsy, No. 1188. Cerebellum
Lt. precentral

Dorsal cord

Choroidal ependyma .

Fluid, No. 2

Autopsy, No. 1189. Rt. sup.
frontal

Rt precentral

Dorsal cord

Lumbar cord

Fluid, No. 7

Autopsy, No. 1190. Cortex

Fluid, No. 61 .

„ No. 8 .

Autopsy, No. 1194. Lt. sup. front
Rt. sup. frontal .

Cerebellum

Floor of IV. ventricle

Dorsal cord

Fluid, No. 28 . .

Autopsy, No. 1192. Cortex .
Cervical cord

Fluid, No. 41 .

„ No. 26 .

Autopsy, No. 1193. Cerebellum
Lt frontal ....
Rt precentral .

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(tenoral paresis.

General paresis .

General paresis.

the clinical picture the former diagnosis seems justified.

226

HENRY A. COTTON and J. B. AYER

spinal fluid. By glancing over this table it is evident that the pia
mater is the origin of most of the cells found in the fluid, and that
the numbers are in a general way correlated.

Here, again, the plasma cell is worthy of the greatest considera¬
tion. Numerous plasma cells were found in the pia of every section
examined in cases of general paralysis, whether cortex or cord, and,
as a rule, sections of the pia as far apart as possible were taken for
this purpose. In our series only in otherwise clearly defined cases
of general paralysis were plasma cells definitely found, and in all of
these cases, whether living or dead, the cerebro-spinal fluid con¬
tained plasma cells.

A very few phagocytic endothelial cells were found in the pia of
those cases of general paralysis of the eight autopsies, whereas
they appeared in the fluid of seven cases. Doubtless further search
would have shown a greater number in the pia. As phagocytes
also occurred in the post-mortem tissues, we cannot attach as great
significance to them as to the plasma cells.

Polymorphonuclear leucocytes were not demonstrated in the
pia of our cases, though it is well known that they do occur in
rapidly progressing cases.

Pial lymphocytosis in these cases is quite characteristic of
general paralysis, and corresponds very closely with the degree of
lymphocytosis in the fluid. Endothelial cell proliferation seems
to be a common occurrence in a variety of conditions.

So we find that in the pia of the cases which came to autopsy
are found approximately the same kind and number of cells which
appear in the corresponding fluids, and notably that in general
paralysis the pia, showing an excess of lymphocytes, is without
doubt the seat of origin of the same cells in the cerebro-spinal
fluid.

In conclusion we desire to extend our sincere thanks to Dr
Chas. W. Page, Superintendent of the Danvers Insane Hospital,
for his kindly interest and encouragement, and to Dr F. B.
Mallory and Dr Adolf Meyer for their valuable assistance in
the identification of the various cell types, to Dr F. P. Gay for
many valuable suggestions, and to our colleagues on the Staff of
the Danvers Insane Hospital, and the assistants in the laboratory,
who were always ready and willing to co-operate with us in this
investigation.

CYTOLOGICAL STUDY OF CEREBRO-SPINAL FLUID 8g7

Summary.

1. We cannot but regard Alzheimer’s method as the best yet
devised for the cytological study of the cerebro-spinal fluid, the good
results depending upon rapid fixation of the cells and the subsequent
treatment of them as if they were tissue.

2. A good differential count and a fair quantitative count are
possible by this method.

3. The cells regarded by us as of greatest diagnostic importance
are the plasma cell, the phagocytic endothelial cell, the fatty
granule cell, and the lymphocyte if in excess.

4. In psychiatry the cell picture in general paralysis stands out
distinctly from that in the other forms of insanity, the latter being
considered by us as presenting nearly normal fluids.

A high cell count, with excess of lymphocytes, over 100 to 100
fields, the presence of plasma cells and perhaps phagocytes, in a case
of suspected general paralysis, is the strongest evidence in favour
of this diagnosis.

5. It is possible that other organic cerebral conditions may show
a cell picture of diagnostic importance, as indicated by the finding
of fatty-granule cells in these conditions post-mortem.

6. The origin of the cells in the fluid is without doubt in large
measure, if not entirely, traced to the pia mater.

Bibliography.

1. NisaL Gentralblatt f. Nervenheil. u. Psych., April 1904.

2. Pomeroy. Jour, of Nerv. and Ment. Die., April and May 1907.

3. Fuchs and Rosenthal. Wien. med. Presse, Noe. 44-47,1904.

4. Jones. Review of New. and Psych., July 1907.

5. Cornell. Amer. Jour, of Intan., July 1907.

6. Alzheimer. Centralblatt f. Nervenheil u. Psych., June 15, 1907.

7. Councilman, Mallory and Wright. “ Epidemic Cerebro-Spinal Menin¬
gitis,” Report of State Board of Health, Massachusetts, 1898.

8. M‘Donald. Review of Neur. and Psych., August 1907.

Description of Plates.

Plates 16 and 16.—Photomicrographs of cells found in cerebro-spinal fluid.
Pyronin stain : x 1500 diameters.

Fig. 1 A.—Lymphocyte. Note the absence of protoplasm and distinct
chromatophflic granules, “ clock-face ” arrangement.

218 CYTOLOGICAL STUDY OF CEREBRO-SPINAL FLUID

B 1, 3, 3.—Various types of endothelial cells.

B 1.—Large endothelial cell, the nnclens swollen, and taking up most of the
cell. Very little protoplasm visible. The nucleus is folded upon itself,
but the thin line between the halves does not show, and the nucleus has
a round appearance.

B 2.—The usual type of endothelial cells. Horse-shoe shaped nucleus beset
around the periphery of the cell, with very little protoplasm visible.

B 3.—Small type of endothelial cells, sharply indented nucleus. Very few
chromatophilic granules. Note the absence of distinct granules in all
nuclei of endothelial cells as compared with the nucleus of phagocytes.

Fig. S.—Phagocyting endothelial cell with lymphocyte inclusion. The
nucleus is flattened and crowded to the periphery. Note the light court
around the lymphocyte and enormous swelling of the protoplasm of the
endothelial cells.

Fig. 3.—Plasma cell Rather indistinct, but dark staining nucleus with

“ clock-face ” arrangement of granules can be made out, also the shape of
protoplasm, with a brighter area in the lower part. Protoplasm a deep
red and nucleus a deep blue. (See Plate II., 6, 7,8, 9.)

Fig. 4.—Cell showing mitotic figure in active state of karyokinesis. Difficult
to determine to which type this cell belongs.

Fig. 5.—“ Kornchen cell.” The nucleus is hardly visible, but the fat droplets
can be distinctly seen.

Fig. 6.—Low power field in case of general paralysis, showing the distribu¬
tion and density of cells. The total cell count here was 900 to 100 fields.
A normal field would show only one or two cells at the most.

Plate 17.—Cells of cerebro-spinal fluid. Pyronin stain : drawn with
camera lucida (No. 4 ocular and ^ oil immersion).

Figs. 1, 2, 3.—Phagocytes. In 1 and 3 the inclusions are lymphocytes, but in
fig. 2 the inclusion is apparently an endothelial cell, or perhaps a
degenerated lymphocyte.

Figs. 4, 5.—Endothelial cells.

Figs. 6, 7, 8, 9.—Plasma cells.

Fig. 10.—Transitional form (?) between lymphocyte and plasma cell.

Fig. 11.—Lymphocyte.

Fig. 12.—Mitotic figure in cell, whether plasma or endothelial not decided.

Fig. 13.—“ Kornchen ” cell.

Fig. 14.—Fibroblast (?).

Fig. 15.—Polymorphonuclear lymphocyte. No protoplasm visible.

Platk 15.

f*' #

— A

Fig. 1.

Fig. 2 .

Fig. 3.

Fig. 4.

Plate 16

Fio. 6.

PLATE XVII.

1. 3.

Phagocytes.

1*2. Mitotic Figure (Plasma Cell ?).

4, 5.

Endothelial Cells.

13. Kornchen Cell.

♦5, 7, S, U.

Plasma Cells.

14. Fihrohlast (?).

10.

Transitional Cell (?).

15. Polymorphonuclear Leucocyte.

11.

Lymphocyte.

All cells staincil will) pvronmim-thvl yreen

EXOPHTHALMIC GOITRE

229

EXOPHTHALMIC GOITRE COMBINED WITH
MYASTHENIA GRAVIS.

By GEORGE E. RENNIE, HD., F.R.C.P. Lond.,

Physician to the Royal Prince Alfred Hospital, Sydney.

The combination of the symptoms of Graves’ disease with those
of myasthenia gravis does not appear from the literature to be a
common one, in spite of the assertion of Meyerstein (1) to the
contrary. I have only been able to find recorded, in addition
to Meyerstein’s case, two cases by Loeser (2) and one by Brissaud
and Bauer (3). The association of the symptoms characteristic
of these two diseases in one individual patient is sufficiently
striking to be recorded. The following case of this nature was
admitted under my care on September 11, 1907, in the Royal
Prince Alfred Hospital, Sydney.

The patient was a single man, 27 years of age, a blacksmith
by occupation, who had always lived in a country town in New
South Wales, and whose life, according to all accounts, had been
an exemplary one. He had been a good, hard-working son, and
had always been temperate so far as alcohol was concerned, a
moderate smoker, and had never suffered from any venereal
infection.

His family history showed nothing remarkable. His father
died from a paralytic shock; his mother is healthy, except for some
slight rheumatism. Nothing could be ascertained as to the
existence of any disease in near relatives which could throw
any light on his condition.

He had always lived in the same town in which he had been
born, in a healthy part of the country, which is dry and hot.

So far as could be ascertained, his illness began about three
years ago with symptoms suggestive of diabetes. He first
noticed that he was eating more than usual, and also taking a lot
of fluid, as his mouth and tongue were very dry, and he began
to get very weak. He then left his occupation—that of a
blacksmith—because he did not feel equal to the work. He
took to droving, and for the last three years has been subject to

230

GEORGE E. RENNIE

much exposure. Eighteen months ago he first noticed swelling in
the neck, and twelve months ago noticed that his hands trembled.
Eight months ago he noticed that his eyes were becoming more
prominent, and soon after that his right eyelid began to droop, and
shortly afterwards the same condition was noticed in the left
eyelid. Six months ago he noticed weakness in his right arm;
then in his right leg; then in the left leg and left arm in that
order. He noticed that he got tired very easily, but after a
short rest was able to go about his work again.

On examination his intelligence is normal. He has no
headache and no pain of any kind. He has no fits or faints, and
his speech is normal. It is noticed that his speech does not
become nasal in character, nor does he become tired after talking.
His hearing and smell are normal; he has occasional diplopia ;
there is marked exophthalmos of both eyes, and bilateral ptosis
which is but slightly marked in the morning, but which becomes
more marked towards night. The pupils are moderately dilated,
but react to light and on convergence.

There is marked external opthalmoplegia in both eyes, the
movements of the eyeballs being very limited in all directions,
but the amount of movement varies to a slight extent from day
to day. The face is smooth and somewhat expressionless. All
the facial movements are limited, but are equal on both sides.
The angles of the mouth tend to droop, and the “ nasal smile ”
is characteristic. There is no difficulty in swallowing; no
regurgitation of fluid through the nose; no paralysis of the
palate; the tongue is protruded in the middle line ; the muscles
of the jaw are weak, and become rapidly exhausted during the
mastication of food.

There is marked weakness in all the muscles of the trunk,
but there is no difficulty in maintaining the head erect. The
‘muscles of the limbs are all weak; the extensors of the forearms
and arms are more affected than the flexors; and the muscles of
the right arm and leg are somewhat weaker than those of the
left. All these muscles become easily exhausted on exertion.
For instance, when the patient is taking his food he can raise his
right arm to his mouth two or three times, and then is exhausted
and has to use his left arm to assist the right.

The wrist and elbow jerks are difficult to elicit. The knee*
jerks are present on both sides, though somewhat diminished, and

EXOPHTHALMIC GOITRE

231

become exhausted after twenty or thirty taps. But after a rest
of a few seconds they become more active than before. The
muscles of the face, arm, and leg, on being stimulated by a
faradic current,become exhausted in about twelve to fifteen seconds,
but recover their excitability after half a minute and become as
active as before. The sphincters are normal, and no alteration
in sensation could be elicited.

The thyroid gland is moderately enlarged, but no enlargement
of the thymus could be made out on percussion. The heart sounds
were normal, but his pulse rate varied from 96 to 124, most
frequently being 108. His temperature during the time of his
stay in hospital was irregular; the first few weeks it ranged
from 97° to 100°, but during the latter part of his stay kept
nearer the normal line. He had no frequency of micturition
and no pain in passing water. The quantity of urine averaged
about two pints in twenty-four hours. The urine was always acid,
the specific gravity varying from 1020 to 1026, contained no
albumen, but at times gave the reaction for sugar. His appetite
was fair, he was not thirsty, his tongue generally fairly clean,
and his bowels acted regularly every day without aperient. His
body weight varied very slightly, but on leaving the hospital he
was 1£ lbs. heavier than on admission. His blood examination
showed: red cells, 4,100,000; white cells, 8100; Hb. value, 80 per
cent.; polymorphs, 34 per cent.; large lymphocytes, 48 per cent. ;
small lymphocytes, 12’9 per cent.; eoeinophiles, 3 per cent; mono¬
nuclears, 5 per cent ; mast cells, 1 per cent.

During his stay in hospital he was treated with strychnine
and tincture of belladonna, the latter being given in gradually
increased doses up to 27 minims three times daily; but with
the exception of the thyroid gland being slightly reduced
in size, and the exophthalmos being slightly less marked, no
appreciable effect in his condition was produced.

I think it must be admitted that among the symptoms
above described we have those typical of Graves’ disease, viz.,
exophthalmos add enlarged thyroid gland and tachycardia. Then
the symptoms of myasthenia gravis; the ocular paralysis, the
ptosis varying in amount—worse towards night and better in
the early morning—the smoothness of the face, and the “ nasal
smile,” the rapid exhaustion of the muscles of the jaws and
tongue on eating, the exhaustion of the muscles of the arms

232

GEORGE E. RENNIE

and legs, the exhaustion of the deep reflexes, and the faradic
myasthenic reaction, are all characteristic of this disease. The
intermittent glycosuria is a symptom which may be associated
with either disease.

Meyerstein’s case showed, in addition to the typical symptoms
of myasthenia, such of Graves' disease as: exophthalmos, enlarged
thyroid, tachycardia, vaso-motor disturbances, etc. He remarks
that “ the symptoms of Graves’ disease appear to occur not rarely
in myasthenia gravis, so that the concurrence does not appear
to be accidental—that is, both symptom complexes may follow
from the same noxa ; or ( > raves’ disease may favour the develop¬
ment of myasthenia.”

Loeser discusses two cases of myasthenia which were com¬
bined with Graves’ disease. In both cases, during the course of
a year, typical myasthenia had developed on the basis of Graves’
disease.

The questions that present themselves in considering this
case are:—Is there in this patient the operation of two etio¬
logical factors ? Are the symptoms of Graves’ disease due to
perverted thyroid function, and the myasthenic symptoms to
some hypothetical toxin ? Or, is there but one morbid factor
at work which is producing all the symptoms enumerated ? In
other words, could his myasthenic symptoms be produced by the
perverted thyroid secretion ? Or, could his Graves’ symptoms
be interpreted in any way as the result of the operation of the
toxin of myasthenia gravis ?

In view of the fact that Graves’ disease is comparatively
common, and the association of the symptoms of myasthenia
gravis with it is rare, it seems difficult to believe that the latter
can be caused by the perverted thyroid secretion, more especially
since Buzzard (4), in the cases of myasthenia gravis described
by him, failed to find any evidence of an associated lesion of the
thyroid gland. In this connection it is interesting to note that
the first case of myasthenia gravis I saw, and the first case I
believe to have been reported in Australasia (5), occurred in a
jockey, whose symptoms developed somewhat rapidly after taking
very large doses of thyroid gland tablets for the purpose of
reducing his weight.

In the meantime, however, we cannot arrive at any definite
solution of these questions.

EXOPHTHALMIC GOITRE 233

Rbfkbencbb.

1. Meyerstein. “ Ueber das kombinirte Vorkommen von Myasthenie und
Basedowscher Erankheit,” Neurol. Centralbl., 1904, p. 23,1089.

2. Loeser. “ Ueber daa kombinirte Vorkommen von Myasthenie und
Basedowscher Erankheit, nebet Bemerkungen fiber die okularen Symptome
der Myasthenie,” Zeittehr.f. Avgenheilk., Bd. xii., H. 2, p. 368.

3. Brissaud and Bauer. “Maladie de Basedow avec Paralysie bulbo¬
spinal asthenique,” Arch, de Neurol., T. xix., p. 75.

4. F. Buzzard. “ Brain,” Pta. cxL and cxiL, 1905, p. 438.

5. G. E. Rennie. “Myasthenia Gravis,” Australasian Medical Gazette,
May 1904.

abstracts

ANATOMY.

STUDIES m NERVE CELLS. (1. The Molluscan Nerve Cell, together
(181) with Summaries of recent Literature on the Cytology of Inverte¬
brate Nerve Cells.) W. M. Smallwood and C. G. Rogers,
Joum. Comp. Near, and Psychol., Jan. 1908, p. 45.

This .is an elaborate paper dealing with the structure of in¬
vertebrate nerve cells, more especially in the gastropoda, but
exclusive of the neuro-fibrillae. It is well illustrated, and there is
a large bibliography. The authors own summary is quoted.

(1) The nervous system of gasteropods does not permit of direct
stimulation of a specific ganglion because of the compactness of
the nerve collar and the numerous nerves arising from the differ¬
ent ganglia.

(2) Lymph canals are not identical with the cytoplasmic
vacuoles. They really exist, and have a rather general distribution
among the nerve cells of invertebrates.

(3) Vacuoles are present in the cytoplasm of nerve cells of
Nemerteans, Annelida, Crustacea, Insecta and Mollusca. The
vacuoles can easily be seen in the living cells as independent
structure filled with a fluid or differential bodies. They are tran¬
sitory structures, vary in number, and are not limited by distinct
walls.

(4) Nissl bodies exist in invertebrate as well as vertebrate
nerve cells. They are found to occupy a zone of cytoplasm next to
the nucleus, but not extending out to the cell wall in most instances.
They are chiefly arranged in rows or in spindle-shaped groups.
The Nissl bodies are aggregates of extremely minute particles and
exhibit marked resistance to degenerative changes. They actually

234

ABSTRACTS

exist in the living nerve cell. Those occurring in Limax are
always found within the limits of the cytoplasmic vacuoles.
They can be caused to appear in the cell by rest and feeding, and
can be made to disappear through hibernation, fatigue and
electrical stimulation. They are probably of a fatty nature.

(5) Pigment granules are found very generally in molluscan
nerve cells. They do not readily respond to starvation experi¬
ments, can be increased in size and number through feeding, are
practically unchanged by fatigue on electrical stimulation, but
do show occasional variations in size and number. These bodies
respond to the tests for lipochrome substances or fats.

(6) The centrosome has been described in many of the inverte¬
brate nerve cells, but there is considerable doubt a8 to its per¬
sistent presence in adult nerve cells.

J. H. Harvey Pirie.

REMARKS ON THE PRESENT POSITION OF THE NEURONE
(182) THEORY. (Bemerknngen ztun heutigen Stand der Neuron-
lehre.) Max Verworn, Med. Klinik, No. 4, 1908, p. 111.

This article is a concise review of the present position of the
neurone theory. It contains no original matter. In support of
the neurone theory, to which the author adheres, he quotes the
work of Cajal, Harrison, and others. He indicates the need for
further observations with regard to (1) the mode of connection of
neurones with each other, (2) the relative amount of nutritional
influence exerted on a peripheral nerve on the one hand by its
ganglion cell and on the other by its immediate surroundings,
(3) the parts played in nervous conduction by the neurofibrils and
the perifibrillary protoplasm, and (4) the process of inhibition. He
discusses briefly some of the more important views held as
regards these subjects. Alexander Bruce.

HYPOSPINAL MIORO-SYMPATHETIO GANGLIA. (Uber die mikro-
(183) sympathischer, hypospinalen Ganglion.) Marin esco and

Minea, Neurolog. CentralM ., Feb. 15, 1908, p. 14(5.

While studying the posterior root ganglia in serial sections stained
by Cajal’s method, the authors have discovered what they believe
to be hitherto undescribed ganglia. These lie in the fat outside
or below the posterior root ganglia; they have never found them
on the proximal side. Usually microscopic, they may sometimes
be large enough to be seen by the naked eye in sections. They

ABSTRACTS

235

may be single or multiple, as many as eight having been noted
in relation to one nerve root; their size is inversely proportional
to their number. A ramus communicans has pretty often been
traced to the infra-ganglionic part of the nerve root. This may
be so short that these little ganglia lie in direct contact with the
lower pole of the root ganglion, or it may be of some length,
in which case they are to be looked for in close relationship to
the ramus communicans from the sympathetic cord. Microscopic¬
ally they contain all the three cell types found in the large
sympathetic ganglia: (1) cells with short intra-capsular dendrites
and one axis-cylinder process; (2) large cells with long forking
extra-capsular dendrites and one axis-cylinder process. These
are not abundant, however; (3) cells of a type intermediate
between these two.

The authors regard these hypospinal ganglia as arising in the
same manner as the ganglia of the sympathetic cord, the ventral
separation from the root ganglia simply not occurring to the same
extent. As regards the destination of the fibres arising from the
cells of these hypospinal ganglia, they offer no opinion as to
whether they join the pre-vertebral sympathetic cord, or serve
surrounding tissues, or have some other function.

J. H. Harvey Pirie.

THE FLOOR OF THE FOURTH VENTRICLE. (Le plancher du
(184) quatriftme ventricule. Etude morphologiqne.) Mineff
Michael, NSvraxe, Vol. ix., f. 2, 1908, p. 115.

The author has studied, and illustrates with stereoscopic photo¬
graphs, the surface form of the floor of the 4th ventricle in forty-
nine human brains, of which forty were adult and nine foetal.

The average width in adults is 16 mms., and the length

34 mm

Analysing the different formations, he finds:—

(1) The medullary striae conformed to the description given
by Retzius.

(2) Trigonum hypoglossi—to consist of three parts:

(a) a mesial area;

(b) an area plumiformis, showing oblique striae;

hypoglossi should be reserved.

(3) Trigonum vagi varies in form, and the areas of opposite
sides may be connected together by an intercinereal commissure.

(4) Funiculus separans is merely a local thickening of
ependymal neuroglia, but is useful for description.

(5) Area poetrema is an area situated on either side of the

236

ABSTRACTS

mesial plane at the posterior end of the calamus, with a grey
brown surface slightly mammillated. The inner margins pass
down to the entrance to the central canal, and the pia is adherent
along the outer margin. The true obex is seldom present, but
constitutes a bridge uniting the two areas of opposite sides.

(6) Trigonum acousticum.

(7) Upper part of the floor.

(8) Median furrow.

These parts are carefully described, and compared with the
views of other writers, and it is shown that many variations are
found. David Waterston.

THE CONDITION OF THE NORMAL COCHLEAR NERVE IN
(185) THE INTERNAL AUDITORY MEATUS. (Das Verhalten
des normalen Nervus Oochlearis im Meatus Auditories
Internes.) S. Alexander and D. H. Obsteiner, Zeitschr.
/. Ohrenheilk., Bd. 55, Heft 1-2, 1908, S. 78.

Ten years ago Obsteiner reported on a specimen sent to him
by Siebenmann in which small round bodies, staining blue with
htematoxylin, were observed in the sections of the auditory nerve.
On longitudinal or oblique sections these bodies were arranged
round the central part of the nerve which takes on the eosin
stain more faintly than the peripheral part and appears as a
cone-shaped structure—the apex of the cone being towards the
internal ear. At the time Obsteiner was in doubt as to the
nature of these bodies, but thought that they were either patho¬
logical or post-mortem artefacts. Lately Alexander and Obsteiner
have examined ninety-two specimens of the auditory nerve from
about fifty patients, whose ages varied from an eight months’ foetus
up to ninety-four years. In the younger subjects these bodies, which
both observers regard as corpora amylacea, were never found. They
were first found in the auditory nerves of patients aged twenty-six,
and thereafter the older the subjects were the more frequently the
bodies were observed. Staining reactions proved them to be
corpora amylacea. Similar appearances have been found by
Obsteiner in the posterior spinal nerve roots. The faintly stained
region lies between the part of the nerve which possesses the
sheath of Schwann and the part surrounded by neuroglia—in
other words, where peripheral changes to central. The motor
roots of the spinal nerves and also the motor nerves springing
from the medulla show entirely the peripheral formation. The
work of Nager in Siebenmann’s Klinik and of Hulles is referred
to. Alexander and Obsteiner conclude that the blue staining
bodies are corpora amylacea occurring at the junction of the two

ABSTRACTS

237

parts (peripheral and central) of the auditory nerve, and emphasize
the importance of cutting this nerve as near as possible to the
medulla when the temporal bone is removed for microscopic
investigation, and of obtaining the specimens as soon as possible
after death. J. S. Fraser.

PHYSIOLOGY.

STUDIES IN REFLEXES: THE BEHAVIOUR OF SOME
(186) CUTANEOUS AND TENDON REFLEXES IN INFANCY.

(Reflexstudien: Ueber das Verhalten einiger Haut- und

Sehnenreflexe bei Kindern im Laufe der ersten Lebensjabre.)

Z. Bychowski, Deutsche Ztschr. f. Nervenheilk., 1908, Bd. xxxiv.,

Heft 2, S. 116.

Bychowski finds that the various cutaneous and deep reflexes do
not all develop simultaneously, and that they are of varying
phylogenetic importance. Thus if reflexes A, B and C develop
at different periods, and are probably separated from each other by
considerable intervals, we should expect that in a given individual
their times of appearance should also differ. He has studied the
question as to how during the first few months of life those
reflexes behave which in the adult are constantly present; or, in
other words, does an infant come into the world with all its
reflexes in full activity or not ? Bychowski has examined about
a hundred infants, noting the condition of the knee-jerks and ankle-
jerks, and of the abdominal and cremasteric reflexes. He has
also studied the plantar reflex; but owing to the complex motor
phenomena produced, he has excluded this reflex from his paper. He
selected healthy infants, testing their various reflexes during the
waking condition and in a good light. Crying children were not
examined, since in such a state the abdominal reflexes are difficult
to elicit. He gives a tabular account of the reflexes in sixty-seven
healthy infants under one year old. He also examined a number
of children during the second year of life. The knee-jerk was
constantly present in all of these cases, with only two exceptions,
in both of which the children were ill. The knee-jerk seemed,
as a rule, to be livelier than in the adult. Sometimes a
consensual knee-jerk of the opposite limb was also present.
The ankle-jerk, on the contrary, was absent in 60 out of 64
patients of six months and under: in the remaining case, from
nine to ten months of age, it was present twice out of thrice. The
ankle-jerk is first elicited about the fifth or sixth month, and
becomes constantly present at the beginning of the second year.
In one child the ankle-jerk was tested every two days from the

238

ABSTRACTS

time of birth, until at last, at the age of seveu months, the ankle-
jerk appeared. Fuhrmann, on the other hand, found the ankle-
jerk absent only in 34 per cent, of children examined during the
first week of life. Whether Bychowski or Fuhrmann be the more
accurate observer, the fact remains that the ankle-jerk is less
constantly present than is the knee-jerk.

Next, as to the abdominal reflexes, which in healthy adults are
constantly present (excluding, of course, multiparous women and
other cases with pendulous bellies); the cutaneous reflexes, it
should be borne in mind, are more easily exhausted than are the
deep reflexes. Bychowski found all four abdominal reflexes (upper
and lower on each side) present in sixteen infants out of sixty-seven;
in seven cases the upper and the lower were present alone. The
abdominal reflexes are not present at birth. Fuhrmann’s statistics
also support this view, inasmuch as he found absence of the
abdominal reflexes in 80 per cent, of infants during the first month,
in 65 per cent, during the second month, in 45 per cent, during the
third month, and in 50 per cent, during the fourth month. Which¬
ever statistics be accurate, it is evident from both observers that
the abdominal reflexes are of lower phylogenetic importance than
the deep reflexes.

As to the cremasteric reflex, it was absent in eleven cases out of
twenty-six, being practically constant after the age of four months.

Summing up, then, the knee-jerk is the only one of the above
reflexes which is constantly present from birth. It is therefore of
greater phylogenetic importance than the other.

Purves Stewart.

DOES THE HUMAN RECURRENT LARYNGEAL NERVE CON
(187) TAIN SENSORY FIBRES 7 (Fiihrt der Rekurrens dea
Menschen sensible Fasern?) A. Kuttner and E. Meyer
(Berlin), Archiv fur Laryngologie, Bd. 20, Heft 2, S. 356.

This short paper is only the latest stage of a dispute that has been
running in these Archives for more than a year on the so-called
“ .Recurrent Question.” Grossmann, Katzenstein, Rdthi, Schulz,
and others proved that in cats, rabbits, goats and monkeys the
recurrent laryngeal is a mixed nerve, whereas in the dog it is a
purely motor nerve and only possesses a few sensory fibres by
anastomosis. It was, however, impossible from the above experi¬
ments to draw conclusions as to its nature in man. Massei, in
the Italian Archives of Laryngology, stated that peripheral
recurrent paralyses were always connected with disturbance of
sensibility of the larynx, but says that he never drew from this
fact the conclusion that the recurrent was a mixed nerve. He

ABSTRACTS

239

sought the explanation of the diminished sensibility rather in a
communicating neuritis by way of the anastomosis existing
between the superior and inferior laryngeal nerves. The sensi¬
bility of the larynx was investigated by means of the laryngeal
sound, and, in cases of recurrent paralysis, Massei found that
there was no reaction, or at most slight coughing and spasm, in
marked contrast to the phenomena observed when normal
individuals were investigated.

Kuttner and Meyer injected adrenalin and novocain into the
region of the superior laryngeal nerve, and produced anaesthesia
of the larynx, but Massei states that this disproves in no way
the supposition that the inferior laryngeal is a mixed nerve; just
as the proof that the inferior laryngeal is a mixed nerve would
not upset the accepted rule that the superior laryngeal is the
sensory nerve of the larynx.

Kuttner and Meyer have also examined numerous cases of
recurrent paralysis by the method employed by Massei and have
never been able to make out any anaesthesia: the patient not only
felt each touch of the sound, but they reacted to it by reflex
closure of the glottis and by coughing fits. The intensity of these
reactions varied in these cases within the same limits as in healthy
persons. Finally Kuttner and Meyer state that after section of
the superior'laryngeal nerve, even when the recurrent remains
intact, reflex excitability is obliterated on the side of the larynx
in question. During the course of this dispute the motor fibres
of the recurrent have not escaped, as Kuttner and Grabower have
written somewhat heated articles on Semon’s law, Saundby’s case
and Grossman’s explanation of the appearances in recurrent
laryngeal paralysis. Altogether the “ Recurrent Question ” is
still with us. J. S. Fkaseb.

SENSITIVENESS TO LIGHT AND THE SIZE OF THE PUPIL.
(188) (Lichtempflndlichkeit und Pupillenweite.) H. S. Langfeld,
Ztschr.f. Psychol, u. Physiol., Bd. 42, H. 5, 1908.

It is known that the size of the pupil is, in many persons,
considerably above the average; this is especially noticeable by
lamplight, and is more common in the female than the male sex.
The author, having observed that these unusually large pupils also
react sluggishly to light, was prompted to inquire whether such
deviation in size was connected with any demonstrable peculiarity
in the function of retina or iris.

The examinations were conducted on rather less than a score
of persons,
s

240

ABSTRACTS

The following possible causes of the abnormal size had first
to be considered:—

(1) One of the subjects being blind to red rays, and the lamp
with which the examinations were done being relatively rich in
these rays, a connection between size of pupil and predominance of
red rays might exist. But pupils equally large were present in
those with normal colour-sense.

(2) Some subnormal sensitiveness or else unusual tendency to
exhaustion, either in the light-perceiving organs, the centripetal
pupillo-motor fibres, in the centres themselves, or in the reacting
apparatus (musculature of iris)?

(3) Myopia?

A series of experiments were made on each of the subjects,
and the results are tabulated.

The author tested the width of the pupil both by artificial
light and in the dark, using in the first case an ordinary 10-candle-
power incandescent light, and in the second case taking instan¬
taneous photographs of the pupils by a flash-light apparatus,
the illumination being sufficiently transient to fall entirely within
the latent period of pupillary reaction.

The mode of reaction of the various pupils was then tested, a
light-stimulus of easily variable intensity being employed. The
author found it almost impossible to give the extent of reaction
in figures, and contented himself with observing whether the
degree of movement lay approximately within the normal limits.
This occurred in all but one case. By use of the loup (corneal
microscope) the great differences in energy and rapidity of reaction
were easily observed.

Prof. W. A Nagel’s adaptometer was then employed in estimat¬
ing the ligkt-sense after adaptation (a) to ordinary daylight, ( b ) to
darkness. In a certain number of cases the complicating factor
produced by variations in the size of the pupil was excluded by
employment of an “ artificial pupil,” which admitted the same
amount of light into every eye.

The result of this series of investigations was to show, in the
first place, that the unusually large size of the pupil which occurred
in several of the persons observed had no connection either with
the colour of the iris, with the refraction, with the colour-sense, or
with the degree of sensitiveness to bright light (Blendbarkeit.)

The most striking difference in the size of the pupils is seen by
lamplight—pupils which, in ordinary daylight, are of the same
size, show by lamplight as much as S\ mm. of difference.

The pupils in one case showed a marked tendency to exhaus¬
tion, but the supposition that this might determine the large size
of the pupil proved erroneous, as several equally large pupils
exhibited a quick and lasting reaction.

ABSTRACTS

241

Finally, as regards the light-sense , tested by the Adaptometer.
The fact that the greatest differences in the size of the pupils were
seen in faint lights, especially lamplight, suggested a deficient
sensitiveness to faint light, or a diminished power of adaptation, in
the persons with large pupils. The testing of this problem proved

difficult

The light-sense in every case was estimated (a) within the first
minutes of exposure to darkness, ( b ) after twenty minutes in
darkness. The figures yield nothing characteristic, and are really
not comparable, since the amount of light entering each eye
differed according to the size of the pupil, some pupils enlarging
more than others on exposure to dark. As paralysis of the iris by
homatropine or cocaine did not entirely equalise the size of the
pupils, an artificial pupil of 2 mm. diameter had to be used.
Even here the sensitiveness to light varied very greatly in the
different cases, and gave little material for generalisation. The
author, however, is inclined to conclude that in these persons who
have narrow pupils (other things, such as age and refraction, being
equal), adaptation to darkness occurs somewhat more promptly and
thoroughly than in those with wide pupils.

“Whether, indeed,” he concludes, “the lessened power of
adaptation in the eyes with wide pupils is primary, aud itself
determines the size of the pupil, or whether, contrariwise, some
weakness of the pupil-reflex, coming from another cause, con¬
stantly exposes the eye to light-stimuli of supernormal strength,
and thereby weakens its adaptation—mechanism or chemism—
this question remains unsolved.”

He acknowledges that his observations have yielded “ a picture
peculiarly lacking in order.” Arthur J. Brock.

OBSERVATIONS ON THE LIVING DEVELOPING NERVE FIBRE.

(189) Ross G. Harrison, Amer. Journ. Anat., Vol. vii., No. 1, 1907,

p. 116.

The author, by a series of ingenious experiments, has been able
to observe under the microscope the growth of the axis cylinder
from a nerve cell. Portions of the spinal cord were taken from
frog embryos shortly after the closure of the medullary folds,
placed in a drop of frog lymph and observed on a hollow slide.
The writer succeeded in keeping the nerve cells alive for nearly four
weeks in some cases. The axis cylinder processes were exceed¬
ingly fine, almost hyaline in appearance, and devoid of the yolk
granules which were numerous in the cell-bodies. A fine fibrilla¬
tion was occasionally found in the protoplasm. The fibres were
varicose, grew with an enlarged end, from which sprang numerous
fine filaments. The enlarged end continually changed its form (

242

ABSTRACTS

especially as regards the origin and the branching of the
filaments. Its forward movement resulted in the drawing out
and lengthening of the fibre to which it was attached, one fibre
being observed to lengthen almost 20 /i in twenty-five minutes.
The longest fibres observed were 0 - 2 mm. in length.

When portions of myotomes were left attached to a piece of
the medullary cord, the muscle fibres after two or three days
exhibited frequent contractions. The development of the axon
is thus the result of amoeboid movement of part of the nerve cell.

Alexander Bruce.

ACTION OF THE S EATS ON THE EYE IN COURSE OF DB-
(190) VELOPMENT. (Action des rayons x snr l’ceil en voie de
d£ veloppement. ) Tribondeau and Bellay, Arch. <t filed. Mid.,
d<*c. 10, 1907 p. 907.

In the course of their experiments on new-born cats, the authors
have noted some changes already described in adult animals, such
as various inflammatory affections of the conjunctiva, cornea and
aqueous humor, with temporary loss of the eye-lashes. They have
also found changes which are peculiar to young animals. These are:
(1) earlier opening of the palpebral fissure on the exposed side, due
to more active destruction of the cells in the epithelial septum
which unites the eye-lids to each other; (2) delay in the normal
pigmentation of the iris and nictitating membrane; (3) cataract,
even with minimal doses; (4) microphthalmia, a constant pheno¬
menon when the treatment is long continued; (5) microscopical
malformation of the retina in the shape of a peculiar folding of its
external layers, especially near the ora serrata; and (6) an
occasional fibrillation of the vitreous humor, with a thickening of
the hyaloid membrane.

These observations show that the rays cause injuries in young
animals to organs which in adult animals can resist their action.
They constitute a warning to electricians to be careful in treating
diseases of the ocular region in children by the X-ray method.

Alexander Bruce.

A NEW PROOF OF THE CONDUCTING FUNCTION OF
(191) NEUROFIBRILS. (Ein neuer Beweis ffir die leitende Ftmktion
der Neurofibrillen, nebst Bemerkungen fiber die Reflexzeit,
Hemmnngszelt und Latenzzeit des Muskels beim BlutegeL)

A. Bethe, Pfiiiger's Arch., March 1908, Bd. 122, p. 1.

The author of this important contribution to the physiology of
nerve starts with the assumption that in the Leech (Hirudo

ABSTRACTS

243

medicinalis), where the natural elasticity seen in all nerve fibres
to a lesser or greater extent is greatly exaggerated, the perifibrillar
substance is elastic but the fibrils are not. He devotes some
space to the proof of this, and reproduces some of Apathy's
specimens of leeches fixed in conditions of physiological extension
and contraction. These show that the nerve fibres are not thrown
into wrinkles during contraction, but that they remain straight,
the fibres being elastic; they also show that the fibrils within the
fibres are thrown into wrinkles, the more marked the greater the
contraction is, thus indicating that the fibrils retain their original
length during the contraction of the leech though the fibres contract
with the leech. He then applies this to the question of the
conducting substance in the fibres: if that substance is the
perifibrillar part of the fibre, then the conduction time of a given
piece of nerve in the leech will be lessened if the animal contracts ;
on the other hand, if the fibrils be the conducting part of the
system, then, as they do not shorten, the time of conduction will
not be altered by contraction or elongation of the leech.

In the experimental part of the paper Dr Bethe describes his
experiments to determine this question. He fixed a leech in the
region of the uterus to a cork plate and registered the lengths of
the front and hind segments, which were free, graphically. The
stimulation was electrical and was applied near the hinder end,
the latent-time of the anterior segment being measured. The
stimuli were applied when the hinder end was in different states
of contraction or relaxation and the latent times were measured.
The latent time was found to remain constant within the limits of
physiological stretching, but if these were exceeded then the latent
time became longer.

As the fibrils remain constant in length within the limits of
physiological stretching, he comes to the conclusion that they are
the important factors in the conduction of the nerve-impulse, and
that the perifibrillar substance has no influence on the rate of the
impulse. He also finds that the reflex latent-time and the
muscle latent-time depends on the tonic state of the reacting
muscles, and that the latent-time of reflex inhibition is greater
than that of reflex contraction. T. Graham Brown.

THE DEVELOPMENT OF THE ARTICULATORY CAPACITY
(192) FOR CONSONANTAL SOUNDS IN SCHOOL CHILDREN.

Ernest Jones, Internal. Arch, fur Schvlhygiene , Bd. iv., Heft 2,

S. 186-201.

The maximum articulatory capacity for 237 words was repeatedly
tested in 450 normal school children, twenty-five of each sex
for each year of school life, and marks allotted according to a

244

ABSTRACTS

system here described. The 105,000 tests thus obtained are
analysed from different points of view, and the results recorded
in tabular form. The following conclusions are reached:—

A. Relation to age .—In both sexes progress in the perfection
of this capacity is found principally at two years of school life; in
boys these years are seven and eight, the former being rather the
more important; in girls they are six and ten, the latter being
rather the more important.

Less important steps are also found at other years. With
boys, at the age of ten improvement is found to have occurred in
the worst-speaking boys only; with girls, at the ages of seven and
twelve, especially the former, improvement is found to have
occurred in the better-speaking girls only.

B. Comparison of the two seres at different ages .—On the whole
the capacity is greater in the case of the girls, chiefly owing to the
large number of boys in whom it is unusually badly developed ;
they excel in six of the nine years. In four of the years the
difference between the sexes is negligibly slight. In the other
five there is a decided difference between the capacity of the two
sexes. At one of these years, that of nine, the boys excel; at
the other four, namely at six, seven, twelve and thirteen, the
girls excel.

The greatest sex difference is found at the age of six, and the
next at the ages of seven and nine. Author’s Abstract.

CLINICAL NEUROLOGY.

A CASE OF PERIPHERAL NEURITIS RESEMBLING TABES.

(193) (Um caso de nervo-tabes peripherica.) By H. D. Estrada,

Arch. Brasil, de Rsychiatr., Neur. e Sciencias Affins., 1907, Nos.

3 and 4.

On account of its supposed rarity the author records the clinical
features of a patient in the Hospital de Misericordia at Rio. The
patient, 32 years of age, syphilitic and potator, admitted with
mitral and aortic valvular disease, was found to exhibit ataxia,
Rombergisin, absent knee-jerks, diminished heel-jerks, parasthesia
and analgesia of the feet, and increased superficial reflexes. Pupil
reactions, however, and vibratory sensibility were normal, there
was pain on gastrocnemial pressure, lumbar puncture gave
negative results, and the diagnosis of alcoholic polyneuritic pseudo-
tabes was confirmed by subsequent rapid improvement under
electrical and tonic treatment with massage, the disturbances of
motility lasting barely one month.

R. CUNYNGHAM BROWN.

ABSTRACTS

245

ANTERIOR PARJS8THETI0 MERALGIA. (Beitra* znr Kenntnlss
(194) der Meralgia paraesthetica anterior.) Lasarew, Deutsche
Zeitschr.f,Nervenheilk., Bd. xxxiv., S. 154.

Some hundreds of cases are on record of the Roth-Bernhardt
syndrome (external paresthetic meralgia), but only three of anterior
paresthetic meralgia. Lasarew here reports a fourth case, which
occurred in a woman of twenty-eight. The symptoms were typical
and had been present for six years: paresthesia and hypoaesthesia
for all forms of sensation, and pain only on standing or walking,
strictly confined to the territory of the middle cutaneous nerve.
In the previous cases meralgia was present in the territory of both
the external and middle cutaneous nerves, so that Laserew’s is the
first case of pure anterior paresthetic meralgia.

Ernest Jones.

ON A CASE OF ACUTE POLIOMYELITIS ASSOCIATED WITH
(195) A DIPLOCOGCAL INFECTION OF THE SPINAL SAC.

Pasteur, Foulerton, and Maccormack, Lancet , Feb. 15,1908,
p. 484.

Clinically this was a severe case of poliomyelitis in a boy of 13£,
with involvement of almost the whole muscular system of the
trunk as well as that of the limbs. But the chief interest lies in the
fact that from the cerebro-spinal fluid obtained by lumbar puncture
there was obtained a diplococcus of large size, the cocci being
always free in the fluid. The cellular elements of the fluid were
entirely lymphocytes. By inoculating some of the fluid in rabbits
an ascendiug motor paralysis was produced after long incubation
(about seven weeks). On the death of the experimental animal they
recovered from its cerebro-spinal fluid a micrococcus similar to
that from the human case. By inoculation of another rabbit with
an emulsion of cerebro-spinal substance and fluid from the first
experimental animal they again produced motor paralysis after a
somewhat prolonged incubation period, and again associated with
the presence of the micrococcus in the spinal fluid. Culture of
the organism on artificial media failed entirely.

J. H. Harvey Pirie.

INFANTILE PARALY8IS. Guthrie Rankin, Practitioner, Feb.
(196) 1908, p. 166.

This is a good clinical lecture, but with no new facts to record.

J. H. Harvey Pirie.

246

ABSTRACTS

A CASE OF ACUTE ASCENDING PARALYSIS, WITH RE

(197) 00VERY. C. W. Vining, Lancet , Feb. 8, 1908, p. 425.

The case was that of a man of twenty-four who, in five days, developed
complete paralysis of the legs, almost complete paralysis of the
arms, the diaphragm, one side of the face and tongue muscles
being also involved. Although commencing in the legs the parts
affected were not altogether in succession from below upwards.
The reflexes were entirely lost, there was some anaesthesia of the
palate, and slight sensory disturbance on the legs for a few days,
and incontinence of urine and fieces. A streptococcus was found
in the cerebro-spinal fluid, but no growth could be obtained.
Although not a classical case of Landry’s paralysis, it corresponds
better with that disease than any other; there were no evidences
of diphtheria, syphilis, gonorrhoea, lead or alcohol. When the
diaphragm became involved the case threatened to be rapidly
fatal; strychnine was the sheet anchor in treatment, and appeared
to be very beneficial. Recovery after a week of grave suspense
was rapid and complete. J. H. Harvey Pirie.

LANDRY’S PARALYSIS; RECOVERY, PARTIAL RELAPSE AND

(198) COMPLETE RECOVERY. John K. Mitchell, Joum. Am.
Med. Assoc., Feb. 1, 1908, p. 351.

A report of an apparently typical case in a man of twenty-one with
acute onset after a thorough wetting, rapid ascent of paralysis till
all four limbs were involved, the reflexes being entirely abolished,
sensibility normal and sphincters uninvolved. On the eighth day
there was a distinct reaction of degeneration in anterior tibial and
calf muscles of one leg. He was treated by galvanism to the
spine, alternating applications of hot and cold water to the back,
and small doses of ergot. In a little under three months he was
discharged, walking well, though with still a small weakness in the
legs. Four months later there was perhaps a slight relapse, which
rapidly passed off, with complete recovery, but there is no exact
record of the conditions during this stage, and it may quite well
have been a passing nervous difficulty of an imaginary kind.

J. H. Harvey Pirie.

TABES A FEW YEARS AFTER INFECTION. (Ueber Tabes

(199) in den ersten J&hren nach der Infektion.) Galewsky,
Medizinische KlinUc, Feb. 23, 1908, p. 260.

As a rule five to fifteen years elapse between syphilitic infection
and the onset of tabes. Galewsky records six cases in which the
symptoms of tabes occurred at a much earlier date. In two cases

ABSTRACTS

247

they appeared in the second year. In the third case the symptoms
of tabes made the patient first seek advice three years after
infection, but they had certainly arisen a long time before. In
the remainder they developed in the fourth or fifth year. In two
of the cases syphilitic phenomena co-existed with tabes (cf. Rev.
of Neurol ., 1906, p. 748, and 1907, p. 633). In one case syphilis
showed a special malignancy, but in the others it was relatively
benign. All the cases were alike in having had very little treat¬
ment or none at all.

Alcoholic and venereal excesses, neurasthenia, family pre¬
disposition, and the hardships of a campaign were among the
causes that favoured the development of tabes in these cases.

J. I). Rolleston.

ON SEGMENTAL ABDOMINAL PABALYSE8. (Ueber segmentftre
(200) Bauchmnsbeliahmmigen.) P. Salecker, Deutsche Zeitschr.

/. Nervenheilk., 1908, Bd. xxxiv., Heft 2, S. 160.

The writer comes to the following conclusions:—

1. There exist not only total, but also partial paralytic affec¬
tions of the abdominal muscles in diseases of the spinal cord.

2. The innervation of the abdominal muscles is not multi-
radicular but segmental.

3. The nuclei of the recti do not extend so far backward as
those of the oblique muscles.

4 Individual abdominal reflexes appear to correspond to
definite segments of the spinal cord.

5. Observations on segmental abdominal palsies, when taken
together with sensory and reflex abnormalities, are of considerable
diagnostic value for segmental localisation in the thoracic region
of the cord.

Some four years ago Oppenheim {Deutsche Zeitschr. f.
Nervenheilk., 1903) maintained that the abdominal muscula¬
ture iB innervated as a whole and not in segments or according to
spinal muscle or parts of muscle. During a laminectomy
Oppenheim took an opportunity of stimulating single nerve-
roots and produced a diffuse contraction of the corresponding
abdominal muscle. He therefore concluded that the innervation
of the abdominal muscle is multi-radicular, i.e that every muscle
is supplied by every nerve of the lower thoracic segments.
Oppenheim also directed attention to the absence of clinical cases
where localised atrophy was present in a segment of a rectus or
obliquus muscle. But since then Ibrahim and Hermann {Deutsche
Zeitschr f. Nervenheilk ., 1905) have described four cases of
poliomyelitis in which the oblique muscles were partially atrophied,

248

ABSTRACTS

and one case of meningo-myelocele where the oblique muscles were
totally paralysed, the recti remaining powerful. Strasburger (ibid.,
1906) also described a case of poliomyelitis with total paralysis
of the recti, the oblique muscles remaining unaffected.

Salecker here describes two cases of his own in which segmental
paralysis was present in the abdominal muscles. One of the
cases was completed by autopsy.

1. A previously healthy man, 40 years of age, was suddenly
affected with unilateral shooting pains in the hip and leg of the
right side; parsesthesia developed; then the opposite side
became similarly affected; and finally there was produced a paresis
of both lower limbs, rendering him unable to stand or walk.
Clinical examination showed evidence of a lesion of the cord from
about the 10th or 11th thoracic to the 3rd sacral segment. Anti-
syphilitic treatment having failed, the diagnosis of extra-medul¬
lary tumour was made, as there was no dissociated anesthesia
or other sign pointing to an intra-medullary growth ; the pain, etc.,
pointed to an extra-medullary lesion. The lower abdominal
reflex was absent, the middle and upper abdominal reflexes were
brisk. There was atrophy with reaction of degeneration in the
lower third of the oblique muscles, whilst the recti and upper
tl ird of the oblique were normal. Operation revealed a glioma
which unfortunately was intra-medullary and almost completely
destroyed the lumbar enlargement. The patient died of pneumonia
several mouths afterwards. Anatomical investigation showed
that in the 1st lumbar segment a certain number of anterior
cornual cells still survived (corresponding to the ileo-psoas
muscles, which were unparalysed). The anterior cornua of the
lowest thoracic segments were practically normal, but in the
12th, 11th, and partly in the 10th thoracic segments the
anterior cornual cells were destroyed. Salecker therefore places
the medullary centres for the lower third of the oblique muscles,
together with the ceutre for the lower abdominal reflex, in the
12th and 11th thoracic segments. The recti in this case were
intact, and their medullary centres, therefore, do not extend so
far caudalwards as those for the oblique muscles.

2. A young and healthy workman had an injury in the lumbar
region. This was followed by slight and transient sensory im¬
pairment in the cutaneous distribution of the lower thoracic and
upper lumbar segments. Subsequently there developed muscular
paralysis with reaction of degeneration. The adductors and
quadriceps muscles were affected on both sides, with loss of the
knee-jerks. In addition there was partial paralysis of the
abdominal muscles—the lower third of the left rectus, the lower
two-thirds of the left oblique, and about the lowest fourth of the
right oblique muscle. Together with this there was loss of both

ABSTRACTS

249

lowvr abdominal reflexes and of the middle abdominal reflex on
the left side. The patient was completely cured in about four
months. The diagnosis was that of a haemorrhage in the cord
extending from the 10th thoracic segment above to the 3rd or
4th lumbar segment below, the upper limit being higher on
the left side. Purves Stewart.

MENINGITIS IN MUMPS, WITH INVOLVEMENT OF THE
<201) FIFTH NEBVE AND HERPES OF ONE OF ITS BRANCHES.
(Mdningite lymphocytique ourlienne, avec atteinte du tri-
jtuneau et zona d’une de ses branches.) C. Dopter, Progrh
medical, 1908, p. 101.

A soldier, who had already had mumps twelve years previously,
had a second attack at twenty-two. Headache, vomiting, high
temperature and a slow pulse supervened, and the diagnosis of
meningitis which these symptoms indicated was confirmed by
lumbar puncture. Three days later sensory troubles in the
distribution of the fifth nerve occurred, consisting of hyposesthesia
in the region of the first division, hypersesthesia in that of the
second, and in that of the third hyperesthesia was associated with
the development of herpes. There was no orchitis, as in many of the
cases of meningitis following mumps, nor was there any subsequent
paralysis. J. D. Rolleston.

MENINGITIS IN MUMPS. (Contribution k l’ltude de la mdningite

(202) ourlienne.) Vennat, Arch, de mid. et de pharm. militaires , Feb.
1908, p. 143.

The writer reviews the literature, and records a personal case
in a soldier. All the characteristic symptoms of meningitis were
present, especially headache, stiffness of the neck, and Kernig’s
sign, pyrexia and bradycardia {cf. Rev. of Neur. and Psych., 1907,
p. 301). Lumbar puncture could not be performed through want
of a suitable syringe. Recovery took place. Vennat lays special
stress on the beneficial effects of hot baths, which were given four-
hourly. J. I). Rolleston.

INTRACRANIAL ABSCESS DUE TO THE TYPHOID BACILLUS.

(203) Gurd and Nelles, Ann. of Surg., Jan. 1908.

A machinist, aged 25, under treatment for typhoid fever, exhibited
signs of a severe bruise on the right side of the head, above and in
front of the ear, and extending forward .to the supraorbital ridge.
This was supposed to be the result of a blow sustained about a

250

ABSTRACTS

month previously, but the history was somewhat vague. Redness,
oedema, and fluctuation developed over the bruised area, and incision
under chloroform revealed an abscess containing pus and blood,
the evacuation of which exposed an area of bare bone with a lineal
fracture running across it. The bone was trephined, and a large
extra-dural clot partly organised and beginning to undergo
suppuration was discovered. The patient made a good recovery.
The typhoid bacillus was isolated from both the extra- and intra¬
cranial abscesses. The sequence of events in this case had been
that, as a result of an injury, an extra-dural haemorrhage had
occurred, the abscess ensuing on account of blood-borne infection of
the hsematoma by the typhoid bacillus. Henry J. Dunbar.

HEMORRHAGE INTO THE PONS VAROLII AS THE IMMEDI-
(204) ATE OAUSE OF DEATH IN THE ECLAMPSIA OF PREG¬
NANCY, WITH ILLUSTRATIVE OASES. Carver and
Fairbairn, Med. Press , Jan. 29, 1908, p. 116.

In this communication the authors record a very interesting case,
and review other cases illustrating the occurrence of haemorrhages
in fatal cases of eclampsia.

The patient was a primigravida, tet. 24. When about five
months pregnant on the evening of 23rd March she complained
of vague pains ; her mental condition was good. She stated that
for two or three days she had suffered from loss of appetite, sleep¬
lessness, headache, and spots before the eyes. There had been
neither vomiting nor fits. She had noticed no diminution in the
amount of urine passed. On examination there was found to be
general cedema of the whole body. The uterus reached the
umbilicus, foetal heart sounds were audible. The temperature was
normal, the pulse-rate 84, the arterial tension was considerably
raised. A catheter specimen of urine became solid on boiling.
Patient was ordered to remain in bed, a saline purge was adminis¬
tered, and arrangements were made to admit her to hospital next
day. About 1.20 a.m. on 24th March ( i . e . six hours after patient
had been seen) patient’s husband wakened aud found his wife
unconscious lying on her face and knees on the floor; before
going to sleep he had noticed her hand twitching.

When seen at 2 a.m. the patient was cyanosed and quite un¬
conscious, respirations were shallow and of the Cheyne-Stokes
type, pulse 84, tension very high, all reflexes absent. No unila¬
teral symptoms were noticed, there were no twitchings. The
pupils were equal and moderately dilated. On arrival in hospital
the pulse was found to be weaker and the respiration more
markedly Cheyne-Stokes. Ten ounces of blood were withdrawn

ABSTRACTS

251

from a vein and four pints of normal saline solution infused with¬
out any improvement of patient’s condition. Bapid dilatation of
the cervix was carried out and a living five months’ foetus extracted
by version, which only survived a few minutes. Patient’s condition
did not improve; she died at 7.15 without regaining consciousness.

Post-mortem examination showed that there had been an
extensive haemorrhage into the substance of the pons, which was
greatly torn and disorganised. The haemorrhage passed up for a
short distance into the crura cerebri. The rest of the brain was
normal. There was no disease of the cerebral arteries. Though
the post-mortem shows death to have been due to a cerebral
haemorrhage, the authors maintain that it also affords evidence in
support of their view that the case was primarily one of eclampsia.
The renal changes were slight, but were definitely those of fatty
degeneration and necrosis, such as are often found in eclampsia.
The liver changes were not characteristic of those found in the
toxaemia of pregnancy.

The symptoms of headache and sleeplessness first complained
of point to a pre-eclamptic stage: there was no definite evidence
of a fit except the twitching of the hands, and the further fact
that she was found out of bed on the floor.

In regard to any alternative explanation the authors point out
the difficulty of explaining a large haemorrhage of this kind in a
previously healthy young woman of 24 with no arterial lesions;
they maintain that it is a fair presumption that the poison of
the eclampsia was the determining cause of the apoplexy.

The authors proceed to discuss the incidence of cerebral
haemorrhage in eclampsia. Though definite brain changes are
not found in eclampsia, it is not by any means uncommon to find
small, usually meningeal, haemorrhages which, however, are quite
distinct from extensive tuemorrhages. Schanta’s statistics show
that in 90 post-mortems 10 cases showed evidence of cerebral
haemorrhage; in four it is described as “ apoplexia gravis,” in the
others as “ apoplexia capillaris.” Schrieber in twenty-seven fatal
cases notes no large cerebral apoplexy, but records four capillary
haemorrhages. Glockner in twenty-six examinations noted cerebral
haemorrhage in three, meningeal haemorrhage in one; he does not
give details as to the size of the haemorrhages. The authors then
minutely consider four cases of extensive haemorrhage.

The first case they review is one recorded by Pfannenstiel
(Zentralb. /. G-ynctfc., 1897). This case has many points of interest.
The patient, a primipara, aet. 22, in labour and unconscious, was
admitted to his clinic at 9 A.M., as suffering from eclampsia. The
history was that up to within a few days she had had perfect health;
for a day or two her feet had been swollen. Four hours before
admission she had an attack of sickness and a short fit, after which

252

ABSTRACTS

consciousness had not returned. On admission the limbs were
found to be limp; there was oedema up to the knees. Pulse was
68; respirations shallow, 44. The pupils, which were widely dilated,
were of equal size; the cornea were insensitive; the face was
symmetrical. Sensibility was lost all over the body. The urine,
which contained a few casts, became solid on boiling. In spite of
active treatment, the patient died at 3.15 p.m.

Examination of the brain showed complete destruction of the
left optic thalamus and surrounding parts by a hamorrhage, which
had broken through into the left lateral ventricle, with softening
of the right optic eminence and filling of the ventricles with dark
blood. There were points of blood in the pons. The arteries
were normal except in the neighbourhood of the hamorrhage. Iu
the optic eminence was a varix the size of a cherry stone, with
fresh thrombosis, and microscopically the position of the bursting
of this thin-walled sac was recognised. No varices were recognised
elsewhere in the body. Pfannenstiel considers the case to be one
of true eclampsia on account of the highly albuminous urine,
the oedema, and the premonitory symptoms, as well as the changes
found in the liver and kidney. The thin-walled varix in the left
optic eminence was probably pre-existent, and must be regarded
as a locus minoris resistentise; this, when the eclamptic attack
raised the blood-pressure, gave way.

The authors further cite cases recorded by Meyer-Wiry,
Maygrier, and Chavanc and Esch. In all four cases, however, the
haemorrhage was not actually into the pons. All the cases
cited by the authors have one feature in common, viz., in none
was the cerebral haemorrhage recoguised before death. Among
other points of similarity it is important to note that all the
patients were young primiparae, the ages being 22, 24, 25, 25, 38.
Cerebral haemorrhages at such early ages point in a most striking
manner to the grave effect of the eclamptic toxin on the arterial
walls.

In all five cases there were some premonitory symptoms such as
headache, ocular disturbances, twitchings or respiratory difficulties.
The onset of coma was as a rule the first indication of the serious
nature of the case. In some of the cases a fit preceded the coma,
but deep coma supervened with little in the way of antecedent
convulsions.

The breathing in all cases was early stertorous, and later of the
Cheyne-Stokes type. Cyanosis was a marked feature of all cases.
Though the amount of dilatation varied in different patients, the
pupils in all cases were dilated, equal in size, and inactive.

Malcolm Campbell.

ABSTRACTS

253

THE MUSCULAR STRENGTH OF HEMEPLBGICS. (Uber die
(205) Kraft der Hemiplegiker.) Max Sternberg, Deutsche
Zeitschr.f. Nervenheil/c., Bd. xxxiv., S. 128.

Sternberg reports the results of careful and repeated tests,
graphically recorded, made on twenty-seven hemiplegics. The
object of the research was to check Pitres’ findings, that the healthy
side shows some loss of power, and that simultaneously-made
bilateral efforts increased the strength exerted by the paralysed
limbs. The first of these statements was fully confirmed, the
second not at all. According to Broadbent’s theory, bilateral effort
should diminish the power of the healthy side and increase that of
the paresed. Although in some cases this was true, in others it
was not Sternberg finds that the effect of bilateral effort on
the paresed limbs may be either to increase or diminish their
power, and that this effect may vary in different tests; similarly
on the healthy side. He makes some important remarks on the
technique of dynamometer testing, for which he uses a new instru¬
ment he has invented (see Neurologisches Centralblatt, 1907, No. 11),
and on the bearing of the present results on the theory of the
recovery of power in hemiplegia Ernest Jones.

PSE U DO-HYSTERIGAL HEMIPLEGIA. (Hemiplegia pseudo-
(206) hysterica.) Adamkiewicz, Neurol. Centralbl., Feb. 1, 1908,
S. 98.

The author maintains that as hysterical hemiplegia may resemble
that of organic origin, so may the latter sometimes present the
features characteristic of the former. In illustration of this he
reports the case of a woman, aged 50, who, on receipt of some
distressing news, became excited and suddenly paralysed on the
left side. The hemiplegia was complete, and she was unable to
make the slightest movement with the paralysed limbs. The
cranial nerves were, however, all normal. Complete hemianesthesia,
limited by the middle line, and not implicating the face, existed
for all forms of sensation. No note is made of the plantar reflex.

In favour of the diagnosis of hysterical hemiplegia was the
mode of onset, the intactness of consciousness and intelligence
throughout, the complete hemiansesthesia, the absence of hemi-
anopia and of paralysis of the face or tongue, and the clearness
of speech. Against this, however, was the absence of hemianosmia,
hemiageusia, and hemianopia. The author uses the last argument
first, to exclude the hysterical nature of the affection and then to
exclude the organic nature of it, though few authorities would
maintain that hemianopia is found with hysterical hemiplegia as
often as with organic.

254

ABSTRACTS

On the basis merely of absence of hemianosmia and hemiageusia,
the author inclined to the diagnosis of organic hemiplegia, though
it might be remarked that one would not expect to find these
symptoms in a case in which both the motor and sensory functions
of the face were normal, as here. To decide the problem he resorts
to what he calls the crucial test of the application of mustard paste
to the anaesthetic side, for he holds that this invariably determines
the transference of hysterical hemianaesthesia to the opposite side.
As in this instance the test was negative, his original diagnosis was
confirmed.

It comes as a surprise to read such a contribution in the pages
of the Neurologisches Centralblatt. Ernest Jones.

THE FUNCTIONS OF THE CORPORA STRIATA, WITH A SUG-
(207) GE8TI0N AS TO A CLINICAL METHOD OF STUDYING

THEM. C. L. Dana (of New York), Joum. Nerv. and Ment.

Dis., Feb. 1908.

The paper discusses in a most instructive way the anatomical
structure and the physiology of the striate body, citing the clinical
and pathological results of experimental work done by different
investigators. Four cases are cited in which a careful clinical
study had been made and autopsy performed. The author refers
briefly to the clinical manifestations and post-mortem findings in
the lenticular nucleus of gas-poisoning cases. He summarises his
work as follows:—

The corpus striatum has not any independent or specific motor
function. It probably has some supplementary motor function,
especially in connection with articulation. It may have some
control over the bladder (double lesions). It seems to have some
control over vaso-motor and trophic conditions of the skin (and
lungs ?). It has no thermic centre. It may have some supple¬
mentary and associative psychic function, so that lesions affect
memory or initiative. It is an organ of less importance relatively
in the higher vertebrates. In severe gas poisoning there is a
double softening of the lenticular nuclei, due to thrombosis of “ the
artery of cerebral thrombosis,” and there result vaso-motor and
gangrenous conditions of the skin, so that these conditions in
connection with a history of coma from gas poisoning form a
group of symptoms called “ the syndrome of the corpus striatum.”

C. H. Holmes.

ABSTRACTS

255

CLINICAL CONTRIBUTIONS TO THE QUESTION OF AOUTB
(208) TOXIC AND INFECTIOUS NEURITIS OF THE AUDITORY
NERVE. (Klinische Beitr&ge zur Frage der akuten toxischen
and infektifeen Neuritis des Norms Acasticas.) J. Hboknkr,

Zeitschr. /. Ohrenheilk., Bd. 55, H. 1-2, 1908, S. 92.

The author contrasts the advantages possessed by the ophthal¬
mologists for observing the optic nerve during life and testing its
condition with the difficulties attending the examination of the
auditory nerve during life, and even after death. Siebenmann has
described cases of interstitial auditory neuritis in cancerous
cachexia and of retrolabyrinthine neuritis in pulmonary tuber¬
culosis, but Wittmaack must be given the credit of recognising
a toxic auditory neuritis analogous to optic neuritis. He found
that in animals injected with tubercle as well as in men the
cochlear branch of the nerve is the one that is first and most
severely affected: this explains the prominence of deafness in
these cases, and the almost complete absence of giddiness.
Clinically such cases are characterised by a diminution of hearing,
gradually increasing as one passes up to the upper tone limit,
combined with lowering of this limit. This is analogous to the
toxic affection of the central bundle of the optic nerve. Gradenigo
thinks that damage of the middle of the field of hearing is
characteristic of toxic affections, but Hegener agrees with
Wittmaack.

Manasse has investigated post-mortem material from old
people who had become deaf, and finds that the ramus cochlearis
is usually diseased, less frequently the cochlear and vestibular
branches together; and most rarely the vestibular division was
more severely and therefore primarily affected.

Hegener gives details of six cases. Case I.: M., aged 22, caught
cold on a long journey. Later diarrhoea and a feeling of sickness
came on, followed by giddiness, left-sided facial paralysis, and
indistinctness of vision on looking to the left. Two weeks later
deafness came on in the left ear, but there was no tinnitus, ear¬
ache, headache or anaesthesia of the face: dysphagia, difficulty
in speaking, and disturbance of taste were also absent. The patient
swayed a little when standing with eyes closed, and tended to fall
to the left. When asked to walk straight forward he described a
semicircle to the left, but exhibited no nystagmus or facial spasm.
He stood the faradic current well, but galvanism produced extreme
giddiness with tendency to fall to the left. Examination of the
ear showed that the middle ear was normal. The tuning fork on
the vertex was lateralized to the healthy ear, and both bone and
air conduction were shortened on the left side—air conduction
being the longer. The lower tone limit was 24 V.D. and the

256

ABSTRACTS

upper tone limit for the tuning fork 1024 V.D., but the Galton-
Edelmann whistle was heard up to 17,000 V.D.

The patient was treated with aspirin, rest, and faradic current.
The facial paralysis rapidly improved, the upper tone limit of the
left ear rose to 20,000 V.D. for the whistle, and C. 5 (409G V.D.)
could be heard when forcibly vibrated. The second examination
of the hearing showed that certain tones about the middle of the
scale were heard better than normal, and Hegener suggests that
this may have been due to the stapedius paralysis. Eventually the
case completely recovered. Case II.: M., 31., was probably of
rheumatic origin. Tinnitus was first complained of, followed by
deafness, and later on by giddiness, nausea, and vomiting. After
three days in bed the vomiting disappeared, the giddiness got less,
but the deafness and tinnitus still remained. In this case middle
ear catarrh was also present, and the lowest tones were not heard.
The upper tone limit as tested by the whistle was 14,000 V. D.
Slight nystagmus was present, but otherwise the vestibular
apparatus was not affected. Case III.: M., aged 40, was due to
influenza. Tinnitus and deafness came on four days after the
beginning of the illness, but there was no giddiness. Salipyrin
made the tinnitus much worse—an instance of a synthetic poison
acting on an organ already diseased. After two years the hearing
had only returned for tones in the middle of the scale. Case IV.
was similar, but the patient was sixty-five years old. The other two
cases were diabetics. In the first the upper tone limit was much
reduced, but in the second the lower tones were not heard, though
the bone conduction was shortened. Siebenmann says that in¬
fectious diseases tend to produce nerve changes in an ear already
affected by stapes ankylosis, and Scheibe has described an acute
unilateral affection of the 8th nerve characterised by deafness for
the lowest tones. Hegener compares these pictures of limitation
of the hearing field to cases of optic neuritis with scotoma. The
paper is very interesting, if not absolutely convincing, and the
author rightly emphasizes the necessity of the aurist working in
conjunction with the physician. J. S. Fraser.

A OASE OF ACROMEGALY WITH OSTEO ARTHROPATHIES
(209) AND PARAPLEGIA. (Sur un cas d’acrom4galie avec osteo¬
arthropathies et parapl6gie.) By V. Beduschi (Milan), Now.
Icon, de la Salpetrikre, No. 6, 1907.

In this short paper Dr Beduschi records the clinical features of a
case, a woman set. 30 years, who, in addition to the characteristic
appearances of acromegaly, presented flaccid paralysis of both legs
and grave osteo-articular dystrophies. The principal interest

ABSTRACTS

257

centred round the results of the examination of the nervous
system. Visual fields, pupils, external ocular movements, and all
special senses were normal, but in the upper extremities the
deep reflexes were diminished and in the lower limbs abolished.
Further, there was paralysis with atrophy of the flexors and
extensors of hip and knee on both sides, with in-excitability, or
in some muscle groups hypo-excitability, to faradic stimulation.

Proceeding to the discussion of the exostoses—the text being
illustrated by radiographs—the author separates these from the
arthropathies of tabes and syringomyelia, and relates the whole
clinical appearances to the single and as yet unascertained cause
of the acromegaly, i.e. to the other distinctive forms of acromegaly
is to be added another, a paralytic form.

R. CUNYNGHAM BROWN.

TEMPORARY (EDEMA OF ONE OPTIO DISC AS A LOCALISED
(210) MANIFESTATION OF AGDTE CIRCUMSCRIBED (ANGIO¬
NEUROTIC) (EDEMA (Quincke). (Eurzdauemdes Oedem der
Sehnervenpapille eines Auges, eine Localization des akuten
umschriebenen Oedema (Quincke). Handwerck, Munch, med.
fPchnschr., No. xlviii., 1907, p. 2332.

Handwerck describes a case of an old woman of 73 in whom
there had been at intervals various manifestations of acute
circumscribed oedema. In mid-September she had shown several
manifestations of this disease; during the winter she had been
fairly free from attacks; but in the middle of April she had two
attacks in succession, one area being on the chin, the other on the
under lip. On the 19th April the left side of her tongue was
definitely affected. On the 20th April she complained of a
sensation of white flickering before her eyes, like white leaves
falling to the ground, mostly affecting her right eye. On the 22nd
April an ophthalmoscopic examination was made. Her visual
acuity was good, her visual fields were full, her pupil reactions
normal, conjunctiva healthy; she had hypermetropia + 2 5 D. The
right optic disc showed blurring of the edges, with hyperaemia and
2 D. of swelling. The fovea was also hyperaemic, arteries were
diminished, and the veins dilated.

In the course of eight days the whole process had subsided,
leaving the right fundus normal. The author ascribes this
passing change to a local manifestation of angioneurotic oedema.

Leslie Paton.

258

ABSTRACTS

ALOOHOLIO EPILEPSY. (L’Epilepsid alcoolique.) L. Eli

(211) Joum. de Mid., Jan. 25, 1908.

It is necessary to distinguish between epileptic attacks occurring
in the course of subacute alcoholism and epileptiform convulsions
met with at an advanced period of chronic alcoholism.

Acute Alcoholism .—These attacks occur usually in the case of
an habitual drinker who has passed the point of saturation. Such
a case has visual and auditory hallucinations, and does not know
where he is. The period of occurrence of the epileptic attack is
not fixed, and it cannot be foreseen. Some patients have an attack
in their first subacute alcoholic delirium, others not till their second
or third. In the writer’s experience the seizures have been intense
in character, the violent movements of the arms and legs suggesting
a comparison with hystero-epilepsy. Aura and cry are absent.
The face of the idiopathic epileptic is pale, that of the alcoholic
subject congested and the eyes injected, except in the case of
absinthe drinkers, when pallor is the rule. The epileptic does not
recollect his seizure or the delirium which may follow it. The
alcoholic may, on the other hand, retain the memory of his delirium.
It may be possible by strong effort to fix the attention of the
alcoholic and obtain a certain response, but this could with
difficulty be done in an epileptic.

The seizures may be single or repeated several times. When
the patient abstains from drink they diminish in frequency, and
rapidly disappear when the toxic effects of alcohol are got rid of.
They reappear again if indulgence be resumed.

Prognosis is essentially favourable. In fatal cases at the
autopsy a simple generalized congestion of the meninges and the
brain has been found.

As to diagnosis, only the progress of the case and the effect
of the withdrawal of alcohol enable one to say whether one is
dealing with a case of alcoholic epilepsy or with an epileptic whose
seizure has been coincident.

Chronic Alcoholism .—Alcohol can eventually bring on con¬
vulsions, but these do not appear in the form of a frank epileptic
attack, but as epileptiform seizures, analogous to those met with
in cases of general paralysis and brain tumour. They occur in
those who have long shown the signs of chronic alcoholism. They
are not fixed in occurrence. There is no aura, though sometimes
they are preceded by a dulness in the head and general malaise.
The convulsions which characterise them are not general, but are
limited to one side of the body or face, or one of the limbs. They
may predominate in one group of muscles. They consist in clonic
movements of a part or in involuntary or rapid movements of
deglutition. From these characters, and their tendency to self¬
limitation, they resemble the choreiform movements of general

ABSTRACTS

259

paralytics or patients affected with cerebral tumour. The patient
remains more or less aware of what is going on around him and
does not lose consciousness. He is feeble, bis face congested, the
temperature rising to 38’5° or 39°. Recovery is rare.

A. Hill Buchan.

PO8T DBLIRI0US ALCOHOLIC STUPOR (Alcoholic Cerebral (Edema,
(212) “Wet Brain”). Clarles K. Stillman, M.D., New York
Med. Journ., Jan. 25, 1908.

This peculiar stupor has been little studied. The association of
stupor with oedema of the meninges has led many to regard the
transudate as the central factor in the condition ; but it seems
that the symptoms are merely those of a type of cerebral irritability.
For they may occur in the absence of oedema, e.g. in typhoid and
uraemia; while on the other hand serous effusion may be found
in cases that during life do not manifest symptoms of the kind.
The cause of the oedema has probably to be sought among the
general conditions underlying the stupor. While it is true that
what is generally spoken of as “ alcoholic wet brain ” is a transudate
pure and simple, there is in alcoholic oedema a tendency to low-
grade inflammatory changes about the blood vessels and meninges
more marked than in “ wet brain ” of other types. In true
oedema the effusion occurs well distributed, whereas in post-mortem
oedema the fluid is found only in dependent areas. The special
symptoms are almost always preceded by some alcoholic delirium.
A study was made of 98 cases in the alcoholic wards of Bellevue
Hospital. Out of 2133 patients admitted to the female alcoholic
ward from September 1, 1905, to September 1, 1906, approxi¬
mately 1 per cent, were attaoked with “ wet brain.” The youngest
was twenty-three years old, the oldest sixty; majority thirty to
forty. About 81 per cent. died. Duration of illness in fatal
uncomplicated cases varied from one to forty-five days. Of the
non-fatal cases some were dismissed “improved.” One woman,
thirty-four yearn old, who suffered from the most aggravated form
of attack, is now quite strong and healthy. During the same
period there were 5017 admissions to the male alcoholic ward:
1*5 per cent, of them suffered from the condition in question—
oldest seventy, 3 between sixty and seventy, 14 between fifty and
sixty, 23 between thirty and forty, 4 between twenty-two and
thirty. Mortality, 79 per cent. Duration in uncomplicated cases,
from less than one to twenty-two days. Thirteen patients re¬
covered in from two to forty-five days.

Men survive the shorter attacks better than women, but
succumb more frequently to the longer ones. Men often have
debauches in the course of steady tippling, which precipitate

260

ABSTRACTS

attacks of delirium tremens, whereas women tipple steadily, but
debauch less, and when stupor comes on, their vital powers are
apt to be very low. In men one often sees what may be called
“ transitory wet brain.”

The statistics show a tendency towards a separation into a short
and a protracted type of attack. Wet brain oftenest comes on
about the third or fourth day of delirium tremens. As regards
symptomatology, one notes the alteration in facial expression:
grey pallor and almost cadaveric immobility of countenance, the
hands reaching up towards the head, which is thrown back; the
pupils at first often pin-point, later dilated; the very persistent
“ stiff neck ” ; the pulse small, frequent, and of low tension; the
temperature typically low—99-101F. or subnormal. The degree of
coma varies.

Diagnosis is often more difficult than might be supposed.
Perhaps the most fruitful source of error is tubercular meningitis
in adults. Possibly the best treatment is forced feeding with
judicious stimulation. Enormous amounts of food are required.
The patients do not react to ordinary doses of stimulants. Caffein
is perhaps the best drug, given in five-grain doses of the citrate, or
sodium benzoate. Sitting the patients up in bed is said to be
attended with good results. Tapping the cord produces only
temporary relief. The fluid removed shows no difference from
normal fluid except that it is usually increased in amount and is
under greater pressure. A. Hill Buchan.

COMPLICATIONS OF ALCOHOLISM, WITH SOME STATISTICS

(213) ON TWO THOUSAND OASES. Leonard D. Fresooln,
M.D., Journ. Amer. Med. Ass., Feb. 8, 1908.

The complications and sequelae of the continued use of alcohol are
more to be feared than alcoholism itself.

An examination of 4000 cases of alcoholism at the Philadelphia
General Hospital during the past three or four years showed a
great variety of recorded “complications.” A number of these
were merely accidentally associated troubles, but there were a
number of diseases running band in hand with alcoholism in many
cases.

In 2000 cases the “ complications ” which seemed most reason¬
ably linked with alcoholism were as follows:—

Delirium tremens (7 deaths) . . 49 cases

Forms of nephritis . 28 „

Pneumonia . . 23 „

Pulmonary tuberculosis 23 „

Myocarditis . 20

Uremia . 16

ABSTRACTS

261

Bronchitis .
Gastroenteritis
Lacerations
Valvular heart disease
Contusions
Leg ulcers .
Rheumatism
Pulmonary oedema
Fractures .

Typhoid

Confusional insanity
Multiple neuritis .
Erysipelas .

Cirrhosis of liver .
Epilepsy

15 cases
14
14
11
10
9
7
7
7
6
6
6
5
5
4

Something must be allowed for want of sufficient care in case¬
taking; e.g., arteriosclerosis was noted only in from 8 to 10 per
cent., whereas it must be present in from 80 to 90 per cent, of
cases.

For the most part those who drink to excess are the uncleanly,
the poor, the ignorant, and especially those of bad heredity. The
habits of the alcoholic explain many of the complications. The
author has never seen a lobar pneumonia in a fat man suffering
from delirium tremens end in recovery, but in lean subjects,
several. A. Hill Buchan.

ON THE DIFFERENTIAL DIAGNOSTIC VALUE OF WASSER-

(214) MANN’S SERUM DIAGNOSIS OF SYPHILIS FOR IN¬
TERNAL MEDICINE AND NEUROLOGY. (Ueber den dif-
ferentiell-diagnostischen Wert der Wassermannschen Serodiag-
nostik bei Lues fUr die innere Medizin und die Nenrologie.)
K. Kroner (of Berlin), Berl. klin. Wochenschr., Jan. 27, 1908.

CLINICAL CONSIDERATIONS ON WASSERMANN’S REACTION

(215) IN SYPHILIS. (Klinische Betrachtungen tiber die Wasser-
mannsche Re&ktion bei Syphilis.) W. Fischer (of Berlin),
Berl. Jdin Wochenschr., Jan. 27, 1908.

Kroner records the results of the examination of forty patients
with regard to the reaction of their serum or cerebro-spinal fluid
by Wassermann’s method. The cases were divided into non-
syphilitic (6), probably non-syphilitic (5), and syphilitic (30); in
the third group doubt was excluded either by the anamnesis, the
nature of the clinical symptoms, or the autopsy findings. In the
first two groups the reaction was negative; out of the third group
twenty-two gave a positive reaction.

262

ABSTRACTS

A negative reaction, therefore, does not exclude previous in¬
fection, and, according to the author, a positive reaction may be
given in certain cases of jaundice ; this, however, does not materi¬
ally alter the practical significance of a positive reaction.

Fischer, from a dermatological service, tested the reaction in 250
syphilitic patients, chiefly in early stages of the disease; in 84 per
cent, the reaction was positive. It is doubtful whether a positive
reaction can be expected before the seventh or eighth week after
infection. The reaction allows of the diagnosis of the constitu¬
tional malady, but does not warrant the conclusion that any
definite organ shows, syphilitic changes; thus the pleuritic exsudate
in a patient, whose secondaries had disappeared less than two
months previously, gave a positive reaction.

A negative result is not of diagnostic value; the reaction cannot
be used to test the efficacy of therapeutic measures.

C. Macfie Campbell.

ON WASSERMANN’S SERUM DIAGNOSIS OF SYPHILIS. (Ueber

(216) die Wassernuumsche Serodiagnostik der Syphilis.) E.

Fraenkel and H. Much (of Hamburg). Munch, med.
fVochenschr., March 24th, 1908.

The authors examined by Wassermann’s method the serum of
patients with certain diseases held to be related etiologically to
syphilis—aortitis, orchitis, stricture of the rectum. In all the
cases of aortitis the reaction was positive; in two cases of aortic
aneurysm the result was negative. In the four cases of disease of
the testicle examined the result was negative. In two cases of
general amyloid disease, which, both on clinical and pathological
examination, presented no evidence of any of the disorders usually
associated with this condition, the result was negative: the spleen
in both cases presented the ham-like appearance frequently con¬
sidered to be pathognomonic of previous syphilis. The authors
mention the discovery at the autopsy of definite syphilitic
lesions in a patient who died from pneumonia. In such cases a
positive reaction might be used wrongly as an argument to show
that the Wassermann reaction is present in other diseases than
syphilis. The importance of corroboration by post-mortem
examination is emphasized. C. Macfie Campbell.

NERVOUS MANIFESTATIONS OF ARTERIOSCLEROSIS. A.

(217) Stengel, Amer. Joum. Med. Sc., Feb. 1908.

The author emphasizes the distinction between symptoms that
result directly from arteriosclerosis and those which have some
intermediate organic derangement for their cause. He discusses

ABSTRACTS

263

and gives cases illustrating symptoms associated with obstruc¬
tion of peripheral vessels, painful sensations preceding senile and
diabetic gangrene, panesthesia of various kinds, pains associated
with arteriosclerosis of the abdominal aorta and of its branches,
and of the thoracic aorta, cerebral manifestations of arteriosclerosis.

C. Macfie Campbell.

A NEW CASE OF ANKLE CJLONTJS IN HYSTERIA. (Un

(218) nouveau cas de clonus du pied dans l’hyst^rie.) Van

Gehuchten, Le Nevraxe , Jan. 26, 1908, Vol. ix.

Van Gehuchten, who has done excellent work in breaking down
the inviolability of the French dogmas concerning the non-occur¬
rence of certain reflexes in hysteria, begins this article by refuting
Collier’s objection to a previously published case, namely, that it
was one of early disseminated sclerosis. This case, eighteen months
later, still presents not a single sign of disease of the nervous
system, and it is to be hoped that in a couple of years the author
will again publish a report of it. Collier’s argument as to the
limited evidence in favour of the thesis he answers by pointing out
that the occurrence of Babinski’s sign and ankle clonus in hysteria
is acknowledged, if it occurs at all, to be very rare.

He now reports a second case, that of a woman aged thirty-five,
who, after one of a long series of severe hysterical crises, was seized
with a spastic paralysis of the left leg and a flaccid paralysis of
the left arm. Four months previously she had lost hearing, sight,
taste, and smell on the left side. On examination the paralysis
and contracture were found to present typical hysterical features,
and yielded to psychotherapeutic measures. Further, there was loss
of sight, smell, and taste, and almost complete loss of hearing on
the left side; the left side, including the mucous membranes, was
completely anaesthetic. The right knee-jerk was normal, the left
greatly exaggerated. On the left side a typical permanent ankle
clonus was obtained, showing none of the features of false ankle
clonus. The author, therefore, still maintains that exaggeration of
the knee-jerk and true ankle clonus may be due to hysteria.

Ernest Jones.

NOTE ON A CASE OF SPONTANEOUS SOMNAMBULISM.

(219) Warren Lloyd, Joum. of Abnorm. Psychol ., Feb. 1908, Vol.
ii., pp. 239-269.

This case is reported from notes made by the author when a
psychology student over ten years ago. As the case was never
scientifically investigated, it is of little or no value. All that seems

264

ABSTRACTS

certain is that the patient, then a man of twenty-three, had spent
a great part of his life, certainly since the age of twelve, oscillating
between two states of consciousness. In the assumedly abnormal
one he presented marked changes of character, notably irritability.
Consciousness in this state included all previous memories, whereas
that in the waking normal state included only memories of the
same state. The case developed after a series of epileptiform
fits, and seems to be an ordinary one of hysteric dual consciousness.

Ernest Jones.

UNUSUAL ILLUSIONS OCCURRING IN PSTCHOLEPTIC AT
(220) TACKS OF HYSTERICAL ORIGIN. Harvey Carr, Joum.
of Abnorm. Psychol., Feb. 1908, Vol. ii., p. 260.

Carr relates an interesting case in which attacks of the following
nature occurred. The two features were: (1) a sense of all
surrounding objects rapidly receding to the horizon; this applied
also to the patient’s own body. It usually culminated in not
only blindness, but a sense of blankness in which nothing in the
world seemed to exist; (2) a feeling of total paralysis and helpless¬
ness, evidently of an aboulic nature; this added to the unpleasant¬
ness of the experience. No other disturbances accompanied the
attacks, which dated from the age of six. Fluctuating cutaneous
ansesthesia, incessant nightmares, mai'ked tendency to revery were
features that indicate the hysterical nature of the case.

Although a good descriptive account of the attacks is given,
no psychological analysis of the underlying phenomena is mentioned.
Particularly noteworthy is the lack of attention paid to the dreams,
although the author repeatedly insists on their vividness, pro¬
minence, and the facility with which they could be recalled.
Freud’s epoch-making work on dream analysis as the most
important method of studying sub-conscious feeling memories
seems to be little known in America as yet.

Ernest Jones.

THE VALUE OF OTTODIAGNOSI8 IN PRACTICAL MEDICINE.

(221) James E. H. Sawyer, Lancet , Feb. 1 , 1908, p. 283.

A short paper dealing with the importance of examining serous
effusions and cerebro-spinal fluid for lymphocytes, polymorphs,
and endothelial cells as an aid in diagnosing tubercular, acute,
inflammatory, or malignant diseases and mechanical effusions.
Nothing new. J. H. Harvey Pirie.

ABSTRACTS

265

BECJENT RESEARCHES ON THE DIAGNOSTIC MEANING OF
(222) PUPILLARY SYMPTOMS. (Neuere Untersnehungen fiber
die diagnostische Bedentung der Pupillensymptome.) Bumke,
Munch, med. Wchnschr., No. xlvii, 1907, p. 2313.

This paper, a contribution to a discussion, gives an interesting
account of much recent work on the importance of variations of
the pupillary reflexes in certain diseases of the central nervous
system. Dealing first with the Argyll Robertson pupil, he points
out that its existence is to be regarded as absolutely pathognomic
of the metasyphilitic affections, tabes and general paralysis,
though it has been shown that Argyll Robertson pupils may be
present for years (as long as ten years according to Thomsen)
before other signs of tabes or general paralysis become manifest.
No one has abolition of the light reflex who is not syphilitic.
He regards this as the most important symptom in the diagnosis,
of more importance than any alterations in the leucocytes in
the cerebro-spinal fluid, though he admits that such changes are
relatively seldom missing and the Argyll Robertson pupil in a pure
form may be relatively frequently absent. According to the older
statistics 64 per cent, of tabetics and 62 per ceut. of patients with
G. P. I. showed definite Argyll Robertson pupils, 20-25 per cent,
showed some alteration in the light reaction, and in only 15-20
per cent, was a diagnosis made independently of any change of the
iris movements.

An advance in the refinement of methods has altered
these percentages, but we are still without satisfactory means of
standardising the amount of stimulation, and so measuring the
minimal stimulus requisite to produce a reaction. Schlesinger’s
apparatus the writer regards as unsatisfactory. Wei lee’s method
of noting the secondary reaction in an exposed eye on uncovering
the opposite eye is regarded with more favour. This secondary
contraction is said to be absent in 96 per cent, of general
paralytics.

Bumke’s own method depends on the fact that a normal rela¬
tionship exists between the amount of a galvanic current necessary
to give rise to a sensation of light and that necessary to cause any
pupillary reaction. He finds that while 02 to ‘2 milliamperes
current gives rise to a sensation of light, pupil activity is called
forth by a current between -04 and *5. The proportion between
the two strengths is fairly constant in healthy people. In only
13 per cent, of general paralytics was any reaction produced by
currents under 3 milliamperes.

He does not agree with Wolf and Gaupp’s assertion that
Argyll Robertson pupils are distinctive of tabes as apart
from G. P. I.

266

ABSTRACTS

With regard to other pupillary disturbances, myosis is more
frequent in tabes than in G. P. I. Absolute paralysis of pupils is
rare in tabes, and certainly rarer than in dementia paralytica and
cerebral syphilis. Ophthalmoplegia interna occurs occasionally
in tabetics. Uhthoff saw it in five out of a hundred cases. When
it is double-sided, in most cases it is probably not of syphilitic
origin. Only eight out of thirty cases seen by Uhthoff were
syphilitic.

Bumke does not regard the absence of reflex widening of the
pupil in response to sensory stimuli as a symptom of any great
value. In discussing the pupillary disturbances in functional
diseases, he says that 69 per cent, of the cases grouped
together under the heading of dementia prsecox show no widening
of the pupil in response to sensory or psychical stimuli. The
pupils of such patients are, as a rule, rather wider than those of
healthy people of the same age.

In epilepsy the pupil is fixed during the fits (Romberg), but
Karplus and Westphal have shown that this fixity of the pupil may
also occur in hysterical fits. The fixity may be in a position of
partial dilatation or of contraction. Occasionally they have been
described as being elliptical. In conclusion the writer discusses
the occurrence of sympathetic paresis, and records the occurrence of
a case of unilateral A. R. pupil with myosis following injury to the
skull. Leslie Paton.

PSYCHIATRY.

FIVE CASES OF GENERAL PARALYSIS IN C HILDREN . (Uber
(223) ilinf Fttlle von progressiver Paralyse bei Kindern.) F.

Bachmann, Fortschrittc der Med., Jan. 20, 1908, p. 33.

Bachmann has recently observed five cases. Syphilis played the
chief part in the etiology. In some it was inherited, in other cases
it was possibly acquired. The mothers of two of the children had
tabes. The children up to a certain age showed a normal in¬
tellectual and physical development, and then suddenly became
backward at school. Their psychical condition offered the variety
met with in the general paralysis of adults.

Besides the intellectual changes, all showed amnesia for
recent events and alterations in their dispositions and emotions
(lachrymosity and violent passion). There were no delusions or
expansive ideas. The somatic phenomena were as varied as the
psychical. All exhibited a disturbance of gait, which was clumsy
or definitely ataxic, and affection of speech. Their writing re-

ABSTRACTS

267

vealed a tremor and frequent omission of words or syllables. In
moet there was complete immobility of the pupils. On ophthalmo¬
scopic examination the papillae were found either normal or
atrophic. In some the tendon reflexes were exaggerated, in others
they were abolished. Sensibility in all cases was apparently intact.
In only one case were there sphincter troubles. Lumbar puncture
was performed in all. In three cases lymphocytosis was found.
In one case it was impossible to obtain a specimen free from blood.
Herpes zoster followed shortly after lumbar puncture in this case.
In some of the children there were typical paralytic attacks, followed
in most cases by deep sleep. One case had a remission lasting
three months, during which period there were no paralytic attacks,
and the child became quieter, displayed more interest in its
surroundings, began to read again, and showed a distinct improve¬
ment in memory. J. D. Rolleston.

ONSET OF GENERAL PARALYSIS THREE YEARS AFTER

(224) SYPHILITIC INFECTION. (Oas de paralysis g6n6rale
ayant dlbutl 3 ana aprds l’infection syphiliticus.) Ehlers,
BuU. de la Soc. franq. de derm, et de syph., Jan. 1908, p. 24.

ONSET OF GENERAL PARALYSIS IN THE THIRD YEAR OF

(225) SYPHILIS. (Paralysis g&ilrals debutant £ la troisidms ann6e
d’une syphilis.) Fournier, Ibidem, Feb. 1908, p. 48.

Ehlers’ case was that of a man who contracted syphilis in June
1903, for which he underwent a short course of mercurial inunc¬
tion. The secondary symptoms were mild. In August 1906 he
was admitted to an asylum with general paralysis, the first
symptoms of which had developed two months previously. In
addition to the characteristic mental and physical signs of general
paralysis he presented a generalised indolent adenopathy and a
papulo-squamous eruption.

Fournier’s case developed syphilis in 1880. The secondary
symptoms were few and slight. Treatment was continued for only
a few months. In a little less than three years after the chancre
general paralysis appeared, and ran its course in less than two
years, the patient dying at the age of twenty-four, in the fifth
year of his syphilis. According to Fournier general paralysis is
absolutely unknown during the first two years of syphilis, and only
begins to appear in the third, a time when cerebral syphilis is most
frequent. The most usual date for its development is comprised
between the sixth and twelfth years. J. D. Rolleston.

268

ABSTRACTS

GENERAL PARALYSIS IN THE SENILE PERIOD, WITH A

(226) REPORT OF TWO OASES, INCLUDING POST-MORTEM
EXAMINATION. M. J. Karpas (of New York), N.Y. Med .
Joum. Jan., 25, 1908.

The report of the clinical histories aucl anatomical findings in the
case of two female paralytics, aged sixty-five and seventy
respectively.

The similarity of the picture to that of senile dementia is noted,
and the importance of the examination of the cerebro-spinal fluid
emphasized. The duration of the disease in the first case was five
years. In both cases there was definite megalomania.

C. Macfie Campbell.

ALCOHOLISM AND INSANITY. (Alcoholisme et Folie.) M.

(227) Legrain, Presse Mid., Jan. 29, 1908.

In this paper a somewhat detailed account is given of the results
of a statistical inquiry carried out by Amaldi in Italian asylums
regarding the relations of alcoholism and insanity, and these are
compared with statistics obtained in France. Numerous tables
are given. A. Hill Buchan.

ON PAINS IN MANIC-DEPRESSIVE INSANITY. (Ueber Schmersen

(228) beim manisch-depressiven Irresein.) J. Schroeder (of Roth-
enberg), Centralbl. f. Nervenh. u. Psych., Dec. 15, 1907.

The author calls attention to the occurrence in manic-depressive
patients of attacks of pain, fairly definitely localised and of much
longer duration than attacks of migraine. These pains usually
occur during the period of recovery, frequently after discharge.
They do not show the life-long periodicity of attacks of migraine,
nor are they so severe. Schroeder reports a case which illustrates
the occasional difficulty of diagnosis due to such pains.

C. Macfie Campbell.

THE MENTAL DISORDERS OF ANCHYLOSTOMIASIS. (As
(229) Desordens Mentaes na Ankylostomiase. ) A. Anstreg£silo
and H. Gotuzzo, Arch. Brasil, de Psychiatr., Neur. e Sdencias
Affins., 1907, Nos. 3 and 4.

Many cases have been recorded in which irritation of the intestines
by worms has been assigned as the exciting cause of reflex
psychoses, but, notwithstanding this popular belief in the connexion
between intestinal worms and acute maniacal states, Krafft-Ebing

ABSTRACTS 269

and others have come to the conclusion that insanity due to worms
is an exceedingly infrequent manifestation, and when it does occur
is mostly in children of neuropathic constitution. With this
conclusion the authors of this short but interesting paper are in
agreement. They describe three cases in which the patients
suffered from grave psychoses, apparently due to anchylostomiasis,
all of whom made good recoveries after anthelmintic treatment by
thymol. The authors leave out of count many cases they have
observed of mild alteration in the mental character associated with
the same parasitic condition. In all cases the characteristic
anaemia was present, blood counts showed great deviations from
the normal, and the ova of the undnaria duodenalis were present
in the faeces. All cases were stated to be of degenerate type. As
to type of mental disorder: the first case was depressed and had
delusions of persecution; the second case showed pronounced
alterations in memory, with verbal incoherence and religious
delusions; and the third case, marked mental confusion with
almost complete disorientation. In none of the cases was there a
history of syphilis, alcoholism or other toxic agents apart from those
generated in the intestines or tissues of the body, presumably as
the result of the anchylostomiasis or the consequent intestinal
catarrh. The authors conclude that anchylostomiasis should be
considered as a cause of mental disorder, these being of two kinds,
the first frequent and mild, consisting mainly in slight alteration
in the character; and the second much less frequent but of a
grave kind, their appearance being determined by an original
degenerescence and the existence of the anchylostomum.

R. ClJNYNGHAM BROWN.

PSTOHASTHENIA: ITS SEMEIOLOG7 AND NOSOLOGIC STATUS
(230) AMONG MENTAL DISORDERS. J. W. Courtney (of Boston),
Jornn. of Amer. Med. Ass., Feb. 29th, 1908.

In introducing the subject the author refers to the vagueness of
the term psychasthenia and the struggle it has had and is still
having to gain recognition as a nosological entity. The phenomena
by which it is distinguished are: Obsessions—of sacrilege, of crime,
of disease, of shame of self, of shame of body ; compulsions—of
ideation and activity; manias of going to the extreme—of precision,
of verification, of orderliness, of symmetry, of contrast and con¬
tradiction, of cleanliness, micromania, arithmetical mania, mania
of symbols, of research, of explanation, etc.; enforced reverie; crises
of agitation; phobias; anxious states. All of these phenomena do
not appear in every case, but whether they appear singly or in
groups they belong to one clinical picture and should have one
clinical designation.

270

ABSTRACTS

In its pathology one must expect and will find morbid ideation
and morbid activity of a wide range. About 75 per cent of
cases come from families in which some form of mental alienation
has appeared in more than one generation. The early environ¬
ment and surroundings have much to do in directing the growth
of the personality into morbid channels.

Psychasthenia is differentiated from hysteria by the fact
that “ the disturbance of consciousness which marks it is
general”; from neurasthenia “by the patient being too much
absorbed by obsessions, tics, etc., to dwell upon fatigue, panesthesias,
insomnias, which mark the presence of this disease.” Finally, he
reaches the conclusion that “psychasthenia is a forme fruste of
intellectual petit mal.”

The paper is long, deals much with generalisations, and
furnishes little that is definitely new. C. H. Holmes.

OBSERVATIONS ON THE OPSONIO INDEX TO VARIOUS
(231) ORGANISMS IN CONTROL AND INSANE OASES. C. J.

Shaw, Journ. of Ment. Sc., Jan. 1908.

So far as is at present known, the opsonic index of the blood
serum of healthy persons to the majority of organisms is s imil ar
to the tuberculo-opsonic index. In this paper the average opsonic
indices for five consecutive days of healthy non-tuberculous
control cases to the tubercle bacillus, bacillus coli communis,
staphylococcus aureus, and micrococcus rheumaticus are compared
with those of insane patients in good bodily health, and the
observations were continued after the injection of Koch’s new
tuberculin T. R

There was found to be little difference between the average
indices of the control cases to the various organisms, but in the
insane the indices obtained to bacillus coli and staphylococcus
aureus were rather higher than those to the tubercle bacillus and
micrococcus rheumaticus, but, except in the case of bacillus coli,
the control index was higher than that of the insane to each
organism. After the injection of 1/500 mgr. T. R., a negative
phase was found to occur to the other organisms as well as to the
tubercle bacillus in both the control and insane cases, but, except
to staphylococcus aureus, the percentage of negative phases was
less in the control cases than in the insane. One control case
was injected with 1/750 mgr. T. R, the only negative phase
produced being to micrococcus rheumaticus. In three insane
patients similarly injected negative phases resulted to all the
organisms, though in a less percentage than when the larger dose
was administered. On comparing the results obtained in the
control cases and in the acutely and chronically insane patients

ABSTRACTS

271

before injection, the average indices are found to be lowest in the
acutely insane to all the organisms, while the average of the
chronic cases is below that of the controls to the tubercle
bacillus and micrococcus rheumaticus, but slightly above the
control index to bacillus coli and staphylococcus aureus. The
aggregate average of the control cases, however, was 1*06, while
that of the chronic cases was 1*01. The proportion of negative
phases produced by the injection of T. R. was least in the control
and greatest in the acutely insane cases. It is therefore concluded
that the resistent power of the insane to organismal invasion is
less than that possessed by ordinary individuals, and that the
acutely insane are more liable to infection than the more chronic
cases. Author’s Abstract.

TREATMENT.

OPERATIVE PROCEDURE AS A THERAPEUTIC MEASURE IN
(232) EPILEP8Y. M. Woods (of Philadelphia), Joum. of Amer.

Med. Ass., Feb. 29th, 1908.

Epilepsy is defined as a paroxysmal apyretic neurosis in which
its victims are easily impressed neurotics. Any sudden shock
creates a violent impression on their nervous system, and recoveries
following operations result more from the shock than from the
tangible thing that has been removed or corrected. Any surgical
procedure whatever may be followed by improvement or recovery
from the epileptic attacks.

The author reports three cases of his own in which respectively
an amputation of the arm, a severe wound of the thigh, and an
operation for tuberculosis of the glands were followed by apparent
recovery from these attacks. Dr J. Wm. White records ninety
cases in which trephining was performed, no lesion found, and
nothing particular done, yet marked relief and complete cure
followed.

The author finally concludes that much benefit would be derived
by the patient if in all such cases where operation is considered,
the neurologist would consult with the surgeon.

C. H. Holmes.

SEVERE SPASMODIC CONTRACTION OF A FINGER CURED BT
(233) STRETCHING THE MEDIAN NERVE. James Adam, Lancet,
Feb. 1, 1908, p. 287.

This patient, a woman of forty-five, had her left hand amputated for
a septic infection. Two and a half years later the middle finger of
the right hand began to contract; there were no signs of disease
u

272

REVIEWS

in the finger; with some force and difficulty it could be extended,
but it gave great pain, and when released the finger went back like
a spring with the tip firmly fixed in the palm. This finger was
amputated. In six months a similar condition developed in the
ring finger. There was the same strong spasmodic contraction,
which could be with great pain and force overcome, but there was
no power of voluntary movement. It was not red, swollen, or
painful, and its sensibility was normal, and the other fingers were
normal in every way. Stretching of the median nerve was
suggested; this was done in the upper arm, both distal and
proximal parts being forcibly stretched for four or five minutes.
For nearly a month the patient had numbness and disordered
sensation in, curiously, the little and ring fingers, but none in the
thumb or forefinger. Splints and passive movement were
employed for a little. When seen a year later the finger could
be bent and extended normally, and there was no tendency to
contraction, so that the cure may be regarded as permanent.
The etiology of the case is unexplained.

J. H. Harvey Pibie.

THE PATHOGENESIS AND TREATMENT OF NEURASTHENIA

(234) IN THE YOUNG. R. N. WlLLSON, Am. Joum. of Med. Sc.,
Feb. 1908, p. 178.

The author casts overboard “nerve-stress and nerve-tire” as
causes of neurasthenia. They are merely symptoms; the primary
process is to be looked for in a general lowering of tissue nourish¬
ment, and the upbuilding of this is the means of cure. In all
cases of neurasthenia in the young the beginning is due to some
definite cause which, if removed in time, will admit of a cure of
the patient. Four cases are narrated with, rather scrappily, the
means adopted for treatment—active hygiene with graduated
exercise in the open air to the point of physical tiredness being
apparently the main feature. J. H. Harvey Pirie.

IReviews

OUTLINES OP PSYCHIATRY. Wm. A. White (of Washington),
New York: Nervous and Mental Disease Monograph Series,
No. 1, 1908, pp. 232, price $2.

The purpose of the book is to give in a condensed and simplified
form the essentials of psychiatry which would be useful to the
medical student and the young practitioner in acquiring a working
knowledge of the subject. It is a neatly printed volume of two

REVIEWS

273

hundred and thirty-two pages, divided into eighteen chapters; the
first seven are devoted respectively to a brief psychological in¬
troduction, definition of insanity, classification, its causes, treatment,
symptomatology, and a scheme for examination; the last eleven
chapters take up the individual forms of insanity and discuss each
briefly but concisely.

The chapter on the examination of the insane is one of the
most valuable which the book contains; it is direct, comprehensive,
and should be of service not only to the student but to those more
advanced in the subject.

The classification deals only with the principal groups recog¬
nised in the newer psychiatry; vague and ill-defined terms are
omitted. In treatment hydrotherapy is given a deservedly
prominent place.

Altogether the “ Outline ” is a clear, systematic, conservative,
well-edited work, which should help to meet the popular demand
for a brief outline in English of the newer psychiatry.

C. H. Holmes.

ftrUDB MfiDIOO-PSYOHOLOGHQUE SUB THOMAS DE QUINOEY.

Paul Guerrier, Lyon, Rey, 1907.

In this interesting study the author has analysed the life and
work of Thomas De Quincey from the point of view of the
physician, and comes to some interesting conclusions. The family
from which De Quincey sprang was full of psychopathic personali¬
ties. Almost all the members showed unstable nervous equilibrium,
and the disorder of the nervous system present in his brothers
and sisters was still more pronounced in the person of the essayist
himself. In early boyhood there was evident a morbid sensibility
which left marked traces in his later writings. He was essentially
a “ visual,” and in the dreams of the Confessions it is what he has
seen, and not what he has heard, that he describes so vividly.
The details of memories of the earliest age were deeply engraven on
his mind. His health as a boy was indifferent, and at the age of
sixteen symptoms of gastric intolerance developed, which never left
him. To judge from the symptoms the disorder was of a nervous
nature. At a later period of his life he tended to give a hypochon¬
driacal misinterpretation to these symptoms. At the age of twenty-
two he had profuse sweats and attacks of dyspnoea. After a deeply
emotional incident at the age of twenty-seven he had hallucinations,
and developed a transitory neurosis characterised by intense anxiety.
The disorder disappeared abruptly. For months after being bitten
by a dog he was unable to work owing to the obsession of hydro¬
phobia. From what De Quincey himself has written, one would

274

REVIEWS

imagine that he was a confirmed opium eater who took the drug
in quantities never equalled. As a matter of fact he does not
seem to have suffered from the usual clinical symptoms of chronic
opium poisoning, and what we know of his life and long intel¬
lectual activity is absolutely incompatible with his statements as
to the amount of opium consumed. His writing never showed
any tremor. He was able at the age of seventy to walk uphill with
great rapidity. He showed no evidence of premature senility.
His memory remained always extraordinary. During the periods
when he claimed to have given up opium, there is no trace in his
correspondence of the well-known symptoms of abstinence in the
chronic opium eater. The author concludes that De Quincey was
a psychopathic individual of morbid sensibility with a general
hypenesthesia, with a love of the mysterious and a delight in the
products of the imagination, showing traces in his work of that
mythomania which is so frequent among the hysterical. To a
certain extent the opium habit was a myth, but it pleased his
imagination and gave him a literary pose which was not without a
market value.

The book is delightfully written, is not interrupted by too
frequent references to actual documents, presents the view of the
author in a simple and lucid manner. It is somewhat lighter
than similar studies by Germans on various psychopathic men of
genius. It is an interesting appreciation of the various factors
which went into the composition of the works of the great
essayist, although the author’s neglect of many available sources
of information makes one cautious in accepting without reserve his
conclusions. C. Macfie Campbell.

BOOKS AND PAMPHLETS BEOETVED.

Riv. de Medicina y Cimgia practicas. Feb. 1908. Cardona, Madrid.
Siegfried Weinberg, “tlber den Einfluss der Geschlechtsfunktionen
auf die weibliche Kriminalitat.” Marhold, Halle, 1908, M. 1.

W. v. Bechterew. “ Die Funktionen der Nervencentra.” Deutsche
Ausgabe. Erstes Heft. Fischer, Jena, 1908, M. 10.

P. Sainton et L. Delherm. “ Les Traitements du Goitre Exophtalmique.”
Bailli fere et fils, Paris, 1908, 1 fr. 50 c.

Hans Gudden. “Ueber Massensuggestion und psychische Massenepidemie.”
Verlag der Aerztlichen Rundschau. Munchen, 1908, M. 0.75.

Harris E. Santee. “ Anatomy of the Brain and Spinal Cord with Special
Reference to Mechanism and Function.” Fourth Edition, revised and
enlarged. Sidney Appleton, London, 1908, 16s.

Archibald Church. “Modem Clinical Medicine. Diseases of the
Nervous System.” Authorized Translation from “ Die deutsche Klinik,”
Ed. Julius L. Salinger. Sidney Appleton, London, 1908, 28s.

■Review

IReuroloGi? anb flbsEcbiatvp

Original articles

A CASE OF ACUTE ASCENDING PARALYSIS OF
SYPHILITIG ORIGIN.

By O. CROUZON, Chef de Clinique de la Faculty k l’Hdtel Dieu de Paris,

and

QEOBGES Y1LLABET, Ancien Externe de l’Hopitaux de Paris.

The following case of acute ascending paralysis of syphilitic
origin appears to us worthy of publication. The interest of
such a case lies first of all in the rarity of this syphilitic affec¬
tion of the nervous system, and in this particular case there are
especial points of interest in the history to which we shall later
direct attention.

The patient was 42 years of age. He had contracted
syphilis at the age of 32. We saw him on one occasion, April
1906, with Dr P. Wiart, for an ulceration of the fraenum of the
prepuce, which presented certain features which led one a, priori
to consider it a syphilitic chancre. The lesion was, as a matter
of fact, slightly indurated and ulcerated, the basis of the ulcer
presenting a beefy red appearance. There was, however, no
affection of the inguinal glands, and we made the diagnosis of
chancriform gumma of the fraenum of the prepuce. The treat¬
ment which was instituted confirmed the diagnosis. After a
series of ten intra-muscular injections of biniodide of mercury
the ulcer healed.

R. OF N. & P. VOL. VI. NO. 5—X

276

0. CR0UZ0N and GEORGES VILLARET

In October 1907 the patient, whom we had advised to
follow from time to time mercurial treatment, consulted us again
and was given a series of ten intra-muscular injections of one
cubic centimetre of biniodide of mercury (a watery solution con¬
taining one centigramme in each cubic centimetre). The patient
talked to us incidentally of vague sciatic pains which he had
been feeling for several months in the right inferior extremity.

These pains persisted and became more severe, so that in
December 1907 we examined him from this point of view, and
found marked pain on pressure over the characteristic points,
the sciatic notch, the trochanteric groove, and behind the external
malleolus; raising the extremity, with the knee-joint extended,
caused acute pain (sign of Las&gue).

Different forms of treatment were followed in order to
cure this sciatica, but none gave any result As a last resort we
prescribed, early in January 1908, Dupuytren’s pills to be taken
two daily for twenty days. The sciatic pains, however, became
daily more severe, and finally produced a true functional paralysis
of the right inferior extremity. In view of the failure of the
treatment, we decided on January 31,1908, to again adopt more
energetic measures. We were on the point of beginning a new
series of intra-muscular injections of large doses of biniodide
when, on February 4, 1908, the patient sent for us on account
of symptoms which he ascribed to influenza, and at first they
seemed to us to depend on that disorder. He complained of
general fatigue, pains in the limbs, and headache; he was feverish ;
one symptom dominated all the others, namely, torticollis of the
muscles of the neck, so that it was impossible for him to move
his head in relation to the trunk. Pressure of the muscular
mass of the back of the neck caused very acute pain; on the
other hand, pressure on the vertebral column, and in particular
on the cervical portion, did not cause the slightest pain.

The same symptoms continued without modification during
February 6 th and 7 th.

February 7th .—We note the appearance of a new symptom,
which consists in a paresis of the superior and inferior limbs on
the right side. This paresis is more marked in the lower than
in the upper limb. It appears in the upper limb to affect
particularly the extensor group of muscles, while the movements
of opposition of the thumb, the movements of flexion of the

PARALYSIS OF SYPHILITIC ORIGIN 277

fingers on the hand, of the hand on the forearm and of the
forearm on the arm, appear satisfactory. The weakness, there¬
fore, is a mild degree of paralysis of radicular origin. The face,
on the other hand, is completely spared. There is no impair¬
ment of movement of the muscles of the eyes, of the mouth, and
of the tongue. The tendon reflexes are normal

February 8th .—The same symptoms persist and are more
marked. To-day we have to do with a well-marked paralysis
of the superior and inferior limbs of the right side. In
addition there are the following symptoms—incontinence of
faeces, retention of urine, rise of temperature (40 o, 3 C. in the
rectum).

In view of the serious and progressive nature of these
symptoms we diagnose acute ascending paralysis, and, while still in
doubt as to the nature of the affection, we give an injection of
3 centigrammes of biniodide of mercury, which is continued
daily. From this day onwards the patient requires to be
catheterized twice daily.

February 9th. —The temperature remains raised, is 40°*2 in
the rectum ; the pulse is 96, the respirations 35 per minute. The
paralysis of the superior and inferior limbs becomes more marked.
The patellar reflex is absent on both sides. Examination of the
plantar reflex discloses a well-marked sign of Babinski on the
right side, and the same sign still more marked on the left side.
Notwithstanding this there is not at present, and has never been,
any paralysis on the left side. Sensibility is, and has always
been, intact in all its forms.

Since he has been confined to bed the patient has assumed
the dorsal decubitus, the only position which allows him to keep
his head at rest. From this day onwards it appears that the
movements of the head from right to left and in the opposite
direction are less painful, if care be taken that the head is lying
on a pillow.

Endeavours to flex the thighs on the pelvis, while the legs
are extended on the thighs, cause such extreme pain that these
movements of flexion cannot be carried further.

February 10th, morning. —The rectal temperature is 40°*3.
The movements of the forearm on the arm, of the hand on the
forearm, and of the fingers on the hand are slowly reappearing.
It is the same with the patellar reflex, which is now elicited on

278 0. CR0UZ0N and GEORGES VILLARET

the left side; it is still absent on the right side. The cremasteric
reflexes are still absent

3.30 p.m. —Lumbar puncture is performed. A clear crystal¬
line fluid issues; the cytological examination of the fluid, which
is made one hour later, demonstrates a definite spinal lympho¬
cytosis ; only an occasional polymorphonuclear is to be found in
the centrifuge deposit.

7 p.m. —The rectal temperature is 39°*3.

February 1 1th, morning. —The rectal temperature is 38°*3,
the pulse is 84. We note a very considerable amelioration of
the symptoms so far as the extensors of the right superior
extremity are concerned ; the extension of the fingers is of wider
range. The condition of the tendon reflexes and of the plantar
reflex remains the same.

Evening. —There is progressive improvement. Since noon
the patient has been able, for the first time, to retain his faeces;
he is still unable to urinate, and we are still forced to catheterize
him. From every other point of view there has been no change.

February 12 th, morning. —The temperature in the axilla is
38° - 3, the pulse is 84.

The superior extremity has almost completely recovered the
range of the movements of extension and of flexion of its different
segments. The right inferior extremity still remains inert on the
bed. On the left side the patellar reflex is definitely elicited; on
the right side there is occasionally the suggestion of a reflex; the
cremasteric reflexes are still absent on both sides. Unfortunately
during the night incontinence of faeces again appeared.

Evening. —The axillary temperature is 39 0- 3, the pulse is 92.
The condition is exactly similar to that in the morning.

jFebruary 13 th, morning. —The axillary temperature is 39 0, 3,
the pulse is 92.

None of the symptoms mentioned above have varied; never¬
theless there appears to be slight improvement, since we notice a
faint movement of abduction of the right thigh on the pelvis,
whereas this thigh had previously remained quite powerless.

4.30 P.M. —The axillary temperature is always 39°*3, the
pulse is 92 ; respirations, 40 per minute. We observe that there
is some mental clouding which is quite transitory. There has
never been any vomiting.

Evening. —We observe no change in his general condition;

PARALYSIS OF SYPHILITIC ORIGIN

279

the axillary temperature is 37°'6, the respirations are still 40,
and the pulse 84 per minute.

February 14 th, morning .—The axillary temperature is 39°'2,
the pulse is 88, and the respirations 32 per minute. We again
notice some mental clouding, which is more pronounced and leas
transitory; in addition, there is a certain degree of slurring in
the speech.

On the same day, at 7 P.M., we find the patient in a state of
coma, with tracheal riles, and lying “ en chien de fusil." The pupils
no longer react to light From 7.15 P.M. onwards the following
is the course of temperature, pulse, and respiration:—

( Temp.: in axilla, 41°*6.

Pulse : 108 per min.

Reap. : 54 per min.

’ Temp.: in axilla, 41 0, 7.

7.40 p.m. ” , i “ reCtUm '. 41 °' 7 -

Pulse: 112 per min.

Resp.: 52 per min.

7.55 p.m. Resp.: 54 per min.

Temp.: in axilla, 42 0, 1.

8.40 p.m. ” “ n reCtam '. 42 °' 1 -

Pulse: 110 per mm.

Resp.: 48 per min.

All the cutaneous and tendinous reflexes are absent.

7.40 p.m.

7.55 p.m.

8.40 p.m.

9.15 PJf.

9.40 PJf.

Temp.: in rectum, 42°*1.

Temp.: in rectum, 42°*2.

„ in axilla, 42°*2.
Pulse: 116 per min.
Resp.: 44 per min.

Death at 10.55 p.m.

11.5 P.M., 10 minutes after death—
Temp.: in axilla, 43°.

„ in rectum, 43°.

To sum up, we have had to do with a patient who, after
having suffered for several months with sciatica on the right
side, was suddenly affected with paresis of the superior and

280

O. CROUZON and GEORGES VILLARET

inferior extremities on the right side, the onset being accompanied
by the symptoms of an acute infection. These symptoms were
progressive for two days, and were accompanied by incontinence
of faeces, retention of urine, disorders of the reflexes, and elevation
of temperature. Then, for the following two days, there was a
slight tendency to improvement, and finally, during the last
three days of life, the original symptoms became more marked,
and we observed a slight mental clouding. At the same time
the temperature rose, as is usual in the affections of the nervous
system, where the thermic centres of the medulla oblongata
appear to be affected.

The disease, therefore, is one which ran in eight days a
course similar to that of the acute ascending paralyses.

Two questions must at the start be definitely formulated.
What was the nature of this acute ascending paralysis ? On
what anatomical localisation did it depend?

The nature of this ascending paralysis is made clear to us
through the lymphocytosis of the cerebro-spinal fluid; it allows
us, as a matter of fact, to exclude all other infections except
tuberculosis and syphilis; now, in the history of the disease we
find nothing to suggest the course of tuberculous meningitis.
On the other hand we have exact knowledge as to the syphilitic
history of the patient, admitted by himself and revealed by the
chancriform gumma of the fraenum.

The anatomical localisation of this acute ascending paralysis
can be deduced on the one hand from the state of the cerebro¬
spinal fluid, and on the other from the clinical picture; the
lymphocytosis allows us, as a matter of fact, to affirm that there
has keen meningitis ; the clinical picture has shown us the
existence of a paralysis of radicular type in the superior ex¬
tremity ; there has therefore been present not merely meningeal
inflammation, but also nerve-root inflammation. Finally, the
affection of the sphincters, the rise of temperature, and the
terminal mental disorders allow us to affirm that the centres
themselves have been affected.

We believe, then, that we are justified in concluding that it
is a case of meningo-radiculo-myelitis of syphilitic origin which
followed a sciatica, itself perhaps of syphilitic nature, and that
the clinical picture has been that of an acute ascending paralysis,
ending fatally after a course of eight days.

PARALYSIS OF SYPHILITIC ORIGIN 281

We have examined medical literature to see whether there
have been reported any cases comparable to ours. With this
aim in view we have consulted several authors, Williamson, 1 2 * 4
Rosin,* the two latest monographs on syphilis of the nervous
system, that of Lamy 8 and that of Nonne. 4

Nonne says that there are cases of Landry’s paralysis of
syphilitic origin, following the type described by Goebel and
Yon Hartog, with paralysis of the inferior extremities, bulbar
paralysis, disorders of sensibility, and loss of the reflexes.
Landry himself, in one of his ten cases, found syphilis.
Kussmaul has described several cases of Landry’s paralysis with
a history of syphilis in the parents. Alexandre, in his book
“Syphilis et Yeux,” describes an analogous case.

Heubner, on the basis of his own observations, and those of
Zambaco, L4on Gros, and Lancereaux, describes a form of
Landry’s paralysis which appears without prodromata and without
meningitic phenomena at an early stage of syphilis.

Our case is comparable to the above in its clinical appearance,
bat in it we had the good fortune to observe active syphilitic
manifestations one year before the ascending paralysis, and at the
very moment when there was developing a sciatica, which itself
was perhaps syphilitic.

On the other hand, we have been able to add to our clinical
record one observation which can not be found in the old re¬
cords—namely, the result of lumbar puncture ; the lymphocytosis
of the cerebro-spinal fluid confirmed our clinical diagnosis of
syphilitic meningitis, and in consequence gave much greater pre¬
cision to the etiology of our case.

We wish finally to direct attention to one interesting
feature of the temperature curve; the temperature, which before
death reached 42° 2, as happens in many fatal affections of the
nervous system, rose still further after death and reached 43°;
this fact is also well known. But the most interesting point
appears to us to lie in the fact that, at the terminal period of the
disease the temperature, examined on four different occasions,
reached the same height in the axilla as in the rectum:—

1 Williamson, Edinburgh Medical Journal , October 1900.

2 Roain, Zeitschrift fiir klinische Medizin , 1896.

* Lamy, 11 Syphilis des Centres Nerveux.” Collection L£ant£.

4 Max Nonne, “ Syphilis nnd Nenrensystem,” Berlin, 1902.

282

PARALYSIS OF SYPHILITIC ORIGIN

7.40 p.m.

8.40 P.M.

9.40 p.m.

11.5 P.M.

The two temperatures have been identical on each occasion.

There is thus present a disturbance in the central and peri*
pheral temperature which appears worth attracting attention.
We have looked in the work of Bourneville 1 to see whether there
exist cases of this kind in the terminal period of cerebral hemor¬
rhage, of cerebral softening, of eclampsia, and of epilepsy, and
we have only found temperatures extremely high, but no mention
is made of cases with identical temperature in the axilla and in
the rectum.

Eichhorst, 2 however, has stated that in certain very rare cases,
as to which, however, he gives no details, the axillary tempera¬
ture may exceed by one degree the temperature in the rectum.

The phenomenon in such a case is perhaps due to the absence
of regulation, owing to involvement of the thermic centres in
the medulla, and the symptom should then be considered as a
bulbar trouble which has characterised the terminal period of the
ascending paralysis.

But apart from this thermometric peculiarity the clinical
observation has appeared to us to be specially interesting on
account of the syphilitic origin of this ascending paralysis.

1 “6tude clinique et thermometrique snr les maladies da syst&me norveux,"
Paris, 1878.

* Eichhorst, “Trait6 de Diagnostic Medical.”

Temperature

in axilla,

41°-7.

in rectum,

41°*7.

in axilla,

42°\L.

l»

in rectum.

42°1.

in axilla.

42°-2.

in rectum,

42°*2.

in axilla,

43°.

in rectum,

43°.

ABSTRACTS

283

Hbstracts

ANATOMY.

THE STRUCTURE OF GREY MATTER. John Turner, Brain ,

(235) 1907.

This paper, the last of a series on a similar topic which have
appeared in Brain and elsewhere, seeks to establish in grey matter,
not only two distinct kinds of nerve cells—the “pale” or gan¬
glionic, and the “ dark ” or intercalary, but proceeding from them
respectively two kinds of neurofibrils, one of smooth contour, the
other with beads along its traject.

An endeavour is also made to establish the network character
of the periganglionic beaded fibrillar investment, which is shown
to be derived from the ultimate branchings of the intercalary
cells. As this structure is manifestly recruited on all sides by
fibrils from different intercalary cells, it follows, if this can be
proved, that neurofibrils are continuous, and therefore at some
places beaded neurofibrils should pass over into smooth contoured
neurofibrils, as is shown to be the case.

So far as possible, the appearances shown by the writer's
methylene blue and peroxide of hydrogen method were collated
with those obtained from tissues treated by Cajal's reduced silver
method, but although this latter occasionally selects the inter¬
calary cells, it only imperfectly and rarely does so, and still more
rarely does it select the beaded neurofibrils.

The scheme of the nervous system on the lines of continuity of
fibrils, suggested by the writer a year ago in Brain, is further
amplified, and he believes that it is quite capable, by means of
the periganglonic networks, of meeting the requirements of the
known laws of nervous conduction. Author’s Abstract.

PATHOLOGY.

ON REGENERATION IN THE PERIPHERAL SEGMENT OF A

(236) NERVE PERMANENTLY SEPARATED FROM ITS CENTRE.
(Zur Frage der Regeneration in einem dauerad von seinem
Zentnun abgetrennten peripherischen Nervenstnmpf.) A.

Margulhs (of Prague), Vireh. Arch., Bd. 191, Hft. 1, January
1908.

The author comes to the following conclusions:—1. After section
of a peripheral nerve definite degenerative changes occur in the
distal segment; the axis-cylinder and medullary sheath completely

284

ABSTRACTS

disappear. 2. The cells of Schwann increase in size and number,
and form a new specific fibrous tissue. 3. The nerve remains in
this incomplete condition, if separation from the centre is per¬
manent. 4. If its connection with the centre is restored, it
becomes differentiated into a structurally complete nerve with
axis-cylinder and medullary sheath. 5. Autogenous regeneration,
i.e. the formation of complete nerves, does not occur in the distal
segment in the grown animal if the division of the nerve is per-
mauent 6. Every regeneration of nerve is an autonomous process
of growth in so far as the anatomical basis of the nerve is furnished
by the cells of Schwann. Hart (C.g.B.).

CLINICAL NEUROLOGY.

DIAGNOSIS OF ORGANIC FROM FUNCTIONAL AFFECTIONS

(237) OF THE NERVOUS SYSTEM. J. S. Risien Russell, Brit.

Med. Joum., March 14, 1908.

Cases where the question arises of differential diagnosis between
organic disease and functional disturbance of the nervous system
fall into one of four classes: First, cases of organic disease showing
physical signs characteristic of organic disease ; second, functional
cases with physical signs indicating the functional nature of the
affection; third, cases of organic disease with no physical signs
characteristic of such; and fourth, cases of functional disorder
without physical signs typical thereof. Cases falling into the first
two classes are comparatively simple. The second two classes
present greater difficulties.

1. Organic disease, with physical signs .—Ophthalmoscopic exami¬
nation may reveal the presence of optic neuritis or atrophy. These
are never found in uncomplicated functional conditions. Absence
of the knee-jerks or presence of the extensor type of plantar reflex
justifies a diagnosis of organic trouble. Presence of the extensor
plantar reflex is often the chief sign diagnostic of disseminated
sclerosis as opposed to hysteria or neurasthenia.

Care must be taken not to misinterpret physical signs.

Exaggeration of the knee-jerks must not be regarded as neces¬
sarily due to an organic lesion, unless associated with a true ankle
clonus, the extensor plantar reflex, or other undoubted sign of
organic disease. Any associated abnormality must also be
correctly interpreted. For example, exaggeration of the knee-
jerks associated with pes cavns does not of necessity mean spastic
paraplegia, nor if nystagmus be present with it, is a diagnosis of
disseminated sclerosis necessarily correct Signs of organic disease
may appear late in the history of the case. It often happens that

ABSTRACTS

285

pains in the lower limb, which at first appear to be due to sciatica,
ultimately prove to be due to organic pelvic trouble. It should
be remembered that when there is only functional disturbance of
the sciatic nerve, the ankle-jerk is commonly increased; whereas,
when the nerve is damaged, the jerk is diminished or abolished.

Cases regarded as neurasthenia in the early stages may, after
many months, show signs of organic nerve disease.

2. Functional affections, with physical signs. — In cases of
hysterical paralysis, the muscles antagonistic to the paralysed
muscles may often be found to be in action, when the attempt
is made to use the paralysed muscles. Thus, supposing the
quadriceps extensor to be affected, if, with the patient in bed, the
observer flex the limb, resist the patient’s attempt to extend it,
and then withdraw the resistance, in the case of organic paraplegia
the limb falls to the bed in the extended position ; whereas, in the
case of hysterical paralysis, the limb may remain slightly flexed
because the hamstring muscles are in action.

In other cases, the knee and ankle jerks may remain normal
where one would expect a change were the condition organic, or
anaesthesia may be present where the possible organic disease
suggested would show none.

3. Organic disease, without physical signs .—The best example in
this class is paralysis agitans in its early stages. In a case which
looks like one of neurasthenia, loss of power confined to one side
or to one limb, stiffness of the limbs or inequality of the tendon
jerks on the two sides should suggest the possibility of paralysis
agitans. The knee-jerk is often more active on the side on which
the paralysis agitans begins, and the ankle-jerk diminished or
absent on the same side. Diagnosis of paralysis agitans may be
quite justified although the patient be young, and though the
tremors be in abeyance when the patient thinks herself unobserved.
Tremors may sometimes be noticed in the muscles of the face,
tongue, or jaw of a nature characteristic of paralysis agitans.
There is often an indefinite something in the general appear¬
ance and mode of progression strongly suggestive of paralysis
agitans.

Diagnosis in this class of case is often more difficult because
the circumstances of onset may be those under which functional
affections commonly arise.

4. Functional affections, without physical signs. —Under this
head a case is cited where chorea, a diagnosis of which seemed
otherwise to be the natural conclusion, was excluded by the fact
that the speech affection which was present was not at all like
that characteristic of chorea. Another case is mentioned where
the presence of organic disease was negatived by the complete
absence of any physical sign characteristic of organic disease, by

286

ABSTRACTS

the fact that station and locomotion, while abnormal, were not
typical of any particular organic disease.

In these cases, the faradic current and the assurance that it
would be effective, cured the condition. J. M. Darling.

EARLY OSTEO-ARTHRITIC MANIFESTATIONS OF TABES. (Le

(238) Tabes Ostlo articulaire Prfcoce, etc.) Stefan i, Gaz. des
H6p., Feb. 26, 1908, p. 267.

This article deals with bone and joint affections in the pre-
ataxic stage of tabes. The author recognises three forms: the
first, where the manifestations are purely osseous, principally in
the form of spontaneous fractures, but also as localised osteitis,
especially in the small bones of the extremities; the second,
where the lesions are purely in the joints—tabetic arthropathy;
and the third, which is a combination of the two, before the
appearance of any of the classical signs of tabes. He gives a
full description of a case of the last type, a woman of 54, who
within two years had three spontaneous fractures of the lower
extremity, and associated bony changes in the foot and knee-joint.
At the time of the last fracture she showed also some inequality
of the pupils, sluggish reaction to light, and pains of the lightning
character; these were the sole tabetic symptoms. Fractures in
these cases heal but slowly, and with great excess of callus, the
callus being remarkably transparent to X-rays.

J. H. Harvey Pirie.

SCOLIOSIS IN INFANTILE PARALYSIS. (Skolioee bei Kinder-

(239) Hthmtmg.) P. Ewald, Zeitschr. f. Orthopad. Chir., Bd 19,
Heft 3 u. 4, S. 549.

The author has had an opportunity of investigating the rare con¬
dition of pure paralytic scoliosis. The case was that of a child of
2^, which had a feverish affection during the first year of life,
which left the right leg completely paralysed; the child never
stood or walked, scarcely ever even sat up, but lay constantly in
the horizontal position. Nevertheless, a complete scoliosis with
the convexity to the left developed, with bulging of the ribs and
lumbar region on the left The convexity extended from the 1st
dorsal spine to the sacrum, the 11th dorsal spine being furthest
from the middle line—2*5 cm. There was marked rotation of
the bodies of the upper lumbar and lower dorsal vertebrae, so
that their left transverse processes lay in the same frontal plane
as the tips of their dorsal spines. The curvature of the spine as
seen from the front was therefore much greater than the displace¬
ment of the dorsal spines would appear to show.

ABSTRACTS

287

The affected muscles of the back were all of the left side, viz.,
the multifidus and semispinalis dorsi, the rotatores, interspinales,
and mtertransversales. He shows fairly conclusively that the
resulting deformity is the result of the continuous unopposed
action of the transverso-spinales and small, deep muscles of the
right side. J. H. Harvey Pirie.

TUMOURS OF THE CAUDA EQUINA AND LOWER VERTEBRAE.

(240) William G. Spiller, Amer. Joum. Med. Sc., March 1908.

The author discusses the differential diagnosis between hysteria,
multiple neuritis confined to the lower limbs, intra-pelvic tumour,
tumour or caries of the lumbar vertebrae or sacrum, lesions within
the vertebral canal but external to the dura, tumour or other
lesion (haemorrhage) of the conus, and tumour of the cauda equina.
The paper contains the report of nine cases; seven with necropsy,
three with operation.

Jn case 1 a round-cell sarcoma was found within the roots of
the cauda equina. Case 2 was especially interesting, as the tumour
(tibro-sarcoma) was at the centre of the cauda equina, and yet the
nerves for the bladder and rectum escaped, and the pain at first
was unilateral. The symptoms made the clinical diagnosis be¬
tween tumour of the cauda equina and tumour of the vertebrae
difficult. In case 3 numerous hard masses (osteo-sarcoma) were
found in the roots of the cauda equina, and most of these were in
the roots where they penetrated the dura, although some were
within the roots in the dural cavity. A fibro-sarconia was found
in case 4 outside the dura, and an endothelioma in case 5, also
external to the dura. Cases 6 and 7 were clinical and without
confirmation by operation or necropsy. In addition to these
seven cases brief reference is made to a lipoma of the filum
terminals and to a small osteoma of one of the roots of the cauda
equina.

Statistics as yet do not justify the statement that the prognosis
from surgical intervention on the sacrum and lumbar vertebrae
is decidedly better than on the other vertebrae and the cranium.
In the author’s cases, when the tumours could be examined they
were all of such a character that complete removal would have
been impossible, and this seems to have been true of most, if not
of all, recorded cases. The well-defined almond-shaped fibromas
or fibro-sarcomas occurring frequently at higher levels of the cord
are much less likely to develop in the region of the cauda equina.
If the prognosis for surgical treatment at present is somewhat
gloomy, a larger experience may give reason for hope. It is
possible at least to cut posterior roots in order to relieve pain.
A large amount of cerebro-spiual fluid escapes when the lower

288

ABSTRACTS

part of the spinal column is opened, and urine and faces are
likely to soil the bandages in those cases where the bladder and
rectum are paralysed, although it should be possible to prevent
this. The paper is a long one, and does not lend itself readily to
abstracting. Author's Abstract.

EPIDEMIC CEREBROSPINAL MENINGITIS IN HARTFORD,
(241) CONNECTICUT, DURING 1904-1905. W. R. STEINER and
C. B. Ingraham, Jr. (of Hartford), Amer. Joum. Med. Sc.,
March 1908.

There have been three distinct epidemics of cerebro-spinal menin¬
gitis in Connecticut since 1806. The first continued from 1806 to
1816, the second was in 1823, and the third in 1873.

The epidemic which furnishes the subject for this paper began
in March 1904 and lasted until December 1905; 145 cases were
reported, 74'48 per cent, died; 120 occurred in the first two
decades of life; more are recorded from birth to five years of age
than during any other period of life.

Occupation. —School children and labourers furnished most of
the cases ; none were reported from the well-to-do classes during
this epidemic.

Etiology. —Of 55 cases lumbar punctures were performed in 51,
and 43 of these showed meningococci in smears made from the
centrifuged sediment; the organisms were mostly intracellular
and stained by Gram’s method.

Contagion. —There were but 12 possible examples of contagion
during this epidemic ; on the other hand, there were several
families where but one case developed.

Morbid Anatomy. —Autopsies were performed upon 7 of the
37 patients that died. In the most acute case (two days) there
was merely congestion of the blood vessels of the pia arachnoid.
Four other cases showed, beside this congestion, a marked purulent
exudate following the course of the blood vessels. In the cases
of longer standing no exudate was found, but the pia was markedly
thickened and injected; the exudate was more commonly found
on the posterior surface of the dorsal and lumbar cord.

Onset was rapid in all but 7 of the hospital patients.

Symptoms. —Occipital headache at the onset was the most con¬
stant symptom; 27 were unconscious, 10 wildly delirious on ad¬
mission ; 27 showed partial stiflhess of the neck, 3 marked opis¬
thotonus ; 48 out of 51 showed Kernig’s sign; 8 showed absent
knee-jerks, 4 exaggerated, 5 diminished, and 7 normal (others
not examined). A positive Babinski reflex was never obtained ;
herpes was noted in about 29 per cent.; continued vomiting was
present in 30 cases; 2 showed marked mental impairment.

ABSTRACTS

289

Blood .—Examinations made in 48 patients showed an average
leucocyte count of 29,555.

Urine .—Examination showed albumen, granular and hyaline
casts in 28 out of the 42 examined. During convalescence the
casts and albumen cleared up in those who recovered.

Types of Fever .—In 48 out of 55 the temperature charts were
complete, but showed nothing typical or distinctive. They can be
resolved into four groups : 1, remittent fever type (most fatal);
2, typhoid type ; 3, pneumonia type ; 4, ascending fever type.

Treatment .—Hot baths and packs to lessen the delirium and
relieve pain, lumbar puncture to relieve pressure where extreme
headache and opisthotonus existed. Antitoxin and antistrepto-
coccus serum give little satisfaction; opium seemed to be the
best sedative. C. H. Holmes.

EPIDEMIC CEREBROSPINAL MENINGITIS, etc. W. Dow,
(242) Lancet , March 14, 1908, p. 768.

The clinical symptoms of the cases admitted into Belvidere
Hospital, Glasgow, from May 1906 to May 1907. 183 cases,

numbers of males and females practically identical Mortality,
73 per cent. Only a few of the main points can be noted here.
Onset generally sudden, headache and vomiting almost invariably,
and vertigo frequently. The haemorrhagic skin rash was seen
comparatively rarely—21 per cent of cases. When present, it
has appeared most commonly on the third and fourth days, and is
rapidly evanescent. Herpes was noted as often as the petechial
rash.

The nervous symptoms varied greatly with the intensity and
extent of the meningitis, but certain symptoms occurred in nearly
all—pain, delirium, hyperaesthesia of the skin, contraction of
certain muscles, exaggerated plantar reflexes, rapid emaciation and
hydrocephalus in the chronic cases, convulsions at the onset in
children, twitchings in adults. The eye and ear have been fre¬
quently affected. The temperature usually 102°-104°, and either
rising or falling just before death; sometimes remittent. Pulse-
rate varied greatly, usually much accelerated, but in a number of
cases slow. Respiratory rate always accelerated at commence¬
ment, frequently out of proportion to the pulse acceleration,
although no lung lesion could be detected. Various forms of nervous
breathing in the acute cases. Vomiting the most prominent
digestive disorder. Amount of urine much increased in the
chronic cases. Arthritic pain rare, purulent arthritis only twice.
A historical note shows that although sporadic cases have occurred
in Scotland during the last 20 to 30 years, this is the first large
epidemic. J. H. Harvey Pirie.

290

ABSTRACTS

AOUTE SYPHILITIC MENINGITIS: RECOVERY. (Mlningite
(243) aigue syphilitique avec garrison.) Claisse et Toltrain, Bull,
et Mtm. de la Soc. Mid. des E6p. de Paris, p. 313, 1908.

A man, aged 34 years, of intemperate habits, who had contracted
syphilis in 1898, was admitted to hospital on November 29, 1907.
About six months previously he had exhibited a train of symptoms,
probably due to cerebral syphilis, viz., ictus, epileptiform attacks,
intense headache, and ocular palsy, associated with ideas of perse¬
cution, and attempts at homicide and suicide. These symptoms
gradually passed off, and he was able to resume his work. On
admission furious delirium, with terrifying visual hallucinations,
were present. The next day he showed Kemig’s sign, contracture
of the neck muscles, ptosis, inequality of the pupils, and constipa¬
tion. The history of syphilis had not yet been obtained, and the
possibility of tuberculous meningitis was discussed. Lumbar
puncture gave issue to a clear fluid under high pressure. Leu-
cocytosis with predominance of lymphocytes was found. Neither
the tubercle bacillus nor the treponema pallidum was present. The
diagnosis of syphilis, which was supported by the discovery of
cutaneous gummata, was made, biniodide injections were adopted,
and 10 cc. of electrargol were injected into the spinal caual.
During the next few days the meningeal symptoms were well
marked, but the delirium was less violent A second lumbar
puncture was performed on December 2, and was followed by an
injection of colloidal mercury into the spinal canal. The lympho¬
cytes were now scanty, and there was a marked predominance of
polynuclears. On December 4, complete brachial monoplegia,
with some weakness of the lower limb on the same side, developed.
In two days the paralysis diminished, but the temperature rose to
104°, and there was a return of violent delirium, visual hallucina¬
tions, and ideas of persecution. Cerebral vomiting also occurred.
After another lumbar puncture, which still showed a predominance
of the polynuclears, 10 cc. of colloidal mercury were injected.
Improvement took place the next day. The headache diminished,
and the palsy entirely disappeared. The last lumbar puncture
was made on December 10th, when the cerebro-epinal fluid
contained no albumen, and only a small number of cells (5-6 to
the field). The lymphocytes again predominated. On December
20th the patient was discharged cured. The anatomical lesion in
this case was regarded as a diffuse gummatous meningitis.

J. D. Rglleston.

ABSTRACTS

291

TUBERCULOUS MENINGITIS IN INFANTS. (Mlningite tuber
(244) culeuse du nourisson.) R. Clot, Thises de Lyon, 1906-7,
No. 66.

Tuberculous meningitis in infants is not rare. The diagnosis, as
a rule, is very difficult, and often impossible, at the onset. Its
evolution is much more rapid and its symptomatology much less
complete below the age of two years than in older children. In
addition to the hemiplegic and eclamptic forms described by
Marfan, clinical forms exist in which the affection is manifested
by vomiting only, by generalised rigidity, or by respiratory
arrhythmia and somnolence. Often there is an unaccountable
progressive emaciation. The temperature may not be raised until
the terminal convulsions. Lumbar puncture is not always of help
in diagnosis. The difficulty will often be solved by the effects of
treatment. The digestive disturbances of tuberculous meningitis
are absolutely proof against all treatment, whereas gastro-intestinal
troubles which simulate tuberculous meningitis may yield rapidly
to appropriate measures. Syphilitic meningitis runs a much longer
course than tuberculous meningitis, and the history and other
evidences of syphilis will here be a guide. Acute meningitis due
to other causes is very rare in infants.

The thesis concludes with the record of twelve personal cases
in infants aged from four to twenty-four months.

J. D. Rolleston.

DISSOCIATION OF THE COLOUR-SENSE THROUGH FOCAL
(246) BRAIN DISEASE. (Absp&ltung des Farbensinnes durch
Herderkrankung des Gehirns.) M. Lewandowsky (of Berlin),
Berl. klin. Wochenschr., No. 46, 1907.

The disorders of the colour-sense which occur in brain disease
are—true colour-blindness (total or partial, limited to the absence
of red-green), amnesic colour-blindness (Wilbrand), i.e. a sensory
aphasia limited to names of colours. The author had under
observation a man of fifty, who suddenly developed a typical
sensory aphasia (Wernicke); motor symptoms were absent, but
after the disappearance of the sensory aphasia there remained a
sub-cortical alexia. There was obviously a focus in the anterior
region of the left occipital lobe, probably in the neighbourhood of
the angular gyrus. The patient had right-sided hemianopia. The
colour-sense was impaired; the patient could neither name the
colours in Holmgren’s wool test, nor could he pick out colours
named. He could not name the colour of familiar objects, although
no speech disorder was to blame for this. He failed with black
Y

292

ABSTRACTS

and white as well as with the colours of the spectrum; he dis¬
tinguished dark and light. There was neither congenital nor
acquired colour-blindness; examination of the colour-sense by
the Helmholtz apparatus disclosed no defect; his memory for
colours was intact. The author assumes that in the brain of the
patient the colour-sense was dissociated from the perceptions and
concepts of forms and objects, that it was isolated and could not
be associated with the sense of light and of form. The colour-
centre on the left was destroyed, the right preserved ; the associa¬
tion of the colour-sense not only of the left retinal fields, but of
the unimpaired right fields with the other elements of optic per¬
ception, took place in the brain of the patient only with the
assistance of the colour-centre of the left hemisphere, and after
its destruction the association disappeared. The fact that the
colour-sense was unimpaired was explained by the intactness of
the right-sided colour-centre. The author doubts whether in all
men the association of colours with the other optic perceptions
takes place in the left hemisphere. K. Steindorff (C.g.B.).

RESEARCHES ON TUBEROSE SCLEROSIS. (Recherches sur la
(246) Sclerose Tub&euse.) Ch. de Montet, L’Enctphale, Feb. 1908.

The author gives a detailed description of the histological features
found in the brain of a male epileptic idiot, aged 12, who died, as
is usually the case in tuberose sclerosis, from pulmonary tuber¬
culosis. In one kidney there was a small round growth, which
proved to be a hypernephrone. He regards the giant cells so
characteristic of this affection as aberrant nerve cells, which have
no connection with the neuroglial fibres. His conclusion, agreeing
with Geitlin’s, is that the condition is essentially due to an altera¬
tion of the neuroblasts, which, according as the interaction of other
special factors (degrees of alteration, etc.) varies, results in a diffuse
histioatypism or true teratoid tumours. The relative frequency
of tumours in other organs, such as rhabdomyomes and hyper-
nephrones, is in favour of this theory. The affection commences
probably relatively late in the foetus, as is indicated by the gene¬
rally good configuration of the convolutions. Concerning its
etiology all he has to say is that syphilis may be almost certainly
excluded.

He gives a list of some twenty papers by continental writers on
the subject, but makes no mention of A. W. Campbell’s valuable
article in Brain, 1905.

Campbell describes, probably for the first time, peculiar gland¬
like structures in the cortex, and, according to him, the disease is
the outcome of some evolutionary aberration or disturbance, arising

ABSTRACTS

293

late in foetal life, affecting the endothelium of blood vessels or
lymphatics, and resulting in structural hyperplasia and hetero-
topism. John Turner.

MULTIPLE SYPHILITIC LESIONS. TABES, GENERAL PAR-
(247) ALYSIS, AND AORTIC REGURGITATION. (Lesions
syphilitiques multiples. Tabes, paralysie gdndrale et in-
suffisance aortique.) Debove, Oaz. des ffdp., fdvr. 20, 1908,
p. 243.

This is the report of a clinical lecture specially destined to call
attention to the dangers that may at any time occur to an in¬
dividual who has once had syphilis. Debove points out that even
the most thorough and prolonged treatment may be followed by
an outbreak of tertiary syphilis or parasyphilis, and asserts that
the spirochsete probably survives in the body throughout the
individual’s life. He then demonstrated a typical case showing
the above-mentioned three complications. The patient, a man of
forty, had had syphilis at twenty, and had no after manifestations
of it until these occurred. He refers to the prophylactic action
of mercury administered some hours, and atoxyl some days, after
exposure to infection. Ernest Jones.

THE SIDE AFFECTED BY HYSTERICAL HEMIPLEGIA. (Le

(248) cdtd de l’hdmipldgie hystdrique.) Ernest Jones, Rev. Neurol .,
mars 15,1908, No. 5.

The universally accepted opinion that hysterical hemiplegia affects
the left side three times as often as the right is based entirely
on Briquet’s cases, examined before 1859, and has never been
investigated since. The author has collected the cases published
since 1880, full references to which are given, since which date the
diagnosis of hysterical hemiplegia has been more secure. The
results are given in the following table:—

Briquet, 1859 .
Cases since 1880

Number.

277

Percentage on
right.

233

54-2

Percentage on
left.

76-6

45-8

The author concludes that there is no evidence that hysterical
hemiplegia affects one side more than the other, and that the
question of the side of a hemiplegia is of no value in relation to
the diagnosis of its origin. Author’s Abstract.

294

ABSTRACTS

THE PRECISE DIAGNOSTIC VALUE OF ALLOOHTRIA. Ernest
(249) Jones, Brain, 1907, Vol. xxx., pp. 490-533

The author first reviewed 76 cases published under the name of
allochiria, 12 being the largest number previously collected, and
considers that only 29 of these are true cases of this condition.
In 26 of the 29 there was no reason to suppose that any affection
other than hysteria was present, and in the remaining three
hysteria was present in addition to an organic affection. On the
basis of personal observations, to be detailed later, he describes the
various manifestations of the condition and discusses the previous
hypothesis concerning it The article is summarised in the follow¬
ing conclusions:—

1. Under the name of allochiria two fundamentally different
conditions have hitherto been confused. A patient’s mistake in
determining the side of a stimulus may be—(i) part of a general
defect in localisation—allosesthesia; or (ii) a specific defect in¬
dependent of any error in localisation—dyschiria. The name
allochiria has further been incorrectly applied, as in the terms
electromotor and reflex allochiria, to symptoms which are in no
way related to either of these conditions.

2. Dyschiria may be defined as a state in which there is con¬
stantly either ignorance or error in the patient’s mind as to the
side of given stimuli, quite independent of any defect in sensorial
acuity or in the power of localisation. This corresponds closely
with the definition of allochiria given by Obersteiner, though he
did not distinguish the condition from alloaesthesia.

3. There are three stages of dyschiria: achiria, in which the
patient has no knowledge as to the side of the stimulus; allochiria,
in which he refers it to the corresponding point on the opposite
side; and synchiria, in which he refers it to both sides. There are
three sub-varieties of the latter.

4. All writers subsequent to Obersteiner have abstracted one
feature from his definition, namely, the reference of the stimulus
to the opposite side, and have used it to define allochiria. It is
suggested that the term allochiria be always used in this its
current sense, with, however, the important proviso insisted on
by Obersteiner, that the symptom is independent of any defect in
sensorial acuity or in the power of localisation. The significance
of this proviso has been entirely overlooked hitherto, and even
Obersteiner did not recognise that a direct corollary of it is the
separation of the allosesthesic from the allocliiric error. There are
seven precise clinical features that enable a differential diagnosis
between allosesthesia and allochiria to be made with certainty.

5. Allosesthesia is adequately explained by the Head-Spearman
hypothesis that it is due to a defect in afferent excitations, particu-

ABSTRACTS

295

larly those of the “ articular w type. It occurs in both organic and
functional disease, perhaps most often in tabes.

6. Dyschiric manifestations may be general in distribution or
may relate only to certain segments of the body. There are char¬
acteristic introspective, motor, and sensory manifestations of each
member of the group. The last-mentioned may occur in connec¬
tion with all varieties of stimuli or with only some. The motor
allochiria has been unnecessarily termed ** allokinesia.” Sensation
resulting from stimulation of a dyschiric part has six peculiar
attributes, here grouped under the designation “ phrictopathic.”

7. There have been three explanations of allochiria hitherto
offered. The Fischer-Hammond hypothesis is throughout con¬
tradicted by the facts and should be entirely discarded. The Head-
Spearman hypothesis refers to alloaesthesia only, and has no relation

*to allochiria. The Head-Tanet hypothesis is not borne out by the
observations on which this paper is based, which seem to de¬
monstrate that allochiria is independent of any defect in sensorial
acuity.

8. Dyschiria is due to psychical disaggregation, and is distinctive
of the form of disaggregation characteristic of hysteria. It is
primarily an affection of the feeling of “ sidedness ” (the chirognostic
sense).

9. Of the three stages of dyschiria, achiria represents the most
severe grade of disaggregation and synchiria the least. These two
are essentially transitional forms. Allochiria, on the other hand,
is a stable condition which may be present for years.

10. A number of fallacies in diagnosis are here indicated, and
■especial attention drawn to the close resemblance between uni¬
lateral achiria and hemiplegia, particularly hysterical hemiplegia.

Author’s Abstract.

A FATAL CASE OF PONTILE HEMORRHAGE, WITH AUTOPSY.

(250) T. Dillkr (of Pittsburg), Amer. Joum. Med. Sc., March 1908.

Reported cases of pontile hemorrhage are comparatively rare;
about sixty-seven cases had been reported up to 1890. Since that
-time perhaps the most valuable contributions have been made by
Dana, Bode, Larcher, Glasser, and Deshusses.

Among the most important symptoms of the disease are
vomiting, irregular respirations, polyuria, single or double hemi¬
plegia, paralysis of the lower face and of the tongue and larynx
(Guillain), elevation of temperature (Erb), prodromal headaches,
malaise, sudden development of profound coma, and death in from
six to twenty-four hours (Dana).

Diller’s case was that of a woman of sixty-three years, who had
been in the City Home continuously for thirty-four years. She

296

ABSTRACTS

developed a sudden attack of purging and vomiting, respirations
hurried and of a stertorous character, temperature 99°; later double
hemiplegia and myosis occurred, and death took place in thirty
hours.

Autopsy showed basal vessels in a state of advanced degenera¬
tion, a firmly coagulated hemorrhage extended over the pons and
slightly over the medulla, the exits of all the cranial nerves were
involved in the clot; the hemorrhage was thought to have come
from the basilar artery.

The diagnosis in this case was ventured, on the basis of double
hemiplegia, myosis, and the suddenness of onset with vomiting.

C. H. Holmes.

DOUBLE PERSONALITY FOLLOWING HEMORRHAGE. (D4-

(251) doublement de la personnalitl & la suite dlidmorrhagie.)

Pailhas, L'Endph ., F&v. 1908, p. 139.

In a few lines are mentioned two cases in which a severe haemor¬
rhage—one gastric, the other intestinal—was followed by the
hallucination of consisting of two bodies. For some inexplicable
reason the author calls these cases of double personality, and adds
some hypothetical conjectures about excitation of the coensesthesic
centres. He adds that his two cases seem to show that this
ccenaesthesic projection occurs more often on the right side!

Ernest Jones.

MENTAL DISTURBANCES IN VASOMOTOR NEUROSES.

(252) (Psychische StSrungen bei der vasomotorischen Neurose.)

Rosenfeld, Centralbl. f. Nervenheilk. u. Psychiatr., Bd. xxix.,

S. 137-159.

After some general remarks on the principles of classification of
the psychoses, Rosenfeld continues the discussion begun in two
former contributions as to the possibility of defining a group of
mental affections accompanied by vaso-motor symptoms. He adds
eight to his five previously described cases. The neurological symp¬
toms were acrocyanosis, colour changes, dermographia, disagreeable
cardiac sensations, bradycardia, giddiness, especially on standing,
and marked sweating, there being no evidence of organic disease
of the nervous system. The mental symptoms were exaggerated
anxiety for relatives, feeling of inadequacy, self-reproach, phobias,
emotivity, with absence of psychomotor inhibition and retained
insight into the condition present. The differential diagnosis is
difficult, especially from hysteria. Relapses are frequent, but the
ultimate outlook is good. The author unconvincingly seeks to

ABSTRACTS

297

establish here a separate clinical entity, mainly on the grounds of
the typical course of the affection and the difficulty of otherwise
grouping it. Ernest Jones.

HYSTERIA IN CHILDREN. G. E. Price, Arch, of Pediatrics, Feb.

(253) 1908, p. 95.

A brief report of four cases. One, a girl of 10, with hysterical
tremor in the arm; tremor appeared in a leg as the result of
suggestion. Definite hysterical stigmata. Case ii., a boy of 13,
with spasmodic attacks of pain in the hip-joint ever since a fall
eleven months before. No organic lesion. Areas of hypoaesthesia
and hypalgesia distributed irregularly over the limbs. Case iii., a
girl of 13, was of the psychic type. Very emotional, but no
motor or subjective sensory symptoms. Bad neuropathic family
history. Case iv., a girl of 15, was the subject of attacks of
hysterical dyspnoea. J. H. Harvey Pirie.

CONTRIBUTION TO THE OYTOLOGIOAL STUDY OP THE

(254) OEREBRO-SPINAL FLUID. (Beitr&ge sum Zellstudium der
Oerebrospinalfliissigkeit.) M. Pappenheim, Zeitschr. f. HeiVc.,
H. 10, 1907.

The author has made the interesting discovery that every
cerebro-spinal fluid exercises a deleterious influence on white
blood copuscles; this quality is especially well marked in the
fluid of general paralytics, and heating the fluid to 56® destroys
this action. It is, therefore, advisable to add formalin to the
cerebro-spinal fluid soon after its withdrawal Many peculiar
elements described in the cerebro-spinal fluid are merely degene¬
rated leucocytes, which have been acted on by the leucotoxin.
The author has especially studied the elements described by
Sabraz&s and Muratet, under the name of “ hsematomacrophage ”
elements. Their presence may be due to cerebral haemorrhage
dating back about a week; yellow colouration points to an older
haemorrhage, perhaps due to a previous puncture. The author
shows that the “haematomacrophage” elements may have a similar
cause, for in one of his cases he found these cells in the dura mater
at the site of a previous puncture. H. Hirschfeld (C.g.B.).

LYMPHOCYTOSIS OF THE OEREBRO-SPIN AL FLUID IN LUES

(255) HEREDITARIA TARDA. (Lymphocytose des Liquor cerebro-
spinalis bei Lues hereditaria tarda.) W. Kretschmer (of
Wiesbaden), Deutsche med. Wochenschr., No. 46, 1907.

In the cerebro-spinal fluid of infants and young children with
hereditary syphilis Tobler has demonstrated a lymphocytosis.

298

ABSTRACTS

The author has worked on the same lines at late hereditary
syphilis, but has comparatively little material. In two cases he
found a marked lymphocytosis; further investigation along these
lines is required. H. Hirschfeld (C.g.B.).

THE UNSUCCESSFUL SEARCH FOB OHOLIN IN THE CEREBRO

(256) SPINAL FLUID. (Ueber den angeblichen Befund von Oholin
in der Lnmbalflfjsaigkeit.) M. Kauffmann, Neur. Ceniralbl.,
16th March 1908.

Kauffmann, of the clinic for nervous diseases at Halle, has in¬
vestigated the cerebro-spinal fluid obtained by lumbar puncture
with special reference to the existence in it of cholin, as was
affirmed by Moll and Halliburton in 1899. He has failed to find
it in any appreciable quantity, or even with certainty at all, though
a litre of fluid was obtained for examination. There is a base
present, but its nature is still a matter of doubt. What alone
appears certain is that it is not cholin. He also failed to find
pyrocatechin, which Halliburton states to be present. The cases
examined were general paralytics and epileptics, in whom there is
thought to be an unusually rapid breaking down of nervous material.
His conclusion is that if cholin is present in the cerebro-spinal
fluid of the insane, it is so in such small quantity that it cannot be
chemically identified. It has therefore no pathological significance.

Jas. Middlemass.

SEBUM DIAGNOSIS OF SYPHILIS. (Serodiagnostik der Syphilis.)

(257) F. Plaut (of Munich), Zentralbl. f. Nervenh. u. Psych., Ht. 8,
1908.

In the haemolytic experiment with the original technique of Was-
sermann (who employed watery extract of syphilitic organs as
antigen), the positive reaction of the blood serum in undoubted
cases of syphilis has been present in 80-90 per cent The reaction
is specific, and is never present in a non-syphilitic individual; it
enables us to diagnose the constitutional disorder, but not the
organ affected. Examination of the cerebro-spinal fluid by this
method sometimes enables us to make a diagnosis of the organ
affected.

In twenty-five cases of syphilis, without involvement of the
central nervous system, the author never found an anti-body in the
cerebro-spinal fluid, while the serum, as a rule, gave a positive
reaction. Even in actual syphilis of the central nervous system
the cerebro-spinal fluid is very frequently free from syphilitic
anti-bodies. On the other hand, in all but one of ninety-five
cases of general paralysis examined by the author, the cerebro-

ABSTRACTS

299

spinal fluid gave a positive result; the serum, in every case of
general paralysis examined, gave a positive reaction. In cases of
cerebral syphilis the serum was usually positive, the cerebro-spinal
fluid usually uegative; in tabes the cerebro-spinal fluid gave a
positive reaction in 70-80 per cent, of the cases. The author
emphasizes the value of the method as an aid in separating from
other groups those cases of congenital or early acquired mental
enfeeblement which arise on a syphilitic basis; it may also help
in the differentiation of arterio-sclerosis on a syphilitic basis from
that with different etiology.

As to the nature of the antigen, views have considerably
■changed. Wassermann and his collaborators observed the specific
interference with haemolysis only with extract of a syphilitic
organ; Marie and Levaditi observed the same phenomena some¬
times with extract of normal liver in concentrated solution, and
the author confirms their results. It was then found that the
antigen principle could be extracted with alcohol, and that here,
too, certain normal organs would serve the purpose. The antigen,
therefore, seemed to belong, not to the albumen group, but to the
lipoid substances; Porges accordingly substituted lecithin for
organic extract m the haemolytic experiment, and in some cases
obtained positive results.

Various attempts have been made to arrive at a simpler
technique of serum diaguosis by means of precipitation. For this
purpose Poiges employed equal quantities ("2 c.cm.) of a '2 per
eent. suspension of lecithin in -5 per cent carbolic normal saline
solution and of syphilitic sera. The results were positive, but by
no means absolutely specific.

The author sums up the various methods and their various
Advantages.

A. Method of Binding of Complement.

1. The original method of Wassermann, Neisser, and Brack, of
binding complement by means of a watery extract of a syphilitic
organ is even to-day the most reliable.

2. One only rarely finds watery extracts of non-syphilitic
organs which have a specific action in hindering haemolysis, and
these extracts are of less value than the afore-mentioned.

3. The alcoholic extracts of syphilitic and normal organs give
a reaction which is specific for syphilis, but not with the same
regularity or intensity as the first-mentioned.

4. Lecithin cannot be recommended as a substitute for extract
of a syphilitic organ in the haemolytic experiment

B. Precipitation Method.

1. Fornet’s method is of no use.

2. The phenomenon observed by Michaelis, that precipitation

300

ABSTRACTS

occurred on mixing watery and syphilitic extracts with sera, is of
little practical use, as it is of rare occurrence.

3. The method of Porges-Meier, who employed lecithin, is not
sufficiently specific to be of much practical use.

4 The phenomenon observed by Klausner (precipitation of
globulin on mixing syphilitic sera with distilled water) is not
sufficiently specific for syphilis. C. Macfie Campbell.

CONGENITAL SYPHILIS. A K Wynne, Dub. Joum. of Med. Sci. f

(258) March 1908, p. 191.

Notes of a case, probably of diffuse syphilitic sclerosis, with
dementia, due to congenital disease, in a lad of 17.

J. H. Harvey Pirie.

ACUTE RETROBULBAR NEURITIS AND MULTIPLE SCLEROSIS.

(259) (Neuritis retrobulbaris acuta und multiple Sklerose.) B.

Fleischer, Klin. Monatsbl. f. Augenheilk., Feb. 1908.

The significance of retrobulbar neuritis in the diagnosis of multiple
sclerosis has already been investigated by Uhthoff and others. The
real (etiology of this “idiopathic” neuritis has always been
obscure, and it was a desire to determine whether disseminated
sclerosis had any causal relationship with it that led the author
to investigate the after-history of a number of cases of acute retro*
bulbar neuritis, as well as certain cases of acute optic neuritis
(papillitis) whose clinical course agreed with that of the retrobulbar
variety.

Patients who had been previously treated in the Tubingen
clinic for these conditions were written to, and such of them as
were suffering from any disturbances of their general condition
were asked to attend at the clinic; a thorough examination of
the nervous system was then made in every case.

Thirty cases of retrobulbar neuritis were examined, only those
who had shown the condition in its typical acute “idiopathic”
form being taken into account; cases which depended on direct
extension of inflammation from the orbit, nasal cavities, or
neighbouring parts were also excluded. Twelve cases of marked
papillitis were also examined. The individual histories are all
given, in an abbreviated form. Most of the patients were under
thirty-one years of age.

The result of the investigations was to show that by far the
larger number of these cases did, in point of fact, suffer from
multiple sclerosis.

For a diagnosis of this latter condition we do not nowadays

ABSTRACTS

301

need to wait for a full development of Charcot’s classical picture
(intention-tremors, nystagmus, and scanning speech); certain less
pronounced symptoms, as laid down by the researches of Oppen-
heim and Uhthoff, enable us to establish a no less reliable diag¬
nosis at a much earlier period; specially characteristic are the
occurrence of very transient palsies, and of a peculiar type of
paresthesia.

It is specially to be noted that a long time may elapse between
the appearance of the retrobulbar neuritis and that of the other
symptoms of multiple sclerosis, hence the great importance of the
former condition as an early symptom in the diagnosis.

As regards the twelve cases examined, in which well-marked
optic neuritis existed, here, too, it was demonstrated that almost half
the number were suffering froiu multiple sclerosis.

The fact was thus established that acute retrobulbar neuritis
represents a (mostly) initial symptom of multiple sclerosis. Of
the cases of more marked involvement of the papilla (obvious
papillitis), half became the subjects of multiple sclerosis; it is
possible that the percentage of this latter group may be even
larger.

This confirms the observations of the neurologists that visual
disturbances of the nature of acute retrobulbar neuritis are not
uncommon in the anamnesis of disseminated sclerosis cases; it
also confirms Peter’s view as to the setiological importance of
multiple sclerosis in cases of retrobulbar neuritis, and amplifies
the experiences of Marcus Gunn, who, in 1905, found that of 223
cases of acute retro-ocular neuritis in which the optic nerve was
primarily affected, at least 51 were demonstrably caused by
multiple sclerosis (Ophth. Review , vol. xxiv., p. 285).

Thus in cases of acute retrobulbar neuritis in young adults,
where no obvious cause, such as inflammatory extension, intoxica¬
tions, or the like, can be demonstrated, one may with considerable
probability of correctness make a diagnosis of incipient multiple
sclerosis. Arthur J. Brock.

THE PHYSIOLOGY AND PATHOLOGY OF THE PUPILLARY
(260) MOVEMENTS. (Die Physiologie und P&thologie der Pupil-
lenbe wegungen .) 0. Bumke (of Freiburg), Med. Klin., 1907.
No. 41.

The width and movements of the pupils do not depend on elastic
phenomena nor on variations in blood-pressure, but on the tonicity
of the antagonistic muscles of the iris; these are the sphincter and
the dilator of the pupil, the former supplied by the third nerve,
the latter as well as the muscle of Muller (symptom-complex of

302

ABSTRACTS

Horner) being supplied by the sympathetic. Cocaine stimulates
the dilator, fails to act therefore in sympathetic paresis; eserin
stimulates the sphincter, atropine and its derivatives paralyse the
sphincter. Convergence, accommodation, and narrowing of the
pupil are associated movements which depend on a central
impulse. They are of less diagnostic importance than the light
reflex, the bilateral occurrence of which on illumination of one eye
(consensual reaction) depends on the decussation of the optic
nerves in the chiasma, and the connection of each sphincter
nucleus with the retina of its own eye.

The disorders of innervation of the pupils include amaurotic
rigidity, absolute rigidity, paralysis of the sphincter, which occurs
as one element of a total or partial paralysis of the third. The
more or less complete paresis of the third nerve has several causes,
and is a nuclear affection, just as paresis of the internal muscles
of the eye (internal ophthalmoplegia); uncomplicated absolute
immobility is almost always due to syphilis. True reflex immo¬
bility (Argyll Robertson’s symptom), in which the sensory centri¬
petal and the motor centrifugal branch of the reflex arc are intact,
but the light reflex eliminated, while the reaction on convergence
is preserved, represents a central disorder which is situated between
that part of the oculomotor nucleus presiding over the sphincter
iridis, and the termination of the optic nerve in the external
geniculate body. It is rare, because it depends on the destruction
of a few isolated fibres, and is symptomatic of metasyphilitic tabes
or general paralysis; in extremely rare cases it occurs as an isolated
nervous sequel of syphilis.

It is necessary to guard against confusing this symptom with
paresis of the sphincter. In 20 per cent of cases of tabes or
general paralysis there are no disorders of pupillary innervation
present

The sign of Argyll Robertson almost always points to involve¬
ment of the posterior columns, and therefore to be specifically
tabetic; these changes, as well as rigidity of the pupil, are almost
always present in the terminal stage of general paralysis. No
conclusions as to the pathological anatomy of reflex immobility of
the pupil can be drawn from these observations (degeneration of
certain fibres in the cervical cord, reflex centres in the medulla).
It has not yet been possible to demonstrate any characteristic
changes in the region between the geniculate body and the
sphincter nucleus. K. Steinuorff (C.g.B.).

ABSTRACTS

303

OH THE DIAGNOSTIC APPLICATION OF BSEBIN IN PUPIL-

(261) LARY DISORDERS. (Zur diagnostischen Verwertnng des
Eserins bei Pupillenstdrungen.) F. F. Krusius (of Marburg),
Zeitschr.f. Augenh., Bd. xviii, H. 5, 1907.

Thb author gives iu tabular form the results of his examination
of cases of paresis or paralysis of the sphincter pupillae, and con¬
cludes that eserin does not help us in determining whether in
absolute immobility the central or peripheral neurone is affected—
that is, whether the lesion is anterior or posterior to the ciliary
ganglion. K. Sthindorff (C.g.B.).

ON A PECULIAR PUPILLARY PHENOMENON; BEING AT THE

(262) 8AME TIME A CONTRIBUTION TO THE QUESTION OF
HYSTERICAL IMMOBILITY OF THE PUPIL. (Ueber ein
eigenartiges Pupillenph&nomen; xugleich ein Beitrag zur
Frage der hysterischen Pupillenstarre.) Redlich, Deutsche
med. JFchnschr., February, p. 313.

Thk basis of the author’s observations was the case of a female
epileptic, 33 years of age, who was also the subject of hysterical
attacks; these took place characteristically during the doctor’s
visit, and occurred as long as notice was taken of them. The
patient twisted herself now to one side, now to the other, threw
her head back, cried out loudly and continuously, and threw her
hands about. The attacks were short, but followed each other
quickly. Consciousness was not lost; patient responded to simple
requests, as, e.g., to show her tongue, etc. During these attacks the
pupils were circular, widely dilated, and did not usually react to
light (a small pocket electric lamp was used). This stage of
dilated and irresponsive pupil was often preceded by one in which
the pupils showed a more than medium dilatation, were obliquely
oval and irregular in shape, and contracted imperfectly to light.
Between the individual attacks, and apart from them, the pupils
were of medium width, and reacted promptly to light-stimuli as
well as to convergence and accommodation. The fundus was
normal; vision good.

Careful observation proved that an exactly similar condition
of the pupil (viz., dilatation and immobility) could be artificially
produced by causing the patient to go through, of her own will,
movements similar to the involuntary ones of the fit— i.e. by
making her cry out, throw her muscles into strong contraction,
etc. Here, too, the condition was often preceded by a stage in
which the pupil became oval and showed an imperfect reaction to
light. It was necessary that the muscular effort should be strong.

304

ABSTRACTS

and, above all, persistent; the least slackening in effort was
followed by some contraction of the pupil and by its beginning
to react to light The author was inclined to think that this
phenomenon occurred most readily with certain special movements
— e.g. when the patient pressed an assistant’s hands crosswise with
all her force, her head being bent back and her cervical muscles
powerfully contracted; at the same time the breath was held and
the face became congested.

That strong muscular contractions normally produce dilatation
of the pupil is a fact of common observation, but the dilatation is
not usually great, and the pupillary light-reaction is little, if at all,
altered.

The reaction in the present case was thus simply an extreme
exaggeration of the normal.

Out of various possible explanations of this phenomenon which
suggest themselves, the author prefers the view that it depends on
strong muscular contractions, especially on direct irritation of the
cervical sympathetic by the muscles of the neck.

Irritation of the sympathetic (i.e. spasm of the dilator pupillse)
is not in itself sufficient to produce maximal dilatation and abso¬
lute failure of response by the pupil to light-stimuli; paralysis, or
inhibition of the sphincter, is required besides. In the case under
consideration, however, and in other similar cases, a slight reaction
was retained, viz., that to convergence; thus the majority can be
explained by a mere spasm of the dilator.

This view may furnish us with an explanation of the abnormal
width of pupil so common in hysteria and epilepsy; it will not,
however, explain all hysterical disturbances of the pupil, and only
holds good of the convulsive stage of the attack.

Moreover, quite apart from the attacks themselves, we may get
various disturbances of the pupil in epilepsy, such as total immo¬
bility, or contraction and immobility combined; the latter is a case
of miosis and immobility depending on spasm of convergence.
These various pupillary disturbances can be explained as exaggera¬
tions of normal reactions, dependent on some neurosis (perhaps on
abnormally increased irritability); e.g., the contraction of the pupil
which always accompanies convergence may become exaggerated
into miosis and failure of response to light-stimuli.

Arthur J. Brock.

THE EYE-MOVEMENTS IN CEREBELLAR IRRITATION. (Uber
(263) die Augenbewegungen bei EHemhirareizung. ) A. Louri£,
Neurol. Cenlralbl., Feb. 1, 1908, p. 102.

The author maintains that he has demonstrated that the cere¬
bellum has no influence upon the movements of the eye-balls.

ABSTKACTS

305

He concludes from his experiments that the surface of the cere¬
bellum does not contain centres for the movements of the eyes
and facial muscles, but he does not appear to have made observa¬
tions upon the effects of irritating the intrinsic nuclei of the
cerebellum, so that he is hardly justified in saying that there are
no special centres in the region of the cerebellum for these
movements. Alexander Bruce.

THE ETIOLOGY OF ABDTJOENS PARALYSIS, ESPECIALLY OF

(264) ISOLATED PARALYSIS. (Zur Aetiologie der Abducens-
I&hmung, besonders der isolierten Lahmung.) Kollner, D.
med. Wcknsehr., Jan. 16 u. 23, 1908.

The writer refers to the relatively great frequency of paralysis of
the sixth nerve. Among the etiological factors he includes
alcoholism, arterio-sclerosis, lead paralysis, intra-spinal injection
of stovaine, etc., for anaesthesia, malaria, influenza, erysipelas,
albuminuria, diabetes, various diseases of the brain and spinal
cord, etc. Alexander Bruce.

OOULO-MOTOR PARALYSIS WITHOUT INVOLVEMENT OF

(265) THE INTERNAL MUSCLES IN PERIPHERAL LESIONS.
(Oculomotoriuslfthmung ohne Beteiligung der Binnemuskeln bei
peripheren LSsionen.) E. Fuchs, Arb. a. d. Neurol. Instil, a. d.
Wien. Untv., Bd. xv., T. 1, 1907, p. 1.

It was formerly thought that in a purely external ophthalmo¬
plegia the origin could not be in the peripheral nerves, but must
be in the oculo-motor nuclei or in the intra-cerebral root region.
But the number of cases is increasing in which there has been a
peripheral lesion with a purely external ophthalmoplegia, either
unilateral or more rarely bilateral, or where the oculo-motor nerve
has been alone injured, the interior muscles of the eye having
escaped the paralysis. The author gives references to eighteen
such cases, in six of which there had been a sectio, showing as
lesions compression atrophy, primary atrophy of the nerve-stem,
and inflammation, and he describes five clinical observations of
his own.

From study of all these cases he concludes that a purely
external ophthalmoplegia depends upon no special kind of ana¬
tomical lesion, but may be observed in trauma, inflammation,
simple atrophy and atrophy from compression. He thinks that
the escape of the internal muscles is not so much due to their
central position as to their slighter degree of vulnerability. In
support of this view he refers to the facts that in neuritic optic

306

ABSTRACTS

atrophy, while the sensibility to light is lost, yet the light-reaction
of the pupils is retained owing to greater resistive power of the
fibres concerned, and that in compression of the intra-craniai or
orbital part of the optic nerve a central Bcotoma due to a lesion
of the papillo-macular bundle of the optic nerve may be the first
symptom, probably on account of its special vulnerability.

Alexander Bruce.

CONJUGATE DEVIATION OF THE EYES AND HEAD. (Deviation.

(266) conjugfe des yeux et de la tdte.) A Debrat, Journ. de
Neurol., oct. 5 et 20, 1907.

Two main varieties of conjugate deviation of eyes and head are
described: — (1) That in which the head deviates in the same
direction as the eyes, and (2) that in which the eyes and head are
turned laterally in opposite directions. The author discusses the
parts played by the various afferent and efferent tracts in the
pons, cerebellum, superior peduncles, central nuclei and internal
capsule, and cerebral convolutions. He goes into the details of the
various theories with regard to the mechanism of the movements,
but does not materially add to our knowledge of the subject.

Alexander Bruce.

ON THE INFLUENCE OF BOTATOKY MOVEMENTS ON NYSTAG-

(267) MUS. (Ueber den Einflnss von Drehbewegungen am die
vertik&le Korperachse auf dem Nystagmus.) Cassirer and
Loeser, Neurologisches Centralbl., 1908, p. 252.

The observations here recorded were undertaken with the object
of testing the functional activity of the vestibular nerve. In many
respects they are similar to the well-known observations of B&rdny
and of Wanner.

The chief point emphasised in this paper is the fact that
rotation of the body around its own long axis, by seating the
patient on a turn-table, produces well-marked effects on any pre¬
existing nystagmus. The patient is first carefully observed to
notice whether ocular movements in any direction, the head
remaining fixed, produce nystagmus. The patient is then rotated
six to ten times on a revolving stool, and immediately afterwards
the nystagmus is examined afresh. The writers distinguish
between undulating nystagmus, in which both phases of the nystag¬
mus are equal, both in range and in speed, and rhythmic nystagmus,
in which both movements are of equal range, but the one is slow
and the other fast.

The conclusions to which they come are as follows:—Horizontal

ABSTRACTS

307

nystagmus on lateral movement of the eyes can be made to dis¬
appear on looking to one side, after rotation around the long axis
of the body. After such a rotation, nystagmus, on looking towards
the direction of rotation, disappears, whilst on looking in the
reverse direction, the nystagmus is intensified. Even in a normal
individual, after such rotation, nystagmus appears on looking in
the opposite direction from that of the previous rotation. The
nystagmus is attributed by them to labyrinthine stimulation, from
movement in the endolymph. Purves Stewart.

THE SPINAL CORD IN OASES OF ABSENCE OF THE PUPIL-

(268) LAST LIGHT EEFLEX. (Das Verhalten des Ruckenmarkes
bei reflektorischer PupiUenstarre.) H. Wunderlich, Inaug.-
Diss., Wurzburg, 1907, pp. 28.

On the basis of the examination of the cord in fifteen general
paralytics the author concludes: “There appears to be a con¬
stant connection between degeneration of the posterior columns
and reflex immobility of the pupil.” The posterior columns of
the upper part of the cervical cord (especially one definite region
—namely, the ventral part of Bechterew’s intermediate zone)
were only degenerated in cases where clinically there had been
long-standing loss of the light reflex ; they were always intact in
cases where the pupils were normal or showed only slightly
impaired reaction. F. Loeb (C.g.B.).

TOXIC AMBLYOPIA. (Amblyopic toxique par l’alcool et le tabac.)

(269) Poulard, Prog. Mid.., March 7, 1908.

This condition, so frequent in drinkers and smokers, is easily
recognised, and the unjustifiable carelessness with which so many
medical men regard its existence cannot be set down to any
difficulty in diagnosis.

The normal retina is divided, both from an anatomical and a
physiological point of view, into two parts—(a) the small, highly-
sensitive “ central retina ” (macula); (b) the much larger and much
less sensitive peripheral portion.

The one constant and unfailing symptom of toxic amblyopia
(alcoholic or tabetic) is the loss of central vision, with retention of
peripheral vision; from this alone a sure diagnosis can be made,
and it is unnecessary to investigate other less important symptoms,
of which many exist.

This change in central vision is shown by an inability to see
the fixation object clearly, and, at the same time, to distinguish
colours, especially green and red. The eye cannot see the colour

308

ABSTRACTS

of the fixation object, but can do so as soon as that object passes
into the periphery of the field of vision. There may be a central
scotoma for green, red, etc., or for all colours, or the scotoma may
be absolute, when there is blindness even for white light.

To examine the central vision of a patient, make him close one
eye and hold up before him, at a distance of about 50 cm., a large
blackened surface of cardboard or metal, in the centre of which
there is a small square or round aperture; let him look through
this with his open eye, and name the colours of a series of papers
or other objects which are passed behind the orifice. We begin
with green, as this is the first colour to disappear; the existence
of a central scotoma for green is pathognomonic of alcoholic
amblyopia ; moreover, this type is characterised by being bilateral.
To absolutely confirm this diagnosis, make the patient look straight
at your finger, and, while he does so, move the blackened surface
a little outside the fixation point; he will at once be able to dis¬
tinguish the coloured or white paper through the hole, though he
could not do so when looking straight at it.

Toxic amblyopia proves specially trying for those who read
much, for watchmakers, etc., but in the case of outdoor workers,
coachmen and the like, it gives less trouble, as in these cases the
integrity of peripheral vision is of primary importance.

Differential diagnosis between tobacco and alcoholic amblyopia
is based entirely on the anamnesis, but the two factors are often
combined.

The condition is practically always slow and progressive, and
after the poison has been removed, retrogression is on the same
lines. A complete cure can only be hoped for when the amblyopia
is not far advanced, and, in any case, the affection is slow to yield
to treatment, which consists, essentially, in removal of the cause.

Arthur J. Brock.

GALVANIC REACTIONS OF THE AUDITORY NERVE. (Zur
(270) Klinik der galvanischen Akustikusreaktion.) Alice
Mackenzie, Wien. klin. Wochenschr., Nr. 11, 1908.

Brenner states that the normal reaction of the auditory nerve is
as follows:—With the kathode in the meatus closure of the current
produces a marked sensation of sound, which remains during the
passage of the current and ceases with the opening: if the anode
be in the meatus the result is negative, except that a slight noise
is heard at opening. Other observers have not confirmed these
results. Pollack and Gartner only occasionally obtained a reaction
with currents of six milliamperes in normal cases, while patients
suffering from ear disease reacted to one or two milliamperes. In
the present investigation one electrode was applied over the tragus

ABSTRACTS

309

and the other was held in the hand. The patients were both
suffering from extreme degrees of deafness and tinnitus: the
strength of the galvanic current was increased until the patient
noticed a distinct augmentation of his subjective noises. The amount
of current required was noted, then reduced to nothing, and the
poles reversed. Four milliamperes was found to be the best strength
of current for testing the reactions of the nerve at closure and
opening. The first case, aged 22, had been deaf for twelve years
(after meningitis), and suffered from giddiness and tinnitus, especi¬
ally on the left side. The tympanic membranes were normal, but
the patient was quite deaf: there was horizontal nystagmus on
looking to right or left, but none on syringing the ears with hot
or cold lotions, or on turning ten times to right or left. On testing
the galvanic excitability of the vestibular part of the eighth nerve,
it was found that, with the kathode at the right ear, a current of
ten milliamperes produced rotatory nystagmus to the right when
the patient looked straight forward. The anode at the right ear,
with a current of twelve milliamperes, produced nystagmus to the
left. In the left ear the kathode, with a current of twelve milliam¬
peres, produced nystagmus to the right, and the anode, with only
six milliamperes, nystagmus to the left. The results of the gonio¬
meter test are also given—the difference between the results with
“ eyes open ” and “ eyes closed ” is very striking.

The second case is similar to the first. Dr Mackenzie comes
to the following conclusions:—

1. Subjective noises are increased on one side by applying the

kathode to the ear—on the opposite side when the anode
is in contact with the ear.

2. Increase of the subjective noises of the right ear occurred

with the same strength of current when the kathode was
applied to the right ear, or when the anode was in contact
with the left ear.

3. With the current of four milliamperes kathodal closure

gives an increase of the subjective noises on the same side,
and at the same time the noises in the opposite ear dis¬
appear.

4. With a current strength of four milliamperes kathodal

opening increases the subjective noises only in the
opposite ear.

5. Anodal closure affects the opposite ear, and anodal opening

the ear on the same side.

From these observations Dr Mackenzie attempts to draw some
conclusions as to the value of operation (section) on the auditory
nerve in oases of severe tinnitus; she also thinks that in the two
cases investigated the pathological process had advanced further

310

ABSTRACTS

in the vestibular than in the cochlear nerve, and that this is the
reason for the cochlear nerve reacting to weaker currents: if this
be so, it is very unusual, as the cochlear nerve is the one which
shows most marked degeneration in such cases when examined
microscopically. J. S. Fraser.

DIAGNOSIS AND TREATMENT OF NEURASTHENIA. John E.

(271) Mitchell^ Johns Hop. Hasp. Bull., Vol. xix., No. 203, Feb. 1908.

Neurasthenia is defined as a chronic fatigue, due in part to
malnutrition, in part to functional over-exertion, occurring in
persons with a predisposition hereditary or acquired.

Its diagnosis is said to rest on certain subjective symptoms,
which fall into four main groups:

(1) Fatigue symptoms: general weariness, lassitude constantly
present, greatly increased by the smallest exertion.

(2) Irritable weakness symptoms: increased reflexes, cardio¬
vascular disturbances, muscular tremors, excessive emotionality.

(3) Disorders of will, such as lack of self-control, indecision.
Sir James Paget stated this cardinal symptom epigrammatically:
u The patient says he cannot; the nurse says he will not; the fact
is, he cannot will.”

(4) Psychic depression, and anxiety or fear symptoms. Some¬
times there is simple depression, sometimes definite fears or
“ phobias.”

Negatively there is a fifth very important symptom—namely,
the absence of any typical or peculiar organic changes.

In regard to treatment, the first requirements are met by rest,
or rather by rest treatment, and the latter by a rational system of
education of the will, the logical faculty, and the reasoning powers
of the patient. The amount of rest should be regulated by the
special needs of the case, varying from a couple of hours’ quiet to
long-continued complete recumbency. In slighter cases isolation
is not necessary. D. K. Henderson.

PSYOHASTHENIA. Joseph Collins, N.T. Med. Jour., Vol. lxxxvii.,
(272) No. 7, Feb. 1908.

Janet suggested psychasthenia as the name for a disorder charac¬
terised by mental, emotional, and physical symptoms, made up
principally of obsessions or imperative concepts, fears, doubts,
anguish, uncontrollable movements, enfeebled will power, and
some or all of the customary physical symptoms of neurasthenia.
The patient can realise how strange and morbid the obsession is

ABSTRACTS

Sll

and can discuss it in an impersonal way, without it affecting the
tenaciousness of the obsession.

The most complete and typical case the writer has ever seen is
fully recorded. D. K. Henderson.

MORBID SOMNOLENCE. D’Orsay Hecht, Am. Joum. Med. Sc.,

(273) Yol. cxxxv., No. 3, March 1908.

The clinical report of a case of narcolepsy, occurring in a man aged
48 years, who had contracted syphilis when 18 years of age.

The case was first seen in 1906, the sleeping having gradu¬
ally increased in frequency and duration since 1895. Little atten¬
tion was paid to the “naps” until one day the patient fell
asleep while making a bed, and on another occasion “suddenly
dropped off” in the course of a conversation. He experiences an
unconquerable desire to doze about every three hours, and, if not
disturbed, sleep lasts from one half to one hour. The sleep is
perfectly refreshing, and so light that he is wakened by the
slightest touch, and nothing said within hearing distance escapes
him. Keeping constantly on the move, or doing real, active,
manual labour is his only hope of keeping awake.

Numerous writers on the subject are quoted.

D. K. Henderson.

PATHOGENY AND TREATMENT OF SEA-SICKNESS. (Le mal

(274) de mer. Essai de pathogdnie et de traitement.) L. Maillot,
Theses de Farit, 1907-8, No. 142.

Adopting the views of F. Regnault, Maillet distinguishes between
a psychic and a somatic sea-sickness. The former is due to
suggestion alone, and is curable by suggestion. Psychic naupathy
may be recognised by the patient complaining of symptoms which
are never found in somatic naupathy, e.g., diplopia or anuria, or by
the symptoms occurring in fine weather or on terra firma.

Psychic naupathy is essentially contagious, and is most likely
to occur in nervous persons who are subject to other forms of
locomotor vertigo, e.g., carriage or railway sickness. It may also
be found in animals, which, though also subject to somatic sea-sick¬
ness, are more liable to suggestion than most men.

In the treatment suggestion may be employed either directly
or indirectly, e.g., by drugs. In such cases the quality of the
remedy is of less importance than the assurance with which it is
prescribed. The success that has followed a countless number of
“ specifics ” Maillet attributes to their action on a purely psychic
naupathy. Treatment by auto-suggestion is very efficacious.

312

ABSTRACTS

Numerous observers have noted that the symptoms have become
attenuated, or have entirely disappeared, by the vigorous exercise
of will power.

Somatic naupathy has received various explanations. The
most probable is the abdominal theory proposed by Kdraudren.
The swaying of the vessel produces movements of the abdominal
viscera which irritate the semilunar ganglia. The symptoms are
thus produced by a reflex path. It must be noted that numerous
cases occur of combined psychic and somatic naupathy. The
treatment of somatic naupathy consists in the administration of
sedatives, e.g., opium, morphia, or cocaine, in the constriction of
the abdomen by a belt, and by immobilisation in the recumbent
position. J. D. Rolleston.

THE SYMPTOMS DUE TO OEBVIOAL RIBS. Wm. Thorburn,
(275) Med. Chron., Dec. 1907, p. 165.

Notes of a number of cases are given in this article, the nervous
symptoms being considered in greatest detail. It would appear
that symptoms are much more common in the female than in the
male, that they generally involve the right upper limb, and that
they tend to appear in early middle life. The cases in which
nervous symptoms are present fall into two groups—the neuralgic,
in which pain and subjective weakness are alone complained of,
and the paralytic, in which there is definite loss of power or
sensation. In the neuralgic cases the pain may be felt in the
neck or in the upper limb, but is much more characteristic in the
latter. It follows the distribution of the first dorsal, or first dorsal
and eighth cervical roots; it is usually described as tingling, or as
a numb pain, and is often associated with a marked feeling of
coldness, and is apt to be aggravated by cold.

The more serious paralytic cases commence with purely sub¬
jective symptoms; when objective symptoms are found, they also
are usually limited to the regions supplied by the first dorsal and
eighth cervical roots, e.g., paralysis and wasting of the hand muscles
and sensory defects, frequently with dissociation of the various
forms of sensation. Early removal of the offending rib is recom¬
mended in all cases of reasonable severity. Details of the operation
are given, the author giving preference to a straight, more or less
vertical incision in the posterior triangle, reaching well up above
the clavicle and lying well back, so that in the necessary dissection
the nerves and subclavian artery are turned forward—the operation
being from the side rather than from the front of the neck.

J. H. Harvey Pirie.

ABSTRACTS 313

THE RELATION BE T WEEN BOIATIOA AND DISEASE OF THE

(276) HIP-JOINT. W. Ironside Bruce, The Practitioner, April
1908.

Dr William Bruce five years ago thoroughly discussed the
clinical aspect of the theory that a relation existed between
sciatica and disease of the hip-joint.

The author of the present paper seeks to offer, by means of radio-
grama of the hip-joint in cases of sciatica additional proof of Dr
William Bruce’s contention—namely, that the origin of pain in
sciatica is in the hip-joint, the sciatica referred to being understood
to exclude examples of sciatica due to manifest spinal disease or to
pressure from tumours in the pelvis.

The possibility of recognising, by means of the X-rays, changes
in the normal appearance of joints affected by gout or rheumatism
is demonstrated by means of radiograms.

There are quoted twelve cases presenting typical symptoms of
sciatica in which an associated arthritis of the corresponding hip-
joint was discovered. Five of these are illustrated by radiograms.

A few of the clinical arguments in support of Dr William
Bruce’s contention are advanced; but the main object of the paper
is to bring under notice five cases which presented the signs and
symptoms usually recognised as sciatica, in all of which this
diagnosis had been made independently, and the usual treatment
for the condition been carried out In each of them the radiogram
shows disease of the hip-joint more or less extensive in its nature.

The conclusion is, that if systematic examination of the hip-
joint by X-rays, in intractable cases of sciatica, be carried out it will
be found in many of the cases that the sciatica is present only as
a symptom of disease of the hip-joint. Author’s Abstract.

PSYCHIATRY.

INSANITY, SIMULATION, AND CRIMINALITY. (Locura, Simu-
(277) lacion y Chimin all dad.) Jose Ingegnieros, Arch, de Psig. y
Crim., Jan.-Feb. 1908.

In an article of some length Prof. Ingegnieros publishes an
account of a delinquent whom he describes as one of the most
Complex and interesting cases, and one which has evoked the
most divergent expert opinions since the foundation of the Insti¬
tute of Criminology at Buenos Aires. The man, Alexandra Puglia,
was a Neapolitan, set. 38, with a marked neuropathic heredity, who
at the age of twenty-eight emigrated to South America. Official
documents obtained from Italy showed that he was of an impul-

314

ABSTRACTS

sive, violent, and anti-social character, of bad education and sur¬
roundings, a Camorrist, potator and syphilitic, and that he had
been in prison in Rome in 1895, whence he was sent to the
asylum of St Maria for mental observation. There he presented
auditory hallucinations and persecutory mania of brief duration.
Later in the same year, whilst undergoing military service, he was
again under observation in the asylum at Florence, on account of
his violent and refractory behaviour, and was diagnosed as a
degenerate, subject to episodic psychoses, but not truly insane,
and discharged as unfit for the army. In Buenos Aires he was
thrice imprisoned for fraud, in 1898,1899, and 1901, and again in
1905 for homicide. Whilst awaiting trial on the last charge, he
made an attempt (?) at suicide, was passed to the infirmary, where
he simulated insanity. At the infirmary he was carefully
examined, was found to present numerous physical stigmata of
degeneration, had unequal and sluggish pupils, tongue tremor,
slight articulative difficulty and auditory hallucinations, and delu¬
sions of persecution, which were considered to be simulated, as
they were at variance with his conduct. The medical officer of
the infirmary therefore advised the Court that the prisoner was
not insane, and was a malingerer who was at the time of their
observation in a normal mental condition. The prisoner was there¬
fore sentenced to ten years' penal servitude. He again simulated
insanity, and his sentence was increased to fifteen years by the
Chamber. Shortly before entering upon this sentence he stabbed
a fellow-labourer, and the question of his mental state was re¬
opened. In reviewing the whole facts, Prof. Ingegnieros comes
to the following conclusions:—

1. The prisoner is a mental degenerate, with intercurrent

episodic attacks of excitement, with a profound lack of

moral sense, aggravated by chronic alcoholism.

2. His simulation was the simulation of an insane person— i.e.

was supra-simulation.

3. He should be considered irresponsible with regard to his

last homicidal assault.

4. As his mental derangement is a permanent condition, he

ought to be permanently sequestered as a criminal lunatic.

Those who are intimately acquainted with convict establish¬
ments will be able to recall many cases like this of Prof Ingeg¬
nieros, cases in which prisoners of degenerate physical type,
intellectually of average parts, but cunning, suspicious, inordi¬
nately egotistical, refractory, and liable to periodic explosive
attacks of excitement and violence, during which apparently
genuine auditory hallucinations and delusions of persecution
develop on an original groundwork of morbid suspicion, have

ABSTRACTS

815

been futilely punished over and over again for offences committed
in and outside of prison, and have finally been certified as insane.
The simulation of insanity in such cases is not uncommon, so much
so, indeed, that the simulation of insanity is itself strongly sugges¬
tive of mental defect. As Las&que said—“ On ne simule bien que
ce que Von a." R. Cunyngham Brown.

PARALYSIS AGITATO IN AN INSANE EPILEPTIC. (Maladie

(278) de Parkinson survenue chez one dlmente dpileptique.) H.

Bourilhet, Qaz. des Hfip., jan. 7, 1908.

The author describes the following clinical case:—The patient is
seventy-six years of age; she has suffered since the age of twenty-
seven from recurring mania,characterised by attacks of hallucinatory
delirium,followed by vertigo. In the interval between the attacks the
patient is calm, but sometimes dangerous and impulsive. Towards
the age of fifty there appeared attacks of epilepsy, which increased
in frequency after the menopause. Then her intellectual faculties
diminished, and at the present time she is insane. She now
presents the appearance of a case of paralysis agitans with the
characteristic mask, attitude, propulsion, and tremor. The case
is thus one of paralysis agitans occurring in an insane epileptic.

The author mentions a similar case reported by Combemale,
but he refrains from putting forward any theory, and even from
establishing any causal relation between the symptoms of paralysis
agitans and those of the epilepsy. 0. Crouzon.

ADIPOSIS DOLOROSA IN A CASE OF DEMENTIA PRjEOOX.

(279) Ftjrsac et Pascal, L’Enctyhale, Feb. 1908, p. 131.

The case is that of a woman of 65 who has been in an asylum
with dementia prtecox since 1882. The adiposity had developed
subsequently to her admission, but its development had not been
traced. The disposition of the masses of fat is characteristic, the
face, front of neck, hands, and feet escaping. Spontaneous pain
appears not to be present, but it is readily evolved by pressure on,
or movement of the skin over the masses of fat. The thyroid is
not palpable. The authors attribute the common association of
Dercum’s disease with mental troubles to the action of some still
unknown intoxication on an organism with a neuro-psychopathic
heredity. J. H. Harvey Pikik.

316

ABSTRACTS

.HOW LUNATIC ASYLUMS SHOULD BE CONSTRUCTED. (Como

(280) deben ser los Asilos pan Alienados.) A. GalcerAn
Grants (Med. Supt. Reus Asylum, Spain), Arch, de Psiq.,
Jan.-Feb. 1908.

The author gives an interesting account of the development of
asylums in Spain, their actual state to-day, and the direction
in which he considers they would be improved by the establish¬
ment of sanatoria for psycho-neurotics; special establishments for
epileptics; such alterations in the structure of asylums as would
permit of better classification ; the extension of the “ open door ”
and “no restraint” to all suitable cases, and the provision of
reformatories for moral degenerates.

R. CUNYNGHAM BROWN.

PSYCHIATRIC EXPERT EVIDENCE IN CRIMINAL PROCEED-

(281) INGS: ITS IMPERFECTIONS AND REMEDIES. G. W.

Jacoby (of New York), N.Y. Med. Joum., March 7, 1908.

The present methods of securing, maintaining and remunerating
expert evidence are discussed and frankly condemned. The plan of
permitting experts to be retained “ For the defence ” and “ For the
prosecution ”; the payment of extraordinary fees in competition ;
the chances of the defence when invalidated by poverty are all
commented upon most pertinently.

The author proposes the establishment by the State of a per¬
manent institution of medical experts selected according to fitness,
and uninfluenced by politics. An age limit, special training and
special examination should be considerations upon which a
“ Physician to the Court ” should be selected. His remuneration
should be apportioned in accordance with the difficulties and
length of the case.

The laws of evidence are criticised and the “obstacle race”
denounced. The expert should finish his exposition in continuity,
frankly and honestly founded upon the facts of the case; ques¬
tions from the defence, prosecution, court and jury respectively
should then be allowed. Much advantage would be realised if the
defendant suspected of mental disease was committed for con¬
tinued observation to some regular State hospital, and a written
report submitted by the resident experts.

Finally, the author refers to the absurdity of adhering to the
“right and wrong” tests of the penal code handed down from
English law, and points to Germany as the example of a country
where regulations such as he proposes are in vogue.

C. H. Holmes.

ABSTRACTS

317

TREATMENT.

ARTHRODESIS AND TENDON TRANSPLANTATION IN PARA-
(282) LYTIC CONDITIONS. Robert Jones, Brit. Med. Joum.,
March 28, 1908, p. 728.

A valuable address on the above subject was delivered by Mr
Robert Jones, at the Medical Graduates College and Polyclinic.
The following are some of the more important points insisted on
by the author. The joints most amenable to treatment by arthro¬
desis are the ankle, the mid-tarsal, and next to these the knee.
The operation should not be performed before the eighth year.
The author’s earlier failures were mostly due to non-observance of
this rule. Such early operations are apt to result in feeble fibrous
ankylosis, and later on, from the sacrifice of too much cartilage, in
irregularity of growth. This irregularity of growth, in the case of
the ankle, usually produces a deformity of the pure varus type.
To avoid this, the foot should be placed in an over-corrected posi¬
tion, a wedge of bone being taken if necessary from the astragalus,
with its base to the outer side. If the wedge is taken from the
astragalus the growth of the limb is not interfered with. Arthro¬
desis is also contra-indicated where the surgeon is not satisfied
that the muscles are paralysed beyond hope. At least two years
must have elapsed in the case of muscles Buspected to be com¬
pletely paralysed. In many cases such muscles recover partially
or completely in a surprising manner if proper measures are taken.
Although wasted, and not responding to electricity, these muscles
are not really paralysed but overstretched, and restoration of
function may occur in a few months if structural shortening is
allowed to take place in their bodies. This is brought about by
excising a portion of their tendons with immediate resuture, sup¬
plemented if necessary by division and elongation of their healthy
but tense opponents, and sometimes, in addition, by the transplan¬
tation of healthy tendons. The joint is then kept at absolute rest
in a splint in the corrected position, and electricity and masssge
diligently and persistently applied for a considerable period. The
keynote to treatment, however, is to relieve such over-stretched
muscles from all strain. In many cases also Jones finds the re¬
moval of an elliptical portion of skin over the joint of the utmost
value. When the cut edges are united, if enough has been excised,
it will be foimd that the joint is kept in the proper position. The
skin excision, in fact, acts as a splint, and maintains the over¬
correction. Cases so treated may never require arthrodesis, and,
if such should eventually become necessary, the conditions are
much more favourable for its performance than before. Instances
have occurred in drop wrist where the over-stretched extensors

318 ABSTRACTS

have regained their contractility after seventeen and nineteen
years (Tubby and Jones).

The removal of skin flaps from the proper aspect of the joint
is also very valuable in arthrodesis and in tendon transplanta¬
tion. With regard to the latter operation, Jones usually waits
till the child is five years of age. The sheath of the transplanted
tendon should be spared as much as possible, and should accom¬
pany it to its destination. He has given up transplanting into
tendons; the tendon should be sutured to the periosteum, or into
a tunnel in the bone. The suture fixing it should be tight. Silver
has shown that it is practically impossible to tie and suture
tightly enough to cause necrosis. The tendon must pass straight
to its destination, and not in an angular manner. To avoid such
deflection, it is often necessary to tunnel the soft tissues. The
transplanted tendon must not be subjected to undue tension, or
it will wither.

The patient, in all these operations, must not be allowed to
use the limb fully for a very considerable time, otherwise relapses
will occur. A. A Scot Skirving.

ORTHOPEDIC THERAPY DURING THE EARLY STAGES OF
(283) ACUTE ANTERIOR POLIOMYELITIS. Nutt, N.Y. Med.

Journ., 29th Feb. 1908.

Proper and painstaking treatment, instituted during the acute
stage, will greatly lessen the extent of the crippling results of this
disease, and be the means, in some cases, of a complete cure. The
affected parts must be kept in as healthy a condition as possible by
massage, electricity, and hydrotherapy. Scientifically applied
massage, as contrasted with mere rubbing, should be performed
daily for from ten minutes to half an hour. Each muscle should
be treated by the electric current for three or five minutes daily.
The faradic current is used when any response to it is obtained,
otherwise the constant current is employed. The local temperature
is to be maintained by extra clothing, constantly worn; hot water
bags and electric heaters only have a temporary effect on the
lowered temperature, and are not recommended. Passive move¬
ments, devised to preserve the normal range of action of the joints,
must be commenced at the beginning and carried out daily; other¬
wise muscle-shortening, which sets in very quickly, may render
normal movement without force impossible within six weeks. The
over-stretching of paralyzed and weakened tissues must be pre¬
vented by the constant wearing of suitable apparatus, which
counteract unparalyzed antagonistic structures and the effects of
gravity. Even after years of neglect, overstretched muscles may
partially recover their normal functions as a result of suitable

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319

treatment. Prolonged rest in bed is undesirable. Careful con¬
sideration must be given to each individual case with reference to
the selection of suitable restraining apparatus, and the confined
joints and muscles should be exercised twice daily by passive and
resisted active movements performed with the apparatus removed.

Henry J. Dunbar.

ASYLUM TREATMENT FOR INEBRIATES. (Asilo para Bebe-

(284) dores.) Pedro Dorado (Univ. Salamanca), Arch, de Psiq. t
Jan.-Feb. 1908.

Prop. Dorado, in the lengthy conclusion of a previously published
article, reviews the statistical information bearing upon the rela¬
tion of alcoholism and crime; the parallel fluctuations of alcoholic
consumption and numbers of delinquencies; the various legal
measures which are in force in all countries which legislate on
this matter, either by penal measures, interdiction, control in
State establishments, or control for the purpose of reformation,
and finally examines the results of treatment in inebriate homes.
The author accepts without demur the statistical evidence in
favour of alcohol as an enormously important cause of criminality,
and pleads for the legal enforcement of asylum treatment for all
drunkards, whether they have committed breaches of the law or
not, the treatment to be curative and not punitive in aim. The
author is evidently not in agreement with the Spanish Minister of
the Interior (quoted by Dr Branthwaite, the English Inspector
under the Inebriates Acts Report for 1901), who said :
“ Fortunately the vice in question does not constitute a social
peril in Spain.” R. Cunyngham Brown.

IReviews

ELEMEN TS OF P8YOHOLOOY. Sydney Herbert Mellone, D.Sc.,
and Margaret Drummond, M.A. Edinburgh: Blackwood,
1907, pp. xvi, 483. Price, 6s.

The text-books on psychology recently published in this country
and America offer a perplexing problem to the student, both in
their number and in their variety of treatment. The present
volume is intended primarily for the beginner; it is mainly con¬
servative in its standpoint; the experimental and biological aspects
of psychology receive, it may be thought, inadequate considera-

320

REVIEWS

tion ; and the traditional order of subjects is inverted, the authors
proceeding from the complex to the simple, from Mental Activity,
Conation, Attention to Feeling and Emotion, from these to
Sensation, Perception, Memory, and Conception.

There can be no doubt that for the beginner the work admir¬
ably fulfils its purpose; it is written with an attractive simplicity
of style; the illustrations are drawn in many cases fresh from the
author’s own experiences, in others from the best experimental
work that has been done; the more difficult questions are referred
to in sections of smaller type than the main subjects; there are
many useful quotations from the more systematic works, and
ample references to the literature of psychology. Most teachers
will agree that Sensation and Perception are the hardest parts of
the subject for the average student; the attention given to them
at the beginning of a course is also apt to distort his view of their
importance relatively to Feeling and to Mental Activity. On the
other hand, no discussion of the latter is possible without referring
to certain classes of sensations—the organic and the kinaesthetic—
which, in fact, are dealt with by the authors in the chapters on
Feeling and Mental Activity, and therefore before the special
sensations. This seems neither a logical nor a practical order of
study. The real difficulties of Sensation and Perception must be
overcome rather by a more extended use of experiment. As Wundt
long ago argued, experiment in psychology does not merely aid
or control observation, it offers the only conditions under which
observation is possible. A mind trained to observe the characters
and changes of sensation will more readily appreciate the subtle
influences at play in Emotion and in Volition.

The more advanced student also will find much that is of value
to him in this manual; the greater questions of psychology are
treated broadly, impartially (with rare exceptions, perhaps), and
always with full references to the sources. The portions on
Mental Activity, on the Psychology of Learning (pp. 158 ff.), on
the psychological theory of Pleasure and Pain (250 ff.), and on
Memory (ch. xiii.) may be particularly referred to. Three marked
features of this more detailed work are: the application of the
“hierarchical conception” of the nervous centres (Hughlings
Jackson) to mental life (pp. 32, 71,113, etc.), the adoption of the
interaction theory of the relation of mind to body, and the abundant
use of the idea of “ psychological dispositions ” or tendencies, as
real factors, in the explanation of memory, habit, will, sentiment,
etc. It is doubtful whether the last two principles are consistent
with each other, and still more doubtful whether the argument
adopted in defence of interaction will hold, viz., that of a distinc¬
tion between the direction and the quantity of physical energy.
It is, however, a regrettable necessity that even elementary text-

REVIEWS

321

books in psychology most still contain polemical matter. It has
its uses, of course.

There can be little hesitation in placing this book among the
best of its kind. J. L. MTntyre.

DIE GES0HWUL8TE DES NBRVENSYSTEMS. Ludwig Bruns.

2te Auflage. Berlin: S. Karger, 1908.

This work is a standard one, and its second edition, appearing ten
years after the original, will be read with keen interest. The book
consists of three main divisions. The first of these deals with brain
tumours, the second with tumours of the vertebral column and
spinal cord, whilst the third is devoted to tumours of the cranial
and spinal nerves in their extra-cranial and extra-vertebral course,
and to paraneural neoplasms. Each of these subjects is treated
with the thoroughness and completeness which are to be expected
from the distinction of the author. In a short review it is im¬
possible to give more than a general idea of the wealth of clinical
observation here contained; every page is worthy of study, whilst
the clearness of thought and of diction is particularly commend¬
able, even in the most obscure and difficult divisions of the subject.
Another point which cannot fail to strike the reader is the author’s
candour when he deals with doubtful or disputed points, and the
scrupulous fairness with which he states opposing views, including
those contrary to his own.

Under the first heading, that of brain tumours, we find a
chapter devoted to the pathological anatomy of the different intra¬
cranial growths, including not only neoplasms proper, but infective
granulomata, parasitic cysts, and aneurisms. The etiology of brain-
tumours is then discussed. With regard to the curious predilec¬
tion of tuberculous growths for the posterior fossa, Bruns offers the
suggestion that this may be associated with the close connection
which subsists between the deep cervical lymphatic glands and the
posterior parts of the brain. As regards the influence of trauma
upon the subsequent appearance of a brain tumour, Bruns is of
opinion that in most cases the tumour is pre-existent to the
injury, and that trauma does not produce the tumour, but simply
renders it more manifest. He admits, however, that in cases of
tuberculous and syphilitic growths, trauma may conceivably deter¬
mine the locality of the mass, though it cannot be the prime cause.

There is an interesting discussion of the local effects of a
tumour upon adjacent and remote regions of the encephalon.
The symptoms of increased intra-cranial pressure he attributes,
with emphasis, to the accumulation and increased tension of the
cerebral fluid. To this increased fluid pressure he also attributes

322

REVIEWS

the main etiological factor in the production of one of the most
important clinical symptoms, choked disc. Bruns is a strong
supporter of the mechanical origin of optic neuritis, rejecting the
inflammatory and toxic theories.

The general symptomatology of brain tumours is then dealt
with. He distinguishes between focal symptoms proper, symptoms
of implication of neighbouring parts, and symptoms of affection of
distant parts. It is interesting to note that he denies any special
preponderance of psychical symptoms in frontal growths, in this
respect differing from the opinion of Beevor and most British
neurologists. Amongst clinical methods of examination, he calls
attention to the value of percussion of the skull, noting the degree
of local tenderness, and also the presence or otherwise of a peculiar
percussion-note, sometimes a crack-pot sound resembling that of a
pulmonary cavity. Such percussion changes, however, are of value
only when they coincide with other clinical localising phenomena.
By themselves they are insufficient for focal diagnosis. The crack¬
pot note, in particular, is not pathognomonic of tumour, but merely
indicates a local thinning of the cranial bones.

Then follows a most complete and accurate account of the focal
symptoms of tumours in the different parts of the encephalon.
Space forbids us to enter into details; the account is uniformly
excellent.

The course and prognosis of intra-cranial growths are then
discussed. Attention is drawn to the occasional, though rare,
cases of spontaneous improvement, and even of cure, as by calcifi¬
cation of tuberculous or other growths, coagulation of aneurisms,
etc. Bruns agrees with other observers in noting that gummata
are sometimes resistant to anti-specific treatment, and that certain
cases of tuberculous and even of sarcomatous growths may be
temporarily benefited by mercury and iodides. The list of con¬
ditions from which intracranial growths have to be distinguished
is a long one; it includes plumbism, anaemia, arterio-sclerosis,
migraine, empyema of accessory nasal sinuses, Meniere’s syndrome,
brain abscess, purulent and tuberculous meningitis, gummatous
disease of the meninges, dural hsematoma, cortical encephalitis,
cerebral haemorrhage, thrombosis and embolism, acquired hydro¬
cephalus, acute serous meningitis, multiple sclerosis, paralytic
dementia, epilepsy, trigeminal neuralgia, uraemia, hysteria, neuras¬
thenia, and hypochondriasis. All of these are carefully discussed.
The value of skiagraphy in certain cases is emphasised, and it is
pointed out that shadows may be cast not only in tumours, which
widen or deform the sella turcica, and by calcifying growths, but
occasionally by hard fibromata and other tumours. Bruns ap¬
proves, in certain cases, of Neisser and Pollack’s exploratory
puncture of the skull and brain with aspiration of a fragment of

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323

tumour. The conditions under which such puncture is justifiable
are, however, somewhat inconclusively stated. For example, he
suggests this procedure in cases where the diagnosis lies between
a frontal and a cerebellar growth, or where the physician is in doubt
as to which symptoms are focal and which the result of pressure
on adjacent parts. Many neurologists will be inclined to disagree
with this point of view.

The diagnosis of the nature of the growth is then discussed.
The importance of attempting a pathological diagnosis is empha¬
sised, in view of the fact that some growths (for example, sarcoma,
endothelioma, fibroma and neuro-fibroma, tubercle, cysticercus and
echinococcus cyst) are generally sharply marked off from the
neighbouring brain tissue by a zone of softening, whilst glioma
and carcinoma are truly infiltrating tumours, and have, therefore,
much less favourable chances of removal by operation. Accurate
pathological diagnosis is commoner in the parasitic cysts, especially
cysticercus, in aneurism and gumma and in certain cases of neuro¬
fibroma, and of course in metastatic carcinoma and sarcoma, whilst
it is difficult and often impossible in primary sarcoma, endo¬
thelioma, fibroma, cholesteatoma, and psammoma. Tuberculous
growths, in this respect, occupy a middle position.

In the diagnosis between a cortical and a sub-cortical growth
Bruns lays special emphasis on the value of local percussion of
the skull. The presence of tenderness and local alteration of
percussion-note he regards as strong corroborative indications of
a local cortical growth.

As to the surgical treatment of brain tumours, Bruns’s
statistics lead him to the conclusion that only some 35 per cent,
of intra-cranial growths are surgically removable. This does not
mean that only 35 per cent, are to be operated on, for palliative
operation should be recommended in many cases where enucleation
of the growth is impossible, such palliative operation being for
the purpose of relieving headache and of preventing blindness by
the relief of optic neuritis. This part of the book concludes with
an account of the methods of cranio-cerebral topography and of
electrical exploration of the cortex.

The second division of the book deals with tumours of the
vertebrae and of the spinal cord and its meninges. In view of the
relative frequency with which spinal caries produces secondary
changes in the cord, one could wish that this subject had been
dealt with as exhaustively as that of the neoplasms proper. Still
Bruns draws attention to the main points of resemblance and of
difference between vertebral growths and spinal caries. Curiously
enough he makes the statement that in caries, as contrasted with
neoplasms, herpes zoster has not yet been observed as a symptom.
This is not accurate, for I have seen at least one case of typical

2 a

824

REVIEWS

zoster from tuberculous disease in the neighbourhood of the corre¬
sponding spinal ganglion. In the diagnosis between tumours of
the vertebral column and those of the spinal meninges, Bruns
states the useful dictum that in vertebral tumours the sequence of
symptoms is first bony pain and deformity, secondly root-symptoms,
and thirdly symptoms of spinal cord affection, whereas in extra¬
medullary growths the sequence is firstly root-symptoms, then
spinal-cord phenomena, and bone symptoms last, if at all.

The difficulty of diagnosis between intra-medullary and extra¬
medullary growths is admitted. The chief points of value in this
connection are that in intra-medullary cases root-symptoms and
symptoms of interruption of spinal tracts occur practically con¬
currently and not successively one after the other, the stage of
pure root-symptoms being generally absent; further, in central
gliosis the symptoms are of syringomyelic type, whilst in tumour
or sarcoma of the anterior cornu the phenomena are those of a
rapidly progressive muscular atrophy of spinal type. Intra¬
medullary growths tend to produce bilateral symptoms from the
outset, instead of commencing unilaterally as in most extra¬
medullary growths.

As to the prognosis of spinal-cord tumours, Bruns points out
that in spite of their infrequency (occurring only one-sixth as often
as brain-tumours), they are relatively much more amenable to
surgical treatment, and therefore once the diagnosis is established
(gummata being excluded), operation should be urged. The older
the patient, the more likely is the growth to be capable of complete
removal.

The third and last division of the book deals with tumours of
peripheral nerves—neuromata, and of structures in their neigh¬
bourhood—para-neural tumours. The true and false neuromata,
with all the subdivisions of the latter, are well described, together
with the tuberculous, gummatous, and leprous affections of the
peripheral nerves.

The book is sure of a wide circulation amongst clinicians; its
possession, in fact, is well-nigh indispensable to the neurologist.

Pubves Stewart.

8TUDIEN TIBER POLIOMYELITIS AOTJTA. (Zugleich ein Beitrag
zur Eenntnis der Myelitis acuta.) Ivar Wick man. Berlin:
Karger, 1905, M. 6.

BEITRAOE ZUR EENNTNIS DEB HEINE-MEDINSOHEN ERANE-
HEIT. (Poliomyelitis acuta und verwandter Erkxankungen.)

Ivar Wickman. Berlin: Karger, 1907, M. 6.

These two volumes form an important contribution to our
knowledge of acute poliomyelitis and allied diseases. The

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325

author has combined the names of Heine, who was the first to
show the existence of a lesion of the spinal cord, and of Medin,
who first described the epidemic form of the disease, to include
the different forms which were found to occur during the extensive
epidemics in Sweden in 1905.

The first-named work gives an account of a series of cases
of acute poliomyelitis, and of the microscopic and macroscopic
appearances found in thenn It is illustrated by beautiful micro¬
photographs of the pathological changes present, and the writer
summarises his views as to the nature of the disease in a number
of conclusions, of which the following are the most important:—

(1) Acute poliomyelitis is a disseminated infiltrative myelitis,
associated with oedema and interstitial changes, which may be
limited to the neighbourhood of individual ganglion cells, or to
groups of these, being as a rule most marked in the cervical
and lumbar enlargements.

(2) The changes are not limited to the anterior horns, but may
extend to the rest of the grey matter in the lumbar and lower
dorsal regions, affecting the columns of Clarke as severely as
the anterior horns, or even more so.

(3) The changes may also extend to the white matter and
to the pia mater.

(4) The cellular infiltrations are related to all the vessels,
arteries, and veins, whether central or peripheral, and show no
preponderating dependence on the central artery.

(5) There is no evidence of an embolic origin of the disease.

(6) The interstitial and parenchymatous changes have an
approximately parallel course, and there is some evidence that
the pathological changes depend more upon a lymphatic than
upon a vascular spread.

(7) No bacteria have been shown to be the cause of the
disease.

(8) The changes in acute adult poliomyelitis are entirely similar
to those in the infantile spinal paralyses, and the main cause of
the destruction of the nervous elements must be looked for in the
interstitial inflammation.

The second volume is dedicated as a Festschrift to Professor
Medin, of Stockholm, on his sixtieth birthday, in honour of his
being the first, in 1890, to bring before the profession, at the
International Medical Congress in Berlin, the epidemic form of
the disease, to show that poliomyelitis is intimately related to¬
other processes in the medulla, pons, and cerebrum, and to prove
the teaching of Striimpell and Marie as to the infective nature
of the disease. In it Wickman classifies the cases according to
various forms:—(1) Poliomyelitic form ; (2) Form of Landry’s
paralysis; (3) Bulbar or pontine form; (4) Encephalitic form;

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32 $

(5) Ataxic form; (6) Polyneuritic form; (7) Meningitic form;
(8) Abortive forms. The symptomatology of each of these is
fully described, and the writer gives a valuable discussion of the
relationship of the polyneuritic to the poliomyelitic form, as well
as of their relationship to the meningitic variety. He goes into
the question of the Swedish, epidemic of 1905 in great detail,
showing that it was most prevalent from July to October; that
it spread all over Sweden from north to south in an irregnlar
manner, following lines of communication, and involving the
country districts more than the towns (72 town cases as against
959: country ones); that it tended to occur in foci, and to be
carried by the intermediation of healthy persons, themselves
unaffected, as well aa by direct contact, and that it might affect
several persons in the same family or house, lingering in a
neighbourhood from one to several months.

The author states that prognosis as to life is unfavourable to a
degree that has not hitherto been believed, and that in older
children and in adults it is much more grave than in younger
children, but that prognosis as to complete recovery is, on the
other hand, much less serious than is generally accepted, in so
far as numerous cases (those included under “abortive forms”)
have no paralysis, and that not a few in which paralysis has
occurred completely recover. Alexander Bruce.

PATH0L0GI80H • ANATOMISOHE UNTER8UOHUNGEN USER
AKUTE POLIOMYELITIS UND VBRWANDTE KRANK-
HEITEN VON DEN EPIDEMIEN IN NORWEOEN, 1903-
1906. Francis Harbitz und Olaf Scheel. Christiania:
Dybwad, 1907.

The authors describe a number of cases of acute poliomyelitis which
came under their observation during the epidemics in Norway, and
discuss their pathological conditions, as well as the etiology and
pathogeny of acute myelitis.

This valuable work is illustrated by a series of coloured plates,
which show very beautifully that the incidence of the disease is
not limited to the anterior cornua, but that the inflammation may
affect the posterior cornua and the white matter of all the columns,
as well as the pia mater, and that it is not limited to the spinal
cord, changes of vascular congestion and round-celled exudation
being found in the whole of the central nervous axis. The work
materially supports that of Wickman, and broadens our knowledge
of the distribution, etiology, and nature of acute poliomyelitis.

Alexander Bruce.

REVIEWS

327

DEB FTJHKTIOWEN DEE HBRVENOENTBA. Prof. Dr W. v.
Bbchterew. Deutsche Ausgabe von Dr Richard Wein¬
berg. Erstes Heft Jena: Gustav Fischer, 1908.

This volume, which extends to almost 700 pages, is the work of a
veteran neurologist who has already enriched the literature of his
subject by several standard works. It is a German edition issued
by Dr Weinberg in conjunction with the author, and as such is
accessible to a larger circle of readers than it would be if published
in the Russian language.

The first 82 pages are taken up with a description of the
-different experimental and clinical methods that have been em¬
ployed in investigating the functions of the central nervous system,
and with a general review of the physiology of nerve conduction,
reflex action, inhibition, and co-ordination. The relationships
between afferent (sensory) and efferent (motor) impulses are con-
aidered, and the importance of the state of the posterior roots of
the spiual nerves in all limb and body movements is emphasised.

The rest of the volume is devoted to a consideration of the
various nerve centres in the spinal cord and medulla oblongata,
and of the nervous mechanisms by which these govern and control
the functions of the different organs of the body. These are given
in great detail, and the descriptions are illustrated by many
original schemata. The last chapter is taken up with the con¬
ducting paths in the spinal cord.

The value of the book is increased by the fact that in it is
•embodied much original work by the author and his pupils, which
has not been published elsewhere. It contains a very full biblio¬
graphy, and as a work of reference it will be of great value. The
recent teaching of Sherrington on reciprocal innervation does not
appear to be duly appreciated. Sutherland Simpson.

J.ES TRAITEMENTS DU GOITRE EXOPHTALMIQUE. Paul
Sainton et Louis Dxlhkrmx. Paris: J. B. Baillifere et fils,
1908. Pp. 96. Price, 1.50 fr.

As Professor G. Ballet says in his Preface, “il n’y a pas un traite-
ment, mais des traitements.” Each case must be treated on its own
merits. A choice of methods must be made, and this little
volume, where they are all passed in review, and their value
criticised, and the indications and contra-indications given, will
give considerable help in this often difficult task. The authors
recommend serum of dethyroidised animals in large doses for
typical cases. Electricity, particularly galvano-faradisation, should
be regularly tried. Among drugs they give sodium salicylate the

328

REVIEWS

first place, and quinine the next, but varied symptomatic treat*
ment is often required. Surgical treatment is rarely urgently
needed, but should, they say, be unhesitatingly employed in acute
cases, in cases tending rapidly towards cachexia, and where the
thyroid is giving rise to signs of compression. In the majority of
cases the attack will be along several lines concurrently, isolation,
hydrotherapy, psychotherapy, electricity, and serotherapy perhaps
all being employed at the same time. J. H. Harvey Pirie.

A MIND THAT FOUND ITSELF: AN AUTOBIOGRAPHY.

Clifford Whittingham Beers. London: Longmans, Green

& Co., 1908, Pp. 363. Price 7s. 6d. net.

Whatever the result of this book may be with regard to the
object which the author has so much at heart, there can be no
question that it is full of interest to the student of mental
disorder and to every one engaged in the care of the insane.
It is a very full and detailed record by the author of his
own case and of his experiences during three years of treat¬
ment in various institutions in America. For over two years
he was depressed and full of morbid suspicions. He then
abruptly, after one link in his chain of morbid ideas was de¬
molished, experienced a complete readjustment, but passed into
a state of marked elation with continual activity and great over¬
productivity both in speech and writing. After his recovery from
this second phase he had one later attack. The patient was
treated in a Sanatorium, a Private Hospital, and a State Hospital
for the Insane, and the details of the treatment and the effect of
the treatment upon him at the time are the main theme of the
work. The flaws in the care of the insane, the unsatisfactory
nature of the attendants in some cases, the evil effects of the old-
fashioned strong rooms and artificial forms of restraint are insisted
on. But, while the patient on recovery felt bitterly with regard
to certain episodes in his treatment, the book is written with
moderation, and with a serious desire to do away with certain
abuses which are only tolerated in the present day owing to the
neglect of the public and owing to the deadening effect of routine
on the administrative mind. The presentation of the subject may
naturally be somewhat coloured by the personality of the author,
and several additional facts might be added in order to adjust the
perspective, but the book is one which cannot but be of use to any
one who has to care for patients suffering from mental disorder.
It is written especially for the American public and deals with the
local situation, but it has an important lesson for a country like
Great Britain, where, in a large number of the asylums, there is no

REVIEWS

329

adequate provision for the treatment of cases of excitement, and
where, instead of the continuous hath, the physician has the alter¬
native of employing either chemical restraint or padded rooms,
treatment now recognised on the Continent to be obsolete.

The author does not minimise the practical difficulties in the
way of a solution of the question, and in the second half of the
book he brings forward suggestions as to practical methods of
remedying existing evils. There are five appendices: “ Mechani¬
cal Restraint and Seclusion of Insane Persons,” by Charles W.
Page; a report of the American Consul-General at Berlin, entitled
“ Modern Hospital for the Insane,” describing the new psychiatric
clinic in Munich, the most modern in Germany; official statistics
of "Insane and Feeble-Minded in Hospitals and Institutions,
1904 ”; a description of the working of the Pavilion for Mental
Diseases in the Albany Hospital; certain strictures by Professor
Allen Starr on nursing in private insane asylums.

C. Macfib Campbell.

A MEDIOO-PSY OHOLOGIOAL STUDY OF ALFRED DE MUSSET.

(Etude m&Lico-psychologique sur Alfred de Musset.) R. Odinot,

Thhes de Lyon, 1906-1907. No. 13.

This thesis, inspired by Professor Lacassagne, contains an interest¬
ing study of the celebrated poet. The morbid character of Musset’s
genius is illustrated both by the remarks of his contemporaries
and by quotations from his works. His heredity was good, but
from infancy he was of an extremely irritable and melancholy dis¬
position. Odinot describes Musset as a superior degenerate,
characterised by impulsiveness, instability, aboulia, and obsessions.
In this degenerate soil symptoms of hysteria and neurasthenia
developed. Musset commenced his first alcoholic excesses at
puberty and continued them through life. He also indulged freely
in opium and tobacco. During his stay at Venice with George
Sand he contracted malaria, which was probably the cause of his
subsequent deafness, auditory hallucinations, and aortic incom¬
petence. Though frequently exposed to infection, he does not
appear to have contracted syphilis. His moral and physical
decadence dated from ten years before his death, being determined
by excesses of all kinds, and not least by the “ Green Muse ” of
absinthe, from whom he had sought consolation and inspiration.

His death at the early age of forty-seven from aortic incom¬
petence was preceded for some years by anginal attacks, for which
opium was freely taken. A remarkable symptom of his aortic
disease during the last few years of his life was a jerk of the head
corresponding to each cardiac systole. This phenomenon has since
been known as Musset’s sign. J. D. Rolleston.

330

REVIEWS

CROWD SUGGESTION AND PSYCHICAL CROWD EPIDEMICS.
(Uber Massonsuggestion and psychische M&ssenepidemien.)
Professor Hans Gudden, Verlag der Aerztlichen Rundschau,
Miinchen, 1908. M. 0.75.

This is a popular lecture detailing some of the better-known facts
and instances of crowd suggestion. The psychological differences
in crowd behaviour and individual behaviour are pointed out—
rather on the lines of Sidis’ work on the psychology of suggestion
—but the origin and significance of them is not inquired into.
The volume contains nothing—beyond a few recent examples—
that may not be found fully discussed in the classic work of Le Bon.

Ernest Jones.

ZUR PSYCHOLOGIES DBS FALLES MOLTKE. Georg Merzbach
(ofBerlin). Berlin: A Holder, 1907-8. Pp. 44.

This brochure is one of the products of the late somewhat un¬
savoury case of Harden-Moltke which created so much interest in
social and political circles in Germany. The author, a personal
friend and medical adviser of Moltke’s family, was not permitted
in Court to make any complete statement on the matter at issue.
He therefore takes this opportunity to lay before the public his
conviction that Count Moltke was quite free from homo-sexual
tendencies. He gives a slight sketch of the facts upon which he
bases his views, and analyses the psychopathic personality of the
divorced wife of the Count. The work is interesting from the
medico-legal point of view, but has no wider bearing than the
elucidation of the individual case. C. Macfie Campbell.

BOOKS AND PAMPHLETS RECEIVED.

Wm. A. White. “ Outlines of Psychiatry." New York, 1908, $2.00.

K&uffmann. “ Beitrage zur Pathologie des Stoffwechsels bei
Psychosen. Erster Teil: Die progressive Paralyse.” Fischer, Jena,
1908, M. 6.

“ Neuropathological Papers,” 1906 and 1907. Harvard University Medical
School.

Fabritus. “ Studien viber die sensible Leitung im menschlichen RUcken-
mark auf Grand klinischer and pathologisch-anatomischer Tatsachen.”
Karger, Berlin, 1907.

Tycho Tullberg. “ Linn^portratt. Vid Uppsala Universitets Minnefest
pa Tvahundraarsdagen af Carl von Linnla.” Stockholm.

“ Department of Neurology ; Harvard Medical School,” vol. iii. Boston,
Mass., 1908.

IRevlew

WeuroloGE ant> iftsipcbiatrp

Original articles

A NOTE ON AN ASSOCIATED MOVEMENT OF THE
EVES AND EARS IN MAN.

By S. A. K. WILSON, M.B., B.Sc., M.R.C.P.,

Registrar to the National Hospital, Queen Square, London.

Some time ago, in the course of an examination of a case of
syphilitic paraplegia in the National Hospital, under the care of
Sir William Gowers—who has kindly allowed me to refer to it
—my attention was drawn to a curious and constant phenomenon
exhibited by the patient. As I was testing the lateral move¬
ments of his eyes, I noticed that when the latter were strongly
deviated to one or other side the helix of the homolateral pinna
curled backwards slowly and deliberately, chiefly in its middle
part, just as the eyes attained the extreme position, and
that it resumed its normal place as the eyes returned. This
movement was constant in its appearance, and easily demon¬
strable, and it was shown to various members of the Staff of the
Hospital, who corroborated my observation. I found that the
heterolateral ear behaved similarly, though in its case the
posterior edge of the pinna did not curl quite so far round.
When the patient looked to the right both ears moved in this
way, the right more than the left, and vice versd when he looked
to the left. There was no movement of the pinna as a whole, i.e.
the extrinsic muscles of the ear were not concerned; what
R. OF N. & P. VOL. VI. NO. 6—2 B

332

S. A. K. WILSON

happened was that the helix curled towards the cranium and,
when viewed from the front, partially disappeared behind the
antihelix. The patient was unable, nor had he ever been able,
to move his ears voluntarily, as some can. Further, he was
unconscious of the movement that I have been describing.

If the accompanying photographs of the patient are examined
carefully, it will be seen that in Fig. 1, which is a full face view,
the outer edge of the right helix is opposite a point on the scale
which corresponds to : it is between the 8f and the 8f
marks. The helix of the left ear is opposite a point between
the marks for 17| and 17^, being rather nearer the former: it
will suffice if we say it corresponds to 17^. When the patient
turns his eyes conjugately to the right, as in Fig. 2, his head re¬
maining immobile, we see at once that the contour of each pinna
has changed. The outer edge of the right helix is now opposite
a point corresponding to 8}$, while the left helix is opposite 17.
According to this measurement the upper part of the homolateral
helix has curved back about £ of an inch, while the heterolateral
helix has moved through about fa of an inch. As a matter of
fact, however, the scale has been fastened a little too high, for a
glance at the figure will show that the lower part of the right
helix has moved through a space of considerably more than £ of
an inch, and has disappeared behind the antihelix, while the left
helix has moved rather more than fa of an inch, but still not so
much as its fellow of the homolateral side. A photograph taken
with the eyes deviated to the left shows a similar condition, the
left ear having moved rather more than the right.

The movement of the ears in this patient’s case having pre¬
sumably nothing to do with the disease from which he suffered,
I examined a series of fifty individuals (men) from the point of
view that concerns us here. No one knew beforehand the object
of the investigation, and all, as far as could be ascertained, were
free from any cranial nerve defect. Many were in a state of
normal health. The method was simply as follows:—The in¬
dividual was seated with his head resting on some convenient
support and kept strictly in the mid-plane, either voluntarily or
steadied by my hand. He was then asked to look as far as he
could to one or other side; sometimes he was directed to follow
the tip of my finger as it was moved round.

Of these 50 individuals, 30, or 60 per cent., showed no

Plate 18 ,

Fig.

ASSOCIATED MOVEMENT OF THE EYES AND EARS 333

movement of the piuna that could be detected. The other 20
did exhibit some movement; 6 gave a movement of the right ear
on looking to the right, and of the left ear on looking to the left
(in 2 of these cases the movement of the left ear was obviously
greater than the movement of the right); 5 gave a similar homo¬
lateral movement from either side, and in addition showed a
synchronous heterolateral movement which was greater than the
homolateral movement (in one of these cases the curling back of
the pinna of the left ear when the subject looked to the right was
more evident than that of the right ear when he looked to the
left; in another exactly the opposite condition was noted); 2
showed a similar state to the 5 above mentioned, except that the
synchronous heterolateral movement was less than the homolateral
movement; 5 gave a movement of one homolateral helix only
(in 4 of these it was the left ear); one revealed only a hetero¬
lateral movement, the right ear curling when the eyes were
directed to the left; and one gave a homolateral and a heterolateral
movement from one side only, viz., when he looked to the left.

Thus in no fewer than 40 per cent, a movement of one or
other ear was noticed, and in 13 of the 20, or 26 per cent, of
the series, a homolateral movement was obtained from either side.

In none of the subjects examined was there a movement of
the pinna as a whole; and though some were able to move
their ears voluntarily, this power bore no relation to the occur¬
rence of the particular movement under consideration; further,
none of them could reproduce voluntarily this peculiar pheno¬
menon, which consisted, as has been said, in a curling movement
of the helix and posterior part of the pinna about its middle
towards the side of the head.

It is, I think, clear that this deviation of the helix must be
due to contraction of the transversus auriculse muscle, which
is placed on the cranial surface of the pinna, and consists of
scattered fibres, partly tendinous and partly muscular, extending
from the convexity of the concha to the prominence correspond¬
ing with the groove of the helix (Gray). In its contraction
it probably tends to open the orifice of the meatus; and it
is the homologue of an intrinsic ear muscle which possibly
attains a greater development lower in the scale of animal
creation.

That this little muscular sheet, and it alone, should be

334

S. A. K. WILSON

innervated in association with lateral deviation of the eyes seems
to me to be a curiously interesting fact, and yet it is not more so
than other associated movements with which we are familiar. If
we close the eyes tightly we often are aware of a low rumbling
sound in the ears which, in all probability, is not the muscle
sound of the contracting orbiculares, but is an associated move¬
ment of the tensor tympani. The orbiculares are supplied by
the seventh cranial nerve, while the tensor tympani is innervated
by a motor filament from the otic ganglion probably coming
from the facial by the small superficial petrosal. When the
eyelids are shut the eyeball rolls upward in association; the
superior rectus and the inferior oblique receive their supply from
the oculomotor nerve. Sometimes the opening of the mouth
is associated with a synchronous elevation of the upper eyelid,
and the assumption has been made that there must be twigs
from the motor fifth going to the levator palpebrse superioris.

In a consideration of these and other instances that might
be cited, we should direct attention to the association of move¬
ments rather than the association of muscles. There is no
justification for the supposition that when certain of the muscles
in a particular nerve distribution are innervated, some neighbour¬
ing minute nerve filament going to some insignificant muscle
possesses some special property whereby it is inevitably inner¬
vated at the same time. We gain a truer conception of the
significance of the elevation of the eyelid with opening of the
mouth, or of the upward rotation of the eyeball with closure of
the eye (4), if we consider the association as one of movement
and not of muscles. Let us bear this in mind in the discussion
of the associated movement which is the subject of this paper.

There is no obvious anatomical explanation of the association
in contraction of a minute muscle, supplied by a correspondingly
minute twig of the seventh, with a pair of other muscles acting
in unison under an impulse from the sixth nerve nucleus or a
supranuclear centre. And not only so ; there is no necessity
even to seek an anatomical reason when we remember the
general principle that anatomical juxtaposition does not involve
functional co-operation. We must look for a clue to the
phenomenon in a physiological and ontological direction.

It has long been thought that in the anterior and posterior
colliculi we have a centre, at least in animals, for certain

ASSOCIATED MOVEMENT OF THE EYES AND EARS 335

combined movements of the eyes and ears. On stimulation of
the anterior corpora quadrigemina in monkeys, Ferrier (2) found
that “irritation of the one side causes the opposite pupil to
become widely dilated. . . . The eyeballs are directed upwards
and to the opposite side. . . . The ears are strongly re¬
tracted. . . . Irritation of the posterior tubercles causes the
same . . . general motor symptoms.” Bechterew (1) records:
“ Es i8t interessant hier zu vermerken dass Ich zuweilen nach
der einseitigen Verletzung des hinteren Zweihiigels bei Kaninchen
beobachten konnte dass das Thier in der ersten Zeit nach der
Operation die contralaterale Ohrmuskel nicht aufrichtete. . . .”
And, on stimulation, “ Die Augapfel werden vor allem nach der
entgegengesetzten Seite hin abgelenkt und die gegeniiberliegende
Ohrmuskel nach aussen gedreht und aufgerichtet.” Prus (5)
found that from various parts of the anterior colliculus he could
make the ears turn in various directions, and the eyes move
conjugately to the opposite side, and he noted, in addition, that
these movements of the eyes and ears persisted on stimulation,
even though the surface of the colliculus was cocainised. The
assumption, therefore, is that they are the direct result of the
stimulation, and not reflex in origin. From the posterior

colliculus he obtained deviation of the eyes to the opposite side,
but no ear movements. On the other hand, Thiele (6) states that
“ stimulation of the lateral aspect of the posterior corpora

quadrigemina gave rise to no movements of the eyes. . . .
Stimulation of the fillet, however, gave rise uniformly to pricking
and turning back and down of the contralateral ear, and
rotation of the eyes to the contralateral side — the move¬
ments . . . being of a similar nature to those that would

naturally occur from the stimulation of the ends of the contra¬
lateral auditory nerve, the animal, of course, turning its head and
eyes to the side from whence the sound came, and pricking the
ear towards it to localise it” Sir Victor Horsley (3) also has
referred to this point: “ I have made many observations on
excitation of the colliculi, anterior and posterior . . . and in the
cat, dog, and monkey have observed . . . that faradic excitation
of the outer surface of the posterior colliculus evokes . . .
marked rotation of the pinna of the contralateral ear. . . . Not
infrequently the homolateral rather than the opposite ear moves,
but the character of the movement is the same, viz., rotation for

336 ASSOCIATED MOVEMENT OF THE EYES AND EARS

better audition. . . The close propinquity of the fillet to the
corpora quadrigemina makes it possible that the results of earlier
experiments are, in part at least, attributable to spreading of the
stimulus to the former structure.

It is patent, both from experimentation and clinical ob¬
servation, that in many animals a functional association of the
eyes and ears is frequent; conjugate deviation of the eyes to
one side is accompanied by pricking and rotation backward of
the corresponding ear—an association of movement which is
obtainable experimentally by stimulation of centres superior to
the lower neurones. It is as though the animal makes this
movement or movement-complex in response to an auditory
stimulus; the eyes look in a certain direction; the ear is
pricked or rotated to catch a sound. The action of the trans-
versus auriculae, as has already been said, is one which tends to
open the orifice of the meatus, and thereby to aid audition ; and
it is therefore not improbable that the universal habit of turning
the eyes in the direction of a faint sound is no meaningless
movement, but a method, unconscious though we be of it, for
increasing our chances of catching the sound by enlarging the
mental opening. I venture to suggest that in this functional
connection of the transversus auriculae with conjugate deviation
of the eyes we have a remnant of an associated movement that
is of widespread occurrence among the lower vertebrates. It is
conceivable that individuals in whom the phenomenon is not
forthcoming may not have the intrinsic ear muscles adequately
developed. In the anthropoid apes the transversus auriculae i3
well marked, but below them little definite is known as to the
development it attains.

Bibliography.

1. Bechterew. “ Der hintere Zweihugel als Centrum fur das Gehor, die
Stimme und die Reflexbewegungen.” Neur. Centralbl., 1895, p. 706.

2. Ferrier. “ The Functions of the Brain,” 1886, p. 166.

3. Horsley. “ On a Trigeminal-aural Reflex in the Rabbit.” Brain, 1905,
p. 67.

4. Polimanti. “Sur le phenomfene de Charles Bell.” Nouv. Icon, de
la Salpttr., Nov.-Dec. 1907, p. 608.

5. Prus. “ Untersuchungen liber elektrische Reizung der Vierhugel.”
Wien. klin. Wochensch., 1899, p. 1124.

6. Thiele. “On the Efferent Relationship of the Optic Thalamus and
Deiters’ Nucleus to the Spinal Cord,” etc. Joum. of Physiol., 1905, p. 358.

Plate 10.

Fio.

A CASE OF PARTIAL PTOSIS

337

A CASE OF PARTIAL PTOSIS WITH EXAGGERATED
INVOLUNTARY MOVEMENT OF THE AFFECTED
EYELID: The “Jaw-winking” Phenomenon.

By WILLIAM GEORGE SYM, M.D.

The features of this case are these: A. J., a young woman of 30,
came to me from the North of England complaining of two things,
namely partial ptosis on the left side, and secondly (and from her
point of view more importantly) that at times the left upper lid
executed involuntary and “ ridiculous ” movements. On examina¬
tion I found that the only fault to be found with either eye was
that which is well illustrated in the two accompanying figures
(PL 19, figs. 1, 2). There was a very distinct degree of ptosis
of the left upper eyelid, the levator of which, however, was by no
means paralysed, for within limits it enjoyed ready and free move¬
ments. Movements of the globe were perfect; there was not
a trace of halting or failure to look upwards or in any desired
direction. When, however, the patient was chewing her food or
when she was singing, the left upper lid, one might almost say,
sprang upwards, disclosing perhaps as much as 3 mm. of white
sclerotic above the comeo-scleral junction. It was this really
which had distressed the patient so much, for she could not take
food in the presence of strangers without remarks being made
upon the curious appearance of her eye, nor could she, though
very fond of music, sing before others, for the same reason. I
exhibited the patient to Dr Bruce as an example of what has been
—very inelegantly — called the jaw-winking phenomenon, and
together we investigated the case further.

There was very distinct elevation of the eyelid on use of the left
external pterygoid muscle (moving the jaw to the right), but it was
merely a partial lift, a sort of exaggerated twittering of the eyelid
up and down; when, however, she suddenly opened the mouth by
actively depressing the lower jaw, the lid sprang up in the manner
shown in the second photograph. There was at the same time no
exophthalmos or any alteration of the pupil; vision was good and
equal. When the lid flew up there was no corresponding move¬
ment of the right upper lid, there was no corrugation of the
forehead, nor was there any untoward movement of the eye itself,
whether lateral, vertical, rotatory, or antero-posterior. Nor was

338

WILLIAM GEORGE SYM

there any evidence which might point to any affection of the
sympathetic on one side, such as unilateral sweating or flushing.
The condition had been present all the patient’s life; she could
not say there was any change from childhood. She had no sensa¬
tion of anything happening; it was the obvious, unpleasing facial
contortion which had brought her, nothing else.

The first case of the kind was described by Marcus Gunn in
1883, and since then some twenty to thirty cases have been
noticed. Mr Gunn showed his patient at a meeting of the
Ophthalmological Society, a committee of the members of which
afterwards reported upon the case. The patient was a girl who
presented very similar symptoms to those of A. J., only that the
involuntary movement of the eyelid came on rather with lateral
movement than with vertical opening of the mouth. The com¬
mittee which investigated the case came to the conclusion that
probably the levator was innervated partly from the nucleus of
the third nerve and partly from the external pterygoid portion
of the nucleus of the fifth nerve, and that there was an abnormal
connection between the two. If some of the innervation of the
lid (which is evidently defective) arose from the fifth nucleus, that
would account for the appearances.

Much the most important paper written on this subject will
be found to be that of Sinclair of Ipswich, who in 1895 collected a
number of cases of associated movement, and reviewed them in
the Ophthalmic Review for October of that year. These he divides
into three series, of which the first consists of those in which
certain movements of the lower jaw are associated with an upward
movement of the eyelid; the other two series do not concern
us at present; they are of quite a different type. Our present
case would fall to be included in his first group under Series L, for
that includes cases in which either lateral movement or wide
opening of the mouth brings on the elevation of the eyebrow.
The second group takes in the cases in which depression of the
lower jaw alone brings on the elevation; in the third group are
those cases in which lateral movements of the jaw alone, as in the
process of chewing, set up the contraction, but vertical move¬
ments do not. In some few of the cases the untoward movement
only took place when the eye was also looking down; that was
not true of the present case. It is a curious fact that out of
twenty-five cases in which the point is noted, the error was on the

A CASE OF PARTIAL PTOSIS

339

right side only in seven; in all the others it was left-sided.
Although ptosis was present in nearly all, the associated move¬
ment was noticed in a very few without any ptosis existing. It
has often been remarked upon that if one endeavours to induce a
child to open the eyes widely he is very apt to open his mouth
instead or in addition, and all the more so should there be any
blepharospasm at the time. Ole Bull and others consider that
such a movement is simply reflex, and that the special form we
are discussing is analogous to it. But Sinclair is perfectly correct
when he points out several objections to such an idea, particularly
that in some cases it is on lateral movements of the jaw only that
the symptom occurs, that the symptom is one-sided only, and that
in the children spoken of the attempt to elevate the lid is carried
on by the frontalis muscle, and the facial aspect is therefore
entirely different. The explanation offered by the committee on
Gunn’s case is much more satisfactory, namely, that the levator
receives nerve impulses both from III. and V. nerves. Helfreich
has suggested that the abnormal fibres might perhaps come from
the facial. In a certain number of the cases it may be true, as
suggested by some, that there may be imperfect development of
the oculo-motor nucleus; but, as we have just mentioned, ptosis is
not invariably present.

A singular paper on the subject has been written by Harman,
who endeavours to explain the association of lid-movement along
with jaw-movement, “ not as a ‘ freak,’ but as a revival of an old-
time and long-accustomed associated movement.” He traces the
facial musculature back to our ancestors the fishes, where it forms
the spiracular musculature, the pterygoid muscle of man being
the lineal descendant of the deep gill-muscle which moves the
maxillary cartilage. He considers that as the eye, in the process
of development, became a more mobile organ than primitively it
was, it filched from the spiracle its muscular apparatus, and thus
in man a case will now and then turn up in which this atavistic
association between jaw on the one hand and spiracle-modified-
into-mobile-eye on the other is manifested. His conclusions are
not, it must be confessed, very convincing.

To sum up, there does not appear to be any other probable
explanation of this curious association than that in some inex¬
plicable way there arises some confusion in the joining up of fibres
and cells belonging to the fifth and third nuclei in such fashion

340

A CASE OF PARTIAL PTOSIS

that the levator receives less than its normal innervation, and there
is therefore a certain degree of ptosis (though this is not a neces¬
sary part of the error), but there is no paralysis of the muscle,
which is capable of full contraction ; at the same time, the levator
receives some fibres which were “intended for” the external
pterygoid or the digastric, and when that muscle is put in action,
at all events when put strongly in action, the levator is unin¬
tentionally innervated, producing the curious effect described.
When examining the present case along with me, Dr Bruce put
forward tentatively the suggestion that the elevation of the lid
might be caused by undue contraction of the unstriped muscle of
the lid, and it must be admitted that the appearance of the eye is
not unlike the familiar aspect in exophthalmic goitre; but I think
myself that the contraction is too sudden and swift to be due to
the unstriped muscle, and the unusual nature of the aspect is due
to the fact that we never see the levator act under normal con¬
ditions without the elevator muscles of the globe. Thus we never
see that gap of sclerotic between the upper limit of the cornea and
the edge of the upper lid which is so well brought out in the
photograph as occurring in. this patient. We should take along
with this ca^e, too, those others in which other muscles supplied
by the third nerve have had their innervation mixed up with that
of the jaw muscles, causing the globe to take up an abnormal
position or the pupil to contract.

Since 1895, when Sinclair analysed the cases published up to
then, I am only aware of two other examples, those of Fischer and
Harman, shown at the Ophthalmological Society in 1889 and 1903.
The matter receives recognition in very little of the recently
published literature dealing with the eye and the nervous
system.

Hbstracts

ANATOMY.

THE DEVELOPMENT OF THE MAMMAT.TAN PITUITARY AND
(285) ITS MORPHOLOGICAL SIGNIFICANCE. P. T. Herring,
Quar. Joum. of Exper. Physiol., Vol. i., No. 1, p. 161,
April 1908.

In mammals the epithelial portion of the pituitary is divided
entirely from the ectodermic wall of the buccal iuvagination

ABSTRACTS

341

known as Rathke’s pouch. The epithelium is differentiated at
an early stage into two parts. One, the pars intermedia, is closely
adherent to the wall of the cerebral vesicle from its earliest
appearance and remains attached to it throughout life. It tends
to arrange itself over the adjacent surface of the brain in positions
where it can approach as near as possible to the cerebro-spinal
canal. The other portion of buccal epithelium situated in the
lower portion of Rathke’s pouch gives rise to the anterior lobe
proper, and forms a solid mass of cells which grows into neigh¬
bouring blood-vessels and into the cavity of the pouch itself.
Part of the cavity persists to a greater or less extent as the
epithelial cleft.

The infundibulum is an invagination of part of the wall of the
thalamencephalon which is adherent to the anterior and upper
wall of Rathke’s pouch, and possesses, therefore, an epithelial
covering derived from the latter. The infundibulum with its
covering becomes the posterior lobe of the pituitary.

The intimate nature of the connection between the wall of
Rathke’s pouch and the cerebral vesicle, and the maintenance of
this close relationship throughout life, render probable the view
adopted by Kupffer that the pituitary body of mammalia is to be
regarded as the representative of an old mouth opening into the
canal of the central nervous system. Such an arrangement exists
in its simplest form in the Ascidian larva. A connection is some¬
times seen in the developing cat between Rathke’s pouch and the
interior of the infundibulum, these cavities being continuous for a
short period of foetal life. Author’s Abstract.

“ THE HISTOLOGICAL APPEARANCES OF THE MAMMALIAN
(286) PITUITARY BODY.” P. T. Herring, Quar. Joum. of Exper.

Physiol ., Yol. i., No. 2, April 1908.

The pituitary differs widely in shape and in the arrangements of
its constituent parts in various mammals. In aH there is a solid
glandular lobe permeated by wide blood channels or sinusoids,
and an intermediate part of epithelial cells closely connected
with a third portion which consists of nervous tissue derived
from the brain. The pituitary bodies of mammals may be roughly
divided into three types, according to the degree in which
the infundibular cavity is prolonged into the nervous lobe. In
the cat the cavity runs almost to the posterior margin of the lobe,
in the dog it stops short in the neck, and in man, monkey,
and other animals examined the neck and posterior lobe are
usually solid, although a narrow lumen is sometimes continued
into them.

The anterior lobe consists of columns of cells, some of

342

ABSTRACTS

which are clear, others granular and deeply staining; the latter
give to the lobe its characteristic appearance. These cells are
probably functional stages of the same kind of cell, and the
granules represent the material which is passed into the blood¬
vessels as an internal secretion. No colloid occurs in the anterior
lobe proper.

The intermediate portion is made up of finely granular epithelial
cells, closely applied to the body and neck of the nervous
lobe and to the adjacent part of the brain. That part of it
which covers the body of the posterior lobe is separated from
the anterior lobe proper by a cleft, and is almost devoid of
blood-vessels. In the cat the portion lying in front of the anterior
lobe has a tubular appearance and is very vascular. Colloid
material is commonly met with throughout the pars intermedia,
and, in most situations, appears to pass into the adjacent
nervous substance.

The nervous portion consists of neuroglia cells and fibres, and
contains no true nerve cells. Large ependyma cells line the
central cavity in the cat and send long fibres forwards and up¬
wards towards the brain, most of which terminate in the outer part
of the neck. These ependyma fibres are numerous and coarse,
and give to the neck of the lobe an appearance as though of
nerve fibres running longitudinally in it. Epithelial cells of
the pars intermedia surround and invade the nervous substance ;
islets of them are not uncommonly seen, and may even lie
within the central cavity. A substance resembling colloid is
found in relation to the epithelial cells, and occurs widely
throughout the lobe. It is especially large in amount towards
the neck of the lobe, and may be seen among the ependyma
cells passing into the central cavity and so into the third
ventricle of the brain. This part of the pituitary body may
be regarded as a brain gland, the cells of the pars intermedia
furnishing the secretion.

The pituitary body probably receives its nerve supply
through the sympathetic system The anterior lobe is extremely
vascular; the posterior lobe has a smaller and separate blood
supply, with a capillary circulation unlike the sinusoids of the
anterior lobe.

From a physiological point of view the pituitary body consists
of two distinct parts, in both of which the epithelium is the active
agent. The anterior lobe is an internally secreting gland, the
function of which is unknown. The posterior lobe has a frame¬
work of neuroglia and ependyma supporting epithelial cells, which
apparently produce a secretion destined to enter the ventricles of
the brain. Extracts of this lobe are in some respects similar in
action to extracts of the medulla of the suprarenal capsule, but have

ABSTRACTS

343

in addition a selective action upon the kidney causing dilatation
of the renal blood-vessels and diuresis. Disturbances of the
posterior lobe are probably responsible for the occurrence of the
diabetic conditions which have been so frequently recorded at
some stage or other in the history of cases of acromegaly and of
affections and lesions associated with the base of the skull.

Author’s Abstract.

ON THE NEUROFEBRILS IN THE PROCESSES AND THE OELL-
(287) BODY OF MOTOR OANOLION CELLS. (Uber das ver-
schiedene Verhalten der NeuroflbriUen in den Fortsdtzen und
dem Zellleib der motorischen Qanglienzellen.) Gierlich, Neurol.
Centralbl., Dec. 16, 1907, p. 1154.

From the investigation of various sections prepared by Biel-
schowsky’s method, the writer found that during the development
of motor cells the neurofibrillse appear first in the dendritic pro¬
cesses and then later in the cell-body; and that in degeneration
the fibrils of the cell-body undergo disintegration earlier than
those of the processes. Alexander Bruce.

THE POSTERIOR LOBE OF THE PITUITARY GLAND. (Le
(288) lobe post^rieur do la glande pituitaire.) H. Joris, L’Acad.
roy. de mid. de Belgique, Tome xix., f. 10.

Joris now finds from the results of his comparative anatomical
and embryological investigations that the posterior lobe of the
hypophysis is not a degenerated structure, but is an active gland
secreting a substance which has been found to modify the blood
pressure and diminish the number of the heart beats whilst aug¬
menting them in force.

If this structure represented, as some believe, in the higher
vertebrates the ruins of a nervous centre, it should be found
completely developed in lower vertebrates, whilst if it represented
an atrophied gland it should appear as a developed gland in
lower vertebrates. To test this point he has examined a
large number of hypophysi from fishes among whom it attains
an extreme degree of development, and also from higher vertebrates
(cat, dog, guinea pig) at various stages of embryological development;
and finds that in all these cases it appears as a glandular formation
of mixed origin, derived partly from the infundibular and partly
from the pharyngeal prolongation. John Turner.

344

ABSTRACTS

PHYSIOLOGY.

THE PHYSIOLOGICAL ACTION OF EXTRACTS OF THE

(289) PITUITARY BODY AND 8A00US VASOULOSUS OF
CERTAIN FISHES. P. T. Herring, Quar . Joum. of
Exper . Physiol., Yol. i., No. 1, April 1908, p. 187.

The pituitary body of elasmobranchs, e.g. the skate, has no posterior
lobe, neither does its anterior lobe possess the granular cells
which are characteristic of the anterior lobe of higher vertebrates.
Extracts injected intravenously produce in the cat a slight fall of
blood pressure, a dilatation of the kidney and some increase in the
flow of urine; the latter is so slight that it is doubtful if it is due to
a specific action.

In teleosts, e.g. the cod, the pituitary body more closely re¬
sembles that of mammals. Its anterior lobe contains the deeply
staining granular cells, and there is a nervous portion sur¬
rounded and invaded by clear cells resembling those of the pars
intermedia of mammals. Extracts of pars intermedia and pars
nervosa produce the typical effects of extracts of the posterior lobe
of the mammalian pituitary.

Extracts of the saccus vasculosus of the skate or cod have no
marked physiological effect when injected; very strong extracts
give practically no effect other than that of the Ringer’s fluid in
which they are made up. The saccus vasculosus was considered
by Gentes for anatomical reasons to be a ventral choroid plexus,
and the inactivity of its extracts tends to support this view.

Author’s Abstract.

STUDIES IN RESUSCITATION — II. THE REFLEX EXCIT-

(290) ABILITY OF THE BRAIN AND SPINAL CORD AFTER
CEREBRAL ANEMIA. F. H. Pike, C. C. Guthrie, and
G. N. Stewart, Amer. Joum. Physiol ., Yol. xxi., No. iii.,
p. 359.

The head arteries were temporarily occluded in cats by ligature or
clamp, depriving the brain and the upper part of the spinal cord
of blood supply, and the reflexes were examined during occlusion
and after release of the vessels.

The anterior part of the cord becomes totally inexcitable during
the period of arnemia, but may regain its excitability more or less
completely when the circulation through it is re-established,
and may for a time become hyper-excitable. This hyper-excit¬
ability affects also the posterior part of the cord. In some cases
the anterior part of the cord never regains completely its normal
excitability.

ABSTRACTS

345

Many of the phenomena of spinal shock may be produced by
this method, and when the period of anaemia has been sufficiently
prolonged to cause severe injury to the encephalon and anterior
part of the cord, the animal falls into much the same condition
as the “ spinal ” or “ bulbo-spinal ” animal, and the scratch reflex
is easily elicited. Sutherland Simpson.

PATHOLOGY.

ON NEUROTOXIO SERA AND THE LESIONS OF THE NER-
(291) VOUS SYSTEM CAUSED BY THEM—ISONEUROTOXIO
SERUM. (Oontribnto alio studio dei “Sieri neurotossici ”
e delle lesioni da essi provocate nel sistema nervoso—
Siere isoneurotossico.) 0. Rossi (of Florence), Riv. di Pat.
nerv. e merit., Sept. 1907.

The injection into an animal of given species of a preparation of the
nervous tissue of an animal of another species confers on the serum of
the former toxicity with regard to the nervous system of the second.
This observation can be made by injecting dog brain into guinea-
pigs and then injecting the serum of the latter into the dog. The
clinical manifestations vary according as the grey or white matter
is used. After several injections of guinea-pig brain into the
guinea-pig, the serum of the latter acquires a toxicity for the
nervous system of the guinea-pig. The action of these sera is
not at all specific; in the author’s experiments the isoneurotoxic
serum produced pathological phenomena in the dog as well as in
the guinea-pig. The properties of these sera do not agree in all
points with those of the typical cytolytic serum, i.e. the hiemo-
lytic serum. The anatomical changes are constant and well
marked; the most severe are those implicating the nervous
tissue. C. Macfie Campbell.

ON CHANGES IN THE PERIPHERAL NERVES IN GENERAL
(292) PARALYSIS AND OTHER PSYCHOSES. (Beitrftge zur
Kenntnis des Vorkommens von Ver&nderungen in den
peripheren Nerven bei der progressiven Paralyse und ein-
zelnen anderen Psychosen.) E. Stransky (of Vienna), Arb.
a. d. Neur. Inst. a. d. Wien. Univ., 1907, p. 281.

The peripheral nerves in 60 cases were examined by the Marchi
method—general paralysis (29), cerebral syphilis (1), senile de¬
mentia (8), arteriosclerotic dementia (4), senile melancholia (1),
senile mania (1), paranoia (4), dementia prsecox (3), epilepsy (2),

346

ABSTKACTS

amentia (2), alcoholism (5). In general paralysis parenchymatous
changes in the peripheral nerves are on the average more frequent
and more severe than, ceteris paribus, in other mental disorders
accompanied by marasmus and somatic complications.

C. Macfie Campbell.

LESIONS OF TEE CEREBRAL AND CEREBELLAR CORTEZ IN
(293) ALCOHOLICS, WHO HAVE DIED SUDDENLY FROM AC¬
CIDENT OR HOMICIDE. (Lesioni della Cortecda Cerebrale
e Oerebellare in Individui Alcoolisti, etc.) V. Alessi, Ann.
di Neurologia , Anno xxv., f. 4-6, 1908.

The author of this paper holds a position in which he has
exceptional opportunities of investigating the nervous systems of
individuals who are suddenly killed while in a state of alcoholic
intoxication. He records here the results of his investigation of
five such cases.

The original paper is worthy of perusal, because a detailed
account of the microscopical appearances is there given. In the
cerebral cortex, the signs of degeneration are most marked in, and
almost limited to, the layer of pyramidal cells; little change can
be detected in the more superficial zones. Still more marked are
the signs of degeneration in the cells of Purkinje in the cerebellar
cortex; and the author correlates this fact with the clinical ex¬
perience that inco-ordination is a prominent symptom of alcoholic
intoxication.

The signs of degeneration referred to are chromatolvsis of
somewhat characteristic distribution, dislocation and vacuolation
of the nucleus, varicosity of the protoplasmic processes, etc. The
blood-vessels of both the cerebral and cerebellar cortex are dis¬
tended with blood. There is no obvious affection of the neuroglia.

W. H. B. Stoddakt.

THE SENILE OEREBELLUM. (Sur le cervelet senile.) Anglade
(294) and Calmettes (of Bordeaux), Nouv. Icon, de la Salp., Sept.-Oct.
1907.

On the basis of the examination of senile brains by the elective
neuroglia method of Anglade, the authors conclude that the senile
cerebellum presents characteristic lesions, and that the frequency
and extent of these cerebellar lesions explain to a certain extent
several of the symptoms in the clinical senile picture.

The senile cerebellum does not present an atrophy en masse,
but rather limited patches of perivascular sclerosis; these patches

ABSTRACTS

S47

may occur anywhere in the cerebellum, but have certain points of
predilection; there is considerable tendency to the formation of
lacunas. The patches of sclerosis are sharply defined, they are
frequent in the neighbourhood of the cells of Purkinje, there is no
meningitis associated with the process, and rod-cells are absent.
The picture therefore is distinct from that of generalised cerebellar
atrophy: there the sclerosis is diffuse, the cells of Purkinje absent,
there are many nuclei and few fibres, the granular layer is indis¬
tinguishable from the white matter.

There is no confusion, therefore, between the purely atrophic
and the senile cerebellum: one finds sometimes a patch of atrophic
or hypertrophic sclerosis in the midst of senile lesions. The
diagnosis of the senile cerebellum from that of the general para¬
lytic is simple. C. Macfie Campbell.

PSYCHOLOGY.

THE EFFECT OF MENTAL WOKE ON AUDITIVE, VISUAL,
(295) AND TACTILE SENSIBILITY. (Sur le mode de se corn-
porter de la sensibility auditive, visuelle, et tactile, k la
suite du travail mental.) A. Grazlani (Padua), Arch. Ital.
de Biol., T. xlviii., F. ii., 1908.

Dr Graziani took advantage of a special course of lectures given
by himself and two of his colleagues to men who were their equals
in age and academic standing to study the effects of this consider¬
able mental strain on the sensations of sight, hearing, and touch.
The lecturers were tested in these respects—(1) on arrival at the
laboratory, (2) immediately after the lecture, (3) after a rest of one
hour. Qualitatively the results agreed in all three subjects, the
changes observed being in the same direction; quantitatively, of
course, individual differences appeared. The sensibility of the ear,
tested by the ticking of a watch, was notably augmented after the
lecture, the distance at which the sound was audible being in¬
creased by about 50 cm. After the hour’s rest the sensibility had
decreased to a little below normal. Analogous results were
obtained with respect to the visual sensibility and the tactile
sensibility of the face. With respect to the tactile sensibility of
the hand no consistent variation could be established.

In Dr Graziani’s opinion his results can be explained by two
hypotheses based on already ascertained facts.

1. When mental work is being done an increased supply of
blood comes to the brain; hence even the parts that are not work¬
ing are in a state of hypersemia. It may well be that this con¬
dition brings about an increase in the functional potentiality of
2 c

348

ABSTRACTS

these parts. This supposition would explain the increased sensi¬
bility of eye, ear, and face. The fact that no increase of sensibility
could be detected in the hand is obviously in favour of this
explanation.

2. The investigations of Mosso with the ergograph, and the
researches of numerous other authors, have shown that the first
effect of mental or muscular work is to produce a period of ex¬
citation during which the output of work increases. Dr Graziani
supposes that in virtue of the intimate connection which exists
throughout the central nervous system, the whole may feel the
excitation due to the work of a part, and thus a general increase
in sensibility result. This hypothesis appears all the more prob¬
able in view of the fact that, according to the experiments of
Griessbach the variations of tactile sensibility before and after
mental work are really due to differences in the concentration of
attention on the tactile sensation. The excitation produced by
mental work not carried to the point of fatigue might very well
increase this power of concentration.

These two factors, the one purely physiological, the other
psycho-physical, appear to Dr Graziani necessary and sufficient to
account for the phenomena observed by him. At the same time
he emphasises the need for further observation and experiment.

Margaret Drummond.

CLINICAL NEUROLOGY.

PROGRESSIVE OSSIFYING MYOSITIS IN A BOY jET. ELEVEN.

(296) C. A. A. Dighton, Edin. Med. Joum., April 1908.

The condition started when the boy was five years old. The
muscles became stiff, and following the stiffness hard lumps
formed in the muscles, and have increased steadily up to the
present time.

In the arms large nodules of the consistence of bone are felt in
the biceps, triceps, coraco-brachialis, and anconeus muscles, the
biceps being almost completely converted into bone.

In the lower limbs the adductors are completely converted
into bone, while the extensors and flexors are affected to a less
degree.

The case is typical in that the patient is of the male sex, that
it is symmetrical, and that the disease commenced in early life.
It is also quite the exception for the disease to have been in pro¬
gress so long without affecting the muscles of the back.

An excellent skiagram is shown.

D. K. Henderson.

ABSTRACTS

349

A CASE OF OLD MTOPATHT. (Myopathie ancienne, etc.)
(297) Ballet and Laignel-Lavastine, L’Enciphale , March 1908,
p. 229.

This was a case of progressive myopathy, the patient dying at the
age of thirty-seven. Clinically he presented the picture of a
myopathy of the pseudo-hypertrophic type, affecting the shoulder
and pelvic girdles, and progressing steadily until the muscular
wasting was, in certain regions, extreme. There was a certain
amount of generalised scleroderma, with the “facies de sphinx.”
Occasional fibrillary contractions occurred in certain muscles of
the arms and neck, and at one stage a reaction of degeneration
was obtained in them. Deep reflexes were abolished. The
patient was mentally somewhat of an “arri^rA” Pathologically
changes of considerable interest were found. In the muscles, an
exhaustive description of which is supplied, the lesions were those
of a typical myopathy; involvement of individual fibres, some of
which were markedly hypertrophied, others as markedly atrophied;
the greater the hypertrophy the more translucent and vitreous the
fibre, and the less evident its transverse striation. Surrounding
the degenerating fibres was an interstitial sclerosis, with a certain
amount of fatty change. Sometimes muscle fibres seemed to be
disappearing in a sclerotic tissue rich in nuclei and strings of
deeply staining round cells. Many of the fibres which were in an
atrophic state showed an intensely basophilic formation in their
interior of irregular shape, with prolongations losing themselves in
the myoplasm. The appearance suggested a sarcoplasmic de¬
generation. The peripheral nerves furnished no indication of a
neuritic process. Some were rather atrophic, specially such as
were in connection with atrophic muscles.

In the spinal cord, in its cervical enlargement, the most notice¬
able feature was the almost' complete absence of the anterior
cornual cells : in a single section not more than one or two were
discoverable, and these were confined to the antero-internal groups.
Such cells as persisted were not deformed, but simply atrophic;
there was no sign of chromatolysis, pigmentation, neurophagia or
neuroglial proliferation. The vessels were normal. Sometimes
traces of the cells were found in the shape of indefinite protoplasmic
masses with a few chromatic grains within them. In ten sections
the total number of anterior horn cells was seven for the antero-
internal group, seven for the antero-external, and twenty-two for
the lateral. In the motor cortex the Betz cells were usually globular
and deformed, with excentric nucleus, but little pigment. By Pal’s
method the tangential fibres were seen to be rarified, while the
fibres of Exner had almost disappeared in places. The large and
small pyramidal cells seemed fairly normal, except that towards

350

ABSTRACTS

the deeper parts of the cortex they were surrounded by consider¬
able numbers of satellite cells, with an obvious increase of
neuroglial elements.

A full discussion is appended of analogous cases in the
literature. The authors’ view is that the disappearance of the
anterior horn cells is secondary to the atrophy of the muscular
masses whose function they regulate. Attention is drawn to the
concurrent mental changes. S. A. K. Wilson.

SENSORY AND TROPHIC NEURITIS SECONDARY TO ZONA,
(298) ETO. (Ndvrite sensitive et trophique k la suite d’un zona,
etc.) Rose, Nouv. Icon, de la Salpetrike., Jan.-F^v. 1908, p. 64.

In a woman of sixty-seven an ordinary herpetic eruption occupying
a strip down the outer side of the right arm was followed by
violent pains in the shoulder, forearm and hand, and at the same
time oedema of the forearm and hand and tropic changes in the
bones made their appearance. The appearance of the hand
resembled what one is accustomed to see in chronic rheumatism.
The author supposes the osseous change to be secondary to the
neuritis, which was in its turn a consequence of the original
infection or intoxication. S. A. K. Wilson.

A CASE OF PARALYSIS OF THE ABDUCENT AFTER SPINAL
(299) ANAESTHESIA. (Bin Fall von Lkhmung des Abducens infolge
von Rhachistovainisierung.) C. Parhon and M. Goldstein
(of Bucharest), Spitalvi, No. 11, 12, 1907.

Spinal anaesthesia has several advantages, but also many draw¬
backs, one of which is paralysis of the abducent some time after
the operation. The real cause of this paralysis is not yet accurately
known, nor has it been conclusively shown why the injection of an
anaesthetizing solution into the arachnoidal space should act in an
elective manner on the sixth pair. It is possible that it is a question
of meningeal irritation or a toxic phenomenon.

The case observed by the authors was a man of thirty-one,
who was operated on for haemorrhoids under spinal anaesthesia;
•1 eg. stovaine was employed. Ten days later there ensued complete
paralysis of the left and paresis of the right abducent, which lasted
more than three months. E. Toff (C.g.B.).

ABSTRACTS

351

PABALT8I8 CONSECUTIVE TO RACHI8T0VAINISATI0N. (Oon-
(300) tribntion k l’dtude Clinique des paralysies cons6cutives k la
r&chistovainisation. ) Mingazzini, Rev. Neur., March 15,1908,
p. 185.

A youth of sixteen was operated on for varicocele. A 5 per cent,
solution of stovaine in a 5 per cent, solution of sodium chloride,
acidified with lactic acid, was injected into the spinal theca. The
amount injected is not specified. On the day after the operation
the patient complained of headache, which continued for some
hours and recurred on succeeding days. Thirteen days after the
operation he observed that his left upper eyelid was drooping, and
in the morning the eye was completely closed. On lifting the lid
he saw double. On coming again under observation, a day later,
it was found that his right eyelid also was drooping and that the
right eye was deviated slightly outwards. In the course of nine
or ten days the patient’s condition scarcely altered: he was unable
to look up with either eye; there was a certain amount of weak¬
ness of the left lower face, and fatigue soon showed itself in the
lateral ocular movements. Two months later the diplopia per¬
sisted: there was a marked external strabismus of the left eye:
the right ptosis was much more marked: upward and convergent
movements of the eyes were weak. Pupillary reactions were
normal, but better on the left side than the right. Gradually the
patient became worse: the palate, orbiculares palpebrarum, and
masseters became weak, and the limbs also felt rather feeble. There
was uo indication of muscular atrophy except to a slight extent in
the left masseter. The voice was nasal. In short, the clinical
picture bore a strong resemblance to that of myasthenia gravis.

Whether the stovaine played a part in the genesis of the condi¬
tion is discussed at some length. Ocular palsies after stovainisation
are not infrequent. The author inclines to the view that the
toxic agent sets up a neuritic process in nerve trunks.

S. A. K. Wilson.

TABES DORSALIS AND ITS REEDUOATIVE TREATMENT.

(301) Colin K. Russel, M.D., Montreal Med. Jowm., Feb. 1908,
p. 90.

This paper is a rimmi of Edinger’s exhaustion theory of tabes
dorsalis, showing its importance in the prophylactic treatment of
tabes and its bearing on the re-educative treatment of Frenkel.
Reference is made to Holmes’ contribution to this theory.

Author’s Abstract.

352

ABSTRACTS

FAMILY SPASTIC PARAPLEGIA. (La par&pMgie spasmodique
(302) familiale. £tude clinique.) A. Mendicini Bono, Rev. de Med.,
March 10, 1908, p. 209.

In this article the author gives short clinical notes of two cases of
spastic paraplegia, and brief risumis of fifty-six other recorded cases.
In his own cases there was in neither instance any other member
of the family affected. In one, a man of thirty-nine, some stiffness
in the legs had been noted since the age of twelve ; there were no
sensory symptoms, vesical symptoms had once been present but had
disappeared, there was slight Rombergism ; the spasticity, of slow
development, was limited to the lower limbs. His second case,
a woman of twenty-eight, had spasticity in the upper limbs also,
and complained of shooting pains in the back and legs.

The author regards the disease as due to a degeneration of
the pyramidal tracts in individuals who are poorly developed
from some hereditary cause. There is frequently some associated
slight lesion of the posterior columns. There is a good bibliography.

J. H. Habvey Pirie.

HEMANGIOMA IN THE PONS VAROLII. Nambu, Neurol.

(303) Centralbl., Dec. 16, 1907, p. 1162.

As haemangioma is a rare form of brain tumour, the writer gives a
description of one of the cavernous variety found in the case of a man
of sixty-three. Microscopical examination showed that the tumour
had no marked arterial or venous character, but was distinguished
by the appearance in places of old thromboses of the blood spaces
and by hyaline changes in the walls of the dilated vascular
spaces. These spaces were lined with a distinct epithelium.
Many of them contained blood, and others homogeneous masses,
which were apparently old degenerated thrombi.

There was no clinical history of the case, but it is not likely
that the tumour gave rise to any symptoms, as there was no
secondary degeneration in the spinal cord.

Alexander Bruce.

THE SERUM TREATMENT OF EPIDEMIC CEREBROSPINAL

(304) MENINGITIS. Dunn, Boston Med. and Surg. Joum., March 19,
1908.

The object of this paper is to enlist the co-operation of those in
actual practice in testing the value of serum therapy in cerebro¬
spinal meningitis. In 1906 a number of favourable reports were
published of the use of diphtheria antitoxin in this disease, but

ABSTRACTS

353

Rotch and others have shown that no specific benefit is to be
derived from such treatment. In 1907 Rotch treated cases with
vaccines prepared from the meningococcus, but the results were
totally inconclusive. Several investigators had meanwhile been
working upon the production of a specific antiserum, and Flexner
has brought such an antiserum into the domain of practical thera¬
peutics. This antiserum is prepared from horses inoculated with
the meningococcus, hut it differs from diphtheria antitoxin in that
its action is directed against the organisms themselves, and not
against the toxins elaborated by the organisms, for which reason
it is designated an antiserum and not an antitoxin. Flexner
recommends that a maximum dose of 30 c.cm. should he injected
directly into the spinal canal by lumbar puncture, and that the
dose should be repeated daily for three or four days. The writer
gives very full reports of fifteen cases treated by this antiserum.
Of these, eight have recovered completely, having been left with no
sequelae of any kind ; two have died, both chronic cases not seen
till the disease had run for a considerable time; and five are still
pending, four of them convalescent and certain to recover; one (a
chronic case) doubtful. Early cases afford the greatest hope of
permanent benefit from the treatment, and also exhibit the most
marked response to the injections. Henry J. Dunbar.

SOME CLINICAL OBSERVATIONS ON EPIDEMIC OEREBRO-
(305) SPINAL MENINGITIS. J. G. Browne, M.D., Montreal Med.

Joum., Feb. 1908, p. 98.

This report is based on 46 cases verified by bacteriological ex¬
amination from the wards of the Montreal General and Royal
Victoria Hospitals. The disease has been found to be more
common in the spring and winter months, the largest number of
cases occurring in May. Young adults in the second and third
decades are most frequently affected, males 3*5 times more
commonly than females.

The usual well-known symptoms have been noted at the onset
and during the course of the disease. The following list of com¬
plications in order of frequency may be of interest:—

Otitis media

. 6

130

Acute broncho-pneumonia

. 6

130

Arthritis

. 4

8-7

Acute purulent pericarditis

. 3

6-5

Acute cystitis

. 3

Mastoiditis

. 2

4-3

Hydrocephalus .

. 2

4-3

Chronic phthisis.

. 2

4-3

354

ABSTRACTS

Bedsores....

Furuncles

Septicferaia

Acute endocarditis

Parotitis (double)

Pyonephrosis
Sinus thrombosis
Cerebral abscess .

The mortality was 71*7 per cent,
the production of Flexner’s serum.

. 2 4*3 per cent.

. 2 4-3 „

. 1 2-2 „

• 1 2-2 „

. 1 2-2 „

These cases occurred before
Colin K. Russel.

ACUTE ENCEPHALOMYELITIS. (Enc6phalomyelite aigue, hlmor-
(306) rhagique, hyperplastique, et diap6d6tique.) Laignel-Lavas-
tine, Arch, de Mid. Expir., March 1908.

Owing to the extreme differentiation of the elements of the brain,
the writer restricts the term “ acute encephalitis ” to a particular
case of the cerebral lesions produced by the acute reaction of that
organ to the “ toxi-infections ”; following the phraseology of
Metchnikoff, he defines it as “a connective-vascular reaction
(riaction conjondivo-vasculaire), a proliferation of the elements of
the mesodermic perivascular sheaths, or an infiltration of leuco¬
cytes brought into the nervous tissue by diapedesis.”

As in the case of other visceral inflammations, there are three
types of acute encephalitis, viz., haemorrhagic, diapedetic, and
suppurative. The author aims at showing that there exists a
series of transitions between the acute and sub-acute forms, also
that inflammatory reactions in the brain and medulla are to be
looked on from a similar standpoint.

He analyses minutely a case which presented the clinical
picture of an acute ascending paralysis of Landry, and which
showed, anatomically, the lesions typical of acute diffuse encephalo¬
myelitis. This syndrome of Landry was characterised essentially
by a flaccid paralysis, with sensory, vaso-motor, and sphincterial
troubles, leading in thirteen days to a quadriplegia, and ending in
death four days later.

The lesions found in the brain and spinal cord were very
various, and according to the local predominance of such features
as hannorrhages, epithelioid cells, diapedetic perivascular infiltration,
or puriform interstitial infiltration, the disease might be called
hccmorrhagic, hyperplastic, diapedetic, or purulent.

The writer gives a risumS of a work already published by
Roger Voisin and himself, on the history of the study of acute
encephalitis. The first to point out the rdle of inflammation in
cerebral disease was Broussais, and the idea of encephalitis dates
from his time (beginning of nineteenth century). Later, meningitis

ABSTRACTS

355

was clearly differentiated from it, and subsequently also cerebral
softening of thrombotic or embolic origin (Virchow). Brissaud
and others restricted the term encephalitis to circumscribed
cerebral abscess, but it eventually came to include all the cerebral
phenomena observed in the course of the infections and intoxications.
It is only lately in France, however, that encephalitis has been
generally recognised as an entity, whereas iu Germany a whole
series of important works has been devoted to it, beginning with
that of Virchow on “ The Encephalitis of the New-Born ” (1865),
and including the epoch-making researches of Wernicke and
Striimpell, which established the different types of the disease.
The classical German view of encephalitis is summed up in articles
by Oppenheim (1897) and Friedmann (1903). Probably the
paucity of works on this subject in France as compared with
Germany depends partly on a question of words, as many of the
cases called encephalitis by the Germans would be reckoned serous
meningitis in France; this would not hold, however, of the
hemorrhagic form.

After giving full consideration to the various types described
by different authorities, the writer comes himself to the conclusion
that “ acute encephalitis, an inflammatory localisation of the toxi-
infections in the brain, includes very complex lesions, and may be
grouped, according to the rapidity of its development and the
post-mortem conditions, into three categories—haemorrhagic, dia-
pedetic, and purulent encephalitis.” In the first form we have
haemorrhages and red softenings, produced by venous thrombosis
of phlebitic origin; there are transition forms between this and
diapedetic encephalitis, which is characterised by “ the connective-
vascular reaction,” with various intermediate stages from the
passage of a few leucocytes into the perivascular sheaths up to
purulent infiltration on the one hand or sclerosis (the sub-acute or
hyperplastic form) on the other. Suppuration rarely follows acute
encephalitis, though it does occur; it must not be confused with
cerebral abscess, of which it is only one type.

To sum up, we have: (1) acute encephalitis—haemorrhagic,
diapedetic, or suppurative; (2) sub-acute—the hyperplastic en¬
cephalitis of Hayem ; (3) chronic—either so from the first, or as
a sequel to the acute or sub-acute forms.

In the case under review the histological findings were exactly
the same in brain and medulla; thus the term encephalomyelitis
covers the conditions found in these two sections of the nervous
system.

The causative agent was undetermined, no bacteria being found.
“ At most, the multiplicity and variety of the lesions allow one to
bring forward the hypothesis of a two-fold process—the first sub¬
acute, in the course of which the hyperplastic reaction began;

356

ABSTRACTS

this was surprised in its development by a new and more violent
process, which determined the haemorrhagic and diapedetic form;
on the threshold of suppuration this was arrested by death.”

A full bibliography is appended. Arthur J. Brock.

SOME OF THE COMMONER SYMPTOMS OF CEREBELLAR
(307) ABSCESS. W. Trotter, Brit. Med. Joum., March 14, 1908.

The writer records two cases, the full clinical report of one of
which is given, while a short summary is given of the other.

D. K. Henderson.

BRONCHIECTASIS AND CEREBRAL ABSCESS. (Bronchiektasie
(306) und Hirnabszess.) V. Grunbbrger, Prog. med. JFochn
April 2.

Cerebral abscesses coming from purulent or gangrenous processes
in the lung cause more marked symptoms than metastatic abscesses
originating elsewhere—than those, e.g., occurring in general
pyaemia, where the local cerebral condition may be almost hidden
by the general systemic disturbance. The writer details the
case of a man of thirty, who, during convalescence from pneumonia,
began to develop headaches and slight convulsive attacks, along
with symptoms of intra-pulmonary suppuration. In hospital the
convulsive seizures became more frequent and severe; a clinical
diagnosis was made of gangrenous bronchiectatic cavities with
metastatic abscesses affecting the right motor area of the brain,
thereby producing left-sided hemiplegia and slight hemianesthesia,
with unilateral transient convulsions. Stupor supervened, and
patient eventually died. The sectio confirmed the diagnosis.
Contrary to the usual rule, the cerebral abscess was solitary, and
not on the same side as the lung affection; the symptoms, how¬
ever, pointed typically to a localisation in the motor region of the
cortex, and were Jacksonian in character; these irritative
phenomena gradually gave place to symptoms of paralysis as the
abscess grew in size. Certain marked disturbances of sensibility
which appeared in this case are not the rule in pulmonary cerebral
abscess. The cerebro-spinal fluid obtained by lumbar puncture
was quite clear, and, contrary to expectation, showed no polynuclear
cell-elements, but only lymphocytes; here, as often in these cases,
had other characteristic symptoms been absent, the cytological
finding would have given little, if any, help in diagnosis.

The abscess finally ruptured into the lateral ventricles; despite
its superficial situation, the progress of the disease was too rapid
to allow of operation. Arthur J. Brock.

ABSTRACTS

357

TWO OASES OF CEREBRAL SCLEROSIS OF PSEUDO BULBAR
(309) TYPE IN CHILDREN. Armand-Delillb et Giry, Arch, de
Mid. des Enfants, Feb. 1908, p. 126.

A short clinical note of two children of four years with glosso-
labio-laryngeal symptoms — dysarthria, dysphagia, salivation,
paresis of muscles of palate, tongue and lips. Intellectual
deficiency relatively slight. Upper face intact. General attitude
like that of a child with Little’s disease—limbs contracted and
spastic. The cases resemble others recorded by Sicard and Huette,
Yariot and Roy, by Oppenheim and by Bouchaud. In the two
latter autopsy showed atrophy of the lower Rolandic area.

J. H. Harvky Pirie.

HYSTERICAL HEMIPLEGIA. (Ueber hysterische Hemiplegie.)

(310) Ernst Schulze, Devi, tried. Wochenschnft, March 26, 1908,
p. 544.

The report of an interesting case of nine years’ duration in a man
of sixty-five. He had a flaccid paralysis of the right arm and leg,
without atrophy. Reflexes normal. Gait typical of a hysterical
hemiplegia. Spasm of right genio-glossus, causing protrusion of
the tongue to the left. Spasm of the right orbicularis oculi
causing a pseudo-paralytic ptosis. Some spastic appearance of the
right facial muscles and less marked of the left. Complete right¬
sided sensory anaesthesia, sharply bounded by the middle line,
affecting mucous membranes and testicle as well as skin. Other
hysterical stigmata—such as diminution of fields of vision, etc.—Of
special interest was the fact that patient mistook right and left
sides on both voluntary and passive movement.

J. H. Harvey Pirie.

A CASE OF MOTOR APRAXIA, WITH PATHOLOGICAL FIND-
(311) DIGS. (Ueber einen Fall von motorischer Apraxie mit Sektions-
beftmd.) Wkstphal, Med. Klinik, March 1, 1908, p. 283.

The author describes a case of motor apraxia, complicated, how¬
ever, by a degree of agnosia. The clinical diagnosis was saturnine
encephalopathy, and the apraxic symptoms were highly character¬
istic, and were much more marked in the left upper extremity
than in the right. Perseveration was observed frequently, as well
as a certain ideational inertia, a condition which has frequently
been remarked in apraxic cases. Post-mortem a considerable
degree of internal hydrocephalus was revealed, the left ventricle

358

ABSTRACTS

being more dilated than the right. The author remarks that
macroscopically the corpus callosum appeared normal, but in the
present communication no further details are vouchsafed.

S. A K. Wilson.

CRURAL MONOPLEGIA, ETO. (Monopl&ie crurale par lfeion du
(312) lobule paracentral, etc.) Long, Nouv. Icon, de la ScdpUribre,
Jan.-F6v. 1908, p. 37.

In the first case a lesion of the right paracentral lobule occasioned
a left crural monoplegia, the arm being unaffected: pathologically
the lesion was limited almost entirely to the grey matter, and
immediately subjacent white matter, of the ascending frontal
convolution on the mesial surface of the hemisphere. The
secondary degeneration from this lesion could not be followed in
its entirety, but presented the following interesting form: by
Weigert’s method it was readily detected in the corona radiata,
but in the internal capsule, the crus, the pons and the medulla
it was not to be seen, while the pyramidal degeneration reap¬
peared in the cord and was traceable as far as the lumbar
enlargement. Secondary degeneration was not absent in the
areas above noted; but what had happened was that in them
there was no interstitial sclerosis to replace the degenerated
fibres. Such an absence of neuroglial sclerosis is common in old
cases of infantile cerebral hemiplegia, possibly owing to its
absorption and to the intermingling of healthy fibres. There
seems to be a regional variation of this glial tissue; it does not
merely replace degenerated fibres, it is the result of an irritative
process of varying intensity.

The author describes a second case, one of congenital dystrophy
of the left hand and forearm, with conservation of motility.
Death occurred at the age of forty-seven, when it was found that
a porencephalic lesion occupied the outer surface of the middle
part of the right hemisphere, leaving only the upper third of the
Rolandic convolutions. In this case projection fibres from the
motor area were readily traceable in the internal capsule, crus,
pons, etc. Evidently the fact of the lesion having occurred so
early in life rendered compensatory action on the part of the
opposite hemisphere more complete, for the defect of motility on
the affected side was exceedingly slight. Facial movements were
not impaired in any way, although the lower part of the right
motor area was non-existent. The interesting feature of the case
is the occurrence of projection fibres scattered through the whole
of the internal capsule and subjacent pyramidal tract, which
suggests supplementary evolution of a descending motor path,

ABSTRACTS

359

reduced in dimensions, no doubt, but occupying the whole of the
usual site of the descending pyramidal path. The author believes
that in the course of development the unaffected fibres coming
from the upper motor area scattered themselves out through all
the internal capsule, etc. S. A. K Wilson.

ON FOCAL SYMPTOMS IN DIFFUSE BRAIN DISORDERS.

(313) (Ueber Herdsymptome bei diffusen Hiraerkrankungen.) A

Saenger (of Hamburg), Munch, med. Wchnschr., May 12, 1908.

The author emphasizes the danger of using focal symptoms for
localizing purposes without sufficient allowance for their occurence
in diffuse brain disease. Among the cases of diffuse brain disease
in which focal symptoms were in the foreground, he records briefly
cases of tuberculous, purulent, sarcomatous, carcinomatous
meningitis, of chronic hydrocephalus and cerebral arteriosclerosis ;
he also refers to the occurrence of focal symptoms in senile brain
atrophy and general paralysis. C. Macfie Campbell.

CASE OF CEREBELLAR ATROPHY. (Ueber einen Fall von
(314) Kleinhirnatrophie. ) Stelzner, Monatsschr. f. Psychiatr. u. Ncur.,
Bd. xxiii., Ht. 3, S. 240, u. Ht. 4, S. 323.

This case is described in great detail, including a full account of
the microscopical examination. The patient, a woman of thirty-
six, showed characteristic cerebellar ataxy, with choreiform tremor,
speech disturbances and absent reflexes. Her mother and mother’s
father suffered similarly. At the autopsy was found a strikingly
small cerebellum. The whole cord showed degeneration, with the
exception of the anterior and posterior horns and the pyramidal
tracts. The differential diagnosis and the various grouping of
allied conditions is fully discussed. Ernest Jones.

THE MECHANISM OF NYSTAGMUS. Sir W. R. Gowers. Read
(315) at the Neurol. Section of the Roy. Soc. of Med., May 6, 1908.

It is obvious that nystagmus consists in an alternate contraction
of antagonistic muscles, instead of that synchronous action by
which the opponents support the acting muscles, while yielding to
the movement they produce. Can we discern any similar phe¬
nomenon elsewhere ? Sherrington’s researches on the “ Reciprocal
Action of Antagonistic Muscles” are of great significance. He
found that after division of the cervical spinal cord the lumbar
centres pass into a state of automatic action. If a set of muscles

360

ABSTRACTS

are excited to move a joint, they presently cease to contract, and
their stretched opponents contract instead, to cease in turn, and
this alternation goes on. He has found that the arrest is due to
inhibition of the spinal centre, for it is caused if the nerve to the
opponents is divided and the central end stimulated. But this is
a purely muscular nerve, hence the inhibition must be due to a
stimulus from the stretched opponents, the extension probably
acting on the muscle-spindles. The automatic action is thus a
reciprocal muscle-reflex process. Symptoms somewhat similar
may sometimes be met with in lateral sclerosis. The resemblance
of this alternation to nystagmus is close. The observation of
structures resembling neural spindles in the ocular muscles by
Dr Farquhar Buzzard makes a muscle-reflex process clearer,
though the fact that the nerve to each ocular muscle gives a
branch to the fifth nerve made afferent impulses from them
certain. But nystagmus does not seem to result from a defect of
the voluntary impulse; its causes are so situated as to disturb the
influences that act directly on the mid-brain reflex and co-ordin¬
ating centre for the muscles, which we are compelled to assume.
Whether it has a limited position or not, it must be functionally
above the motor nuclei, and correspond to the spinal centres for
the limbs. It subserves the reflex action of the muscles, including
the muscle-reflex action which is here assumed to be, in insubor¬
dinate degree, the cause of nystagmus. Other influences must act
upon it, including that of light, which is not often conspicuous in
adult life, but seems concerned in the causation of miners’ nys¬
tagmus. A disproportion in the amount of light, excess or defect,
during early infancy, seems to determine the alternate action of
the opposing muscles in many cases of infantile nystagmus, an
indication of the readiness with which the centre may be deranged
and of the existence in it of structural arrangements for the
muscle-reflex alternation.

The stability of the centre, and its control by the voluntary
impulse, seem to depend on the equilibrium’ of the subsidiary
influences that act on it. If any of these are deranged, the
muscle-reflex activity asserts itself in the alternate action of
nystagmus; it may be only when action is excited by the will,
when it is more rapid in the direction of voluntary movement.
The derangement of the centre may be partial, and vary much in
degree, while it often seems to increase with constant activity.
An instance of its production by equilibrial disturbance is the
brief nystagmus from labyrinthine causes, such as the impressions
excited by rotation of the body. It is probably thus that it results
from lesions of the cerebellum. It scarcely ever results from
disease of the cerebral hemisphere, and the lesions that give rise
to it are seldom precise in their indications, insular sclerosis being

ABSTRACTS

361

multiple and tumours causing distant pressure. The cause is
generally in the mid-brain, pons, or cerebellum.

Striking evidence of the insubordination of the muscle-reflex
centre is afforded by the degree to which nystagmus and the
quicker motion may attain. The latter is present even in laby¬
rinthine nystagmus. In other forms the alternate action may
persist even in the mid-position, and a dominant motion, say
quick to the right, may persist even when the eyes are moved to
the left, as well as in upward and downward movements. If
downward nystagmus preponderates, it may deflect downwards that
which should be horizontal These variations in excess make it less
difficult to understand the slight and irregular forms often seen,
when the tendency to the muscle-reflex alternation must be only
trifling and partial in the centre. The explanation also applies to
the form met with in miners’ nystagmus, whatever view is taken
of its causation.

The complex character of the centre, and the numerous influences
by which it is maintained in adjustment, explain the readiness
with which it may escape control. Insubordinate activity, once
established, tends to increase. It is right to add that Wilbrand’s
explanation of nystagmus assumes a disorder of the ordinary
reflex centre for the eyeball movements and a want of harmony
between its condition and that of the volitional impulse. The
muscle-reflex action in the centre, which the author believes to be
the essential cause of nystagmus, seems to have escaped recog¬
nition. Author’s Abstract.

PARALYSIS OF UPWARD ASSOCIATED OCULAR MOVE-
(316) MENT8. Spiller, Arb. a. d. Neurol. Instil, a. d. Wien. Univ.,
Bd. xv., T. 1, 1907, p. 352.

This and the previous paper by the author published in the
Joum. of Nerv. and Ment. Dis., July and August 1905, contain
references to the majority of the recorded cases of paralysis of the
upward associated movements of the eyes. (One by the abstractor,
published in the Trans. Med.-Chir. Soc. Ndin., vol. xix., with an
abstract and illustrations in the Rev. Neurol, and Psychiat., 1903,
p. 441, has not come under the writer’s notice.) Persistent palsy
of the associated upward and downward movements indicates a
lesion near the aqueduct of Sylvius, or, more accurately, near the
oculo-motor nuclei Out of fifty-nine cases of lesion of the corpora
quadrigemina, with autopsy, Todter found such paralysis in nine¬
teen only. Obviously, therefore, proximity of the oculo-motor
nucleus to a lesion in the corpora quadrigemina is essential to the
production of this symptom. In the abstractor’s case there was an

362

ABSTRACTS

angio-glioma involving the peri-Sylvian grey matter, which had
infiltrated the oculo-motor nucleus.

This paper should be read in conjunction with that previously
published in the Joum. of Nerv. and Ment. Dis.

Alexander Bruce.

THE DIAGNOSTIC) VALUE OF PUPILLARY IMMOBILITY AND

(317) SLUGGISHNESS IN NERVOUS AND MENTAL DISEASES.
(Die diagnostische Bedeutung der Pupillenstarre and der
PupiUentrSgheit fur die Erkennung von Nerven- und Geistes-
krankheiten.) K. Retzlaff, Dias., Berlin, 1907, pp. 42.

Immobility of the pupil, especially reflex immobility to light,
occurs in general paralysis in about 50 per cent., in tabes in about
80 per cent, of all cases; it is an early symptom, and may, as an
isolated phenomenon, precede the outbreak of these disorders ten
and more years. The work deserves mention chiefly on account
of the bibliographical index, with 265 references.

F. Loeb (C.g.B.).

CONTRIBUTION TO THE THEORY OF FACIAL PARALYSIS.

(318) (Beitrag zur Lehre von der Facialisl&hmung.) Bernhardt,
Monatsschr. f. Psychiatr. u. Neur., Marz 1908, S. 191.

A polemic aroused by Lipschitz’s recent work on the subject.
Bernhardt defends his view that fibrillary tremor is due to
excitability of the facial nucleus. He further maintains that
Lipschitz’s work on the irregular distribution of regenerating fibres
can be brought fully into harmony with Bethe’s hypothesis of
partially autogenous regeneration of nerves.

Ernest Jones.

ON TORTICOLLIS. (A propos de torticolis.) Bienfait, Joum. dt

(319) Neur., Feb. 5, 1908, p. 141.

The paper concerns a case of “ idiopathic ” spasmodic torticollis,
and does not contain any feature of interest beyond discursive
remarks on the atrophy of the uninvolved sternomastoid.

S. A. K. Wilson.

NOTES ON A CASE OF GRAVES’ DISEASE TREATED BY

(320) THYROIDECTOMY. Taylor, Med. Press, April 15, 1908.

The case was that of a dressmaker aged 24 years, who had
been suffering from the condition for over five years, and

ABSTRACTS

363

exhibited characteristic symptoms of a severe type. Half an hour
before operation l gr. morphine and gr. atrophine were given
hypodermically. Chloroform was the anaesthetic administered.
The greatly enlarged right lobe and almost the whole of the
isthmus were removed. From the second day onwards the pulse
gradually fell in frequency, and on the tenth day was about 80 per
minute; prior to the operation it had varied from 120 to 136.
The operation was performed on May 7, 1906. The eyes are
still prominent, but much less so than formerly. The palpitation,
muscular tremors, and nervousness are now quite gone. The
writer discusses the various surgical procedures adopted in the
treatment of exophthalmic goitre, and indicates that the best
authorities recommend thyroidectomy in preference to division
or removal of the isthmus, sympathectomy, or ligature of two or
more of the thyroid arteries. When symptoms of Graves’ disease
have developed secondarily in patients who have been the
subjects of an ordinary colloid goitre for some considerable time,
the mortality following operation is lower and the prospects of
permanent cure better. In conclusion, more frequent and earlier
recourse to surgical treatment is advocated.

Henry J. Dunbar.

EXOPHTHALMIC! GOITRE. (Morbus Basedowii.) L. v. Schrotter,
(321) Med. Klinik, 5th April.

This article, based on a clinical lecture, begins with a demonstra¬
tion of the characteristic symptoms of the disease. Special
attention is given to the occurrence in one case of an excessive
accumulation of subcutaneous fat, confined to the hypogastrium
and lower extremities. The results of the analysis of this fat are
given; it did not differ in composition from that of the skin of
other parts. The occurrence of lipomatosis in this case was
noteworthy in view of the loss of weight and disappearance of
fatty tissue which is so usual in exophthalmic goitre.

Morbus Basedowii is commonly looked on as the antithesis of
myxcedema, the one depending on defective, the other on excessive
functioning of the thyroid. Setting aside, however, the puzzling
occurrence of cases of exophthalmic goitre without thyroid enlarge¬
ment, and tumour of the thyroid without exophthalmic goitre,
this theory does not explain whether the secretion of the gland
is added to the fluids of the body in order to maintain some
special function or to render certain other fluids innocuous. In
view of the varying size of the gland in different cases, it is
probable that the quality as well as the quantity of the secretion
is of importance; and while typical Basedow’s disease may
2d

364

ABSTRACTS

be designated hyperthyroidism , and myxoedema and its allies
athyroidism, there is yet another form, dysthyroidism, which
includes the absolutely atypical cases. The fact that among these
we may get pigmentary skin affections, striking depositions of fat,
etc., suggests that several of the organs which preside over internal
secretion may be affected simultaneously.

Arthur J. Brock.

RESPIRATORY CHANGES OF CENTRAL ORIGIN. (Tiber einige

(322) Respirationsver&nderuiigen centralen Ursprunga.) Frugoni,

Neur. Centralbl., March 1, 1908, p. 202.

Grocco has described a form of dissociated respiration in which
the synergy of thorax and diaphragm is so altered that one is in
the inspiratory phase while the other is in the expiratory. This
dissociated respiration is to be seen in meningitis, cerebral tumour
and abscess, in general diseases of various kinds—in fact, in any
case of functional disturbance of bulbar centres from toxaemia,
infection, asphyxia, etc. The author has observed a similar
phenomenon in deep chloroform narcosis, on the near approach
of a state of collapse. Tracings are given from a case of cerebro¬
spinal meningitis, in which sub Jincm it was observed that while
the thorax was expanding and falling more or less regularly the
diaphragm was in a state of “ hallorhythm ”: it was contracting
spasmodically, every third contraction being much stronger than
the others, and producing a sobbing type of respiration; the
phases of the thoracic and the diaphragmatic musculature no
longer corresponded. This clonic “ hallorhythmic ” spasm of the
diaphragm is occasioned probably by a “ hallorhythmic ” discharge
from the bulbar centres to the cells of origin of the phrenic nerve
in the spinal cord. S. A. K. Wilson.

A NEW CASE OF OHRONIO TROPHCEDEMA (Sur un nouveau cas

(323) de trophoed&me chronique, etc.) Parhon and Cazacon, Nouv.

Icon, de la SalpHri&re, Nov.-Dee. 1907, p. 448.

A YOUNG woman, 35 years old, had noticed for ten years
a slowly increasing symmetrical swelling of the legs and thighs,
without any change in the colour of the skin. During the same
time she complained of apathy, debility, a degree of agoraphobia,
headache, involuntary quivering of the muscles, and a feeling as
of falling backward. On examination her urine was normal. Her
legs presented a firm elastic pseudo-oedema, which was painless
on pressure and was but slightly dimpled by the application of the
finger. This oedema extended from the groins to the malleoli.

The etiology and pathogenesis of trophoedema are still obscure

ABSTRACTS

365

Its segmental topography suggests a medullary origin. Yalobra
(cf. Review of Neurology and Psychiatry , 1905, p. 628) has pointed
out the relation between urticaria, Quinke’s circumscribed oedema,
and trophoedema, attributing all to a disturbance of lymph
secretion. In urticaria, acute lymphatic oedema is associated
with vasomotor phenomena; in trophoedema there is secondary
hyperplasia of subcutaneous connective tissue. But there may
be a form of trophoedema which is independent of the action of
the nervous system, if Hertoghe's views of its dependence on
hypothyroidism be correct. Wright believes that urticaria is a
consequence of a diminution in the coagulability of the blood, and
considers urticarias and acute oedemas to be serous haemorrhages.
Hence there may be a connection between chronic trophoedema
and the metabolism of the lime salts of the body. The thyroid
gland plays an important role in the assimilation of calcium. This
defect in metabolism facilitates the transudation of lymph, which,
if long continued, leads to the formation of fatty connective
tissue, as in trophoedema, adenolipomatosis, myxoedematous in¬
filtration, etc. S. A. K. Wilson.

▲ MEW DIAGNOSTIC SIGN IN RECURRENT LARYNGEAL

(324) PARALYSIS. A. R. Allen, M.D., Joum. Nerv. and Merti. Dis.,
March 1908.

The author has noticed that in cases of paralysis of one recurrent
laryngeal nerve there is a very material difference in the upward
excursion of pitch when the vocal apparatus is stimulated elec¬
trically during the singing of a tone. A small button electrode is
placed over the lateral part of the crico-thyroid membrane, and
the patient is instructed to sing the note C: for a man the note is
an octave lower than for a woman, and for both the notes fixed on
are free from muscular strain. On the normal side there will be
a rise in pitch equal to from seven to fourteen half-tones, whilst
on the paralysed side the note will only be raised from two to
three half tones. Allen says that this test permits a quantitative
estimation of the contractile ability remaining in a vocal cord.

J. S. Fraser.

the CORPUSCULAR RESISTANCE AND THE HiEMOLYTIO

(325) POWER OF THE SERUM OF EPILEPTICS. (La resistance
globulaire et le pouvoir hemolytique du serum Chez les
epileptiques.) H. Claude, A. Schmiergeld, and A. Blanche-
tiere, L'Encdphale, No. 3, 1908.

The authors repeated a series of experiments on the blood of
epileptics, similar to those made by de Buck last year, but except
on one or two minor points were unable to confirm his results.

366

ABSTRACTS

They found, as did de Buck, that the corpuscular resistance
of the non-heated blood of epileptics is normal or sub-normal,
and with perhaps a slight diminution during active periods of the
illness.

The corpuscular resistance after heating is generally strongly
diminished among epileptics, but so it is in exactly the same
manner in other maladies, in normal persons, and in animals.
Therefore this observation is of no diagnostic significance. The
amount of water necessary to be added to the serum to excite
haemolysis is not less in epileptics than in normal persons. After
heating the serum (to 56° C. for a quarter to half an hour) the
escape of the haemoglobin does not vary, or varies in very slight
degrees. This variation is quite as marked with the serum of non¬
epileptics as with that of epileptics.

They therefore conclude that the examination of the corpus¬
cular resistance, or of the haemolytic power of the serum, does not
supply any new means of diagnosing epilepsy.

John Turner.

CHRONIC ALCOHOLISM IN A CHILD. (Alcoolisme chronique
(326) chez un enfant.) Boulenger, Joum. Neurol ., Feb. 5, 1908.

This is an account of a boy, aged nine, with a strong alcoholic
family history. With the concurrence of his parents, he was in
the habit of drinking daily large quantities of beer ; and he was
familiar with the taste of many liqueurs and other alcoholic
beverages.

There was hypertrophy of the liver and thickening of the
radial arteries. Tremor was induced by attempting any fine
movement, such as writing or drawing. The boy suffered from
visual hallucinations, morning headache, feebleness of attention,
loss of memory, and general backwardness. Euphoria and logor-
rhoea were well marked. W. H. B. Stoddart.

HEADACHES CAUSED BY PATHOLOGIC CONDITIONS OF THE
(327) NOSE AND ITS ACCESSORY SINUSES. Gerhard H.
Cocks, M.D., and John E. MacKenty, M.D., Arch, of Otol. y
February 1908.

According to the authors, headache of nasal origin may be classi¬
fied under two heads:—(1) non-inflammatory, due to enlargement
of the middle turbinal, adhesions of the middle or inferior turbinal
to the septum nasi, deviation of the septum pressing on the
turbinals, or combinations of these conditions; and (2) inflamma¬
tory conditions—which again may be due to either chronic or

ABSTRACTS

367

acute sinusitis. Persons constitutionally prone to headaches
(neuropathic temperament) are more liable to suffer than normal
individuals. Three cases are given in which the sub-mucous
resection of the deviated nasal septum resulted in the cure of
severe headache of long standing. Case 4, in which the headache
was stated to be due to pressure of the middle turbinals on the
septum, was less successful: the patient was neurotic, and the
writers intend to perform a further operation. The following
three cases deal with chronic inflammation of the ethmoidal laby¬
rinth and maxillary antra: headache, which was present before
operation, was either cured or markedly relieved. Three cases of
acute suppuration in the maxillary antrum, frontal sinus, or in both
cavities combined, conclude the series : treatment resulted in cure
of headache in all three. The situation of the pain in the head
associated with suppuration in the various sinuses, as stated by
Cocks and MacKenty, differs considerably from that found in
most of the text-books, e.g. “In maxillary sinusitis the usual
point for the pain is over the anterior surface of the antrum.”
Lack says that in acute cases the pain is situated in the infra¬
orbital region, over the malar bone, and in the teeth of the upper
jaw. Killian, Hartmann, and Hajek state that pain may occur in
the supra-orbital region. The marked periodicity of the pain in
frontal sinus suppuration is very characteristic—usually beginning
about 10 a.m. and going on till 2 p.m. or 4 P.M., when it suddenly
ceases. In sphenoidal sinus suppuration the headache is in the
occipital region. Finally the authors give a short account of the
nerve supply of the nose and its accessory sinuses in order to ex¬
plain the situation of the headache: as they themselves admit, a
good deal of work has still to be done on this subject.

J. S. Fraser.

PSYCHIATRY.

COMPLEXES AND THE /ETIOLOGICAL FACTORS IN DEMENTIA
(328) PREOOX. (Komplexe und Krankheitsursachen bei Dementia
pr&ecox.) Bleuler and Jung, Zentralbl. f. Psychiatr. u.
Ncrvenheilk., 1908, Nr. 257, S. 220.

This is an article of Bleuler’s written mainly to define his attitude
towards Jung’s work on dementia precox, in reply to one by Meyer
in which several misunderstandings occur. Bleuler is very precise
in his views, which shortly are as follows: Some as yet unknown
organic process underlies every case of dementia precox and is
the essential cause of the disease-process; probably some of the
psychical symptoms (called primary) are the direct result of this

368

ABSTRACTS

process ; by far the majority of the symptoms (called secondary),
however, are determined by the operation of various feeling-infused
complexes acting on the pathological basis just mentioned. Thus
the disease would clinically be to a large extent latent were it not
for the action of these complexes, which renders it manifest by
creating the familiar symptomatology of delusions, hallucinations,
obstruction, etc. He gives a number of throughout convincing
reasons for the second view, though the first view concerning the
organic process is given only as an opinion.

In a short addendum Jung criticises Bleuler’s article. He
agrees with all the main points, and differs only in leaving the
cause of the organic predisposition—which he fully accepts—
more open, even suggesting that it may occasionally be produced
by a primary affective process. Ernest Jones.

IDIOCY Ain) DEMENTIA PBjEOOX. (Idiotie und Dementia
(329) pracox.) W. Weygandt (of Wurzburg), Zeitschr. f. d. Erforsch.
u. Behandl. d. Jugend. Schwachs., 1906, Bd. 1, p. 311.

The author discusses the relationship of idiocy to dementia praecox
on the basis of illustrative cases, and comes to the following
conclusions.

1. Many cases of dementia praecox have already shown in
childhood peculiar traits, without the presence of idiocy or even of
mild dementia.

2. Frequently one observes the outbreak of one of the three
main forms of dementia praecox in imbeciles whose mental en-
feeblement had previously shown no characteristic symptom of
dementia praecox.

3. Idiots with deterioration of the apperceptive and emotional
life are not to be considered as allied to cases of dementia praecox
when other aetiological factors are obviously at work.

4. Numerous motor disorders in idiots, which are similar to
those met with in dementia praecox, are found in cases of the most
varied aetiology. These symptoms are not to be regarded as
pointing to dementia praecox, but are to be explained in the same
way as analogous symptoms in catatonics; indications of these
phenomena on the basis of still inco-ordinated motor impulses are
to be seen in normal evolution at a certain youthful period.

5. There are cases where during childhood, after a series of

normal years, a dementia sets in, which resembles dementia praecox
in many features without the resemblance being complete; these
cases may be called dementia infantilis; their explanation is quite
obscure. C. Macfie Campbell.

ABSTRACTS

369

FORGED SPEECH IN MANIC-DEPRESSIVE INSANITY. (Der

(330) Rededrang im manisch-depressiven Irresein—Spez. die dialog-
isierende Manie.) Pfersdorff, Zentralbl. /. Psychiatr. u.
Nervenheilk., 1908, Nr. 257, S. 209.

A valuable casuistic article. Four cases are described, only the
forced speech (Rededrang), not the results of communicative
impulse (Mittheilungsdrang), being given. The associations found
are discussed, and attention called to the frequent impulse to
translate and to spell answers to a question the patient puts to
himself. The main thesis of the article is that manic-depressive
speech can be divided into a motor variety (characterised by
word-stem associations) and a sensory (characterised by sound
associations). Ernest Jones.

SOME REMARKS UPON THE TERM MANIC-DEPRESSIVE

(331) INSANITY. (Einige Worte betreffs der Benennung “ m&nisch-
depressives Irresein.”) A. Wizel, Neurol. Centralbl., April 16,
1908, p. 368.

In this short paper Wizel criticises the term introduced by
Kraepelin to designate one of his groups of mental disease.
Wizel points out that depression is a term which has long been
used to indicate a well-recognised mental symptom, while melan¬
cholia has just as clearly been regarded as expressive of a disease.
He considers that this usage should be strictly adhered to, and
that consequently Kraepelin’s term should be altered to “ manic-
melancholic insanity.” Strictly speaking there appear to be good
grounds for this suggestion. Jas. Middles!ass.

CRANIAL TRAUMATISM AND MENTAL DISORDER. (Trau-

(332) matismes Craniens et Troubles Mentaux.) Roger Dupouy
and Ren£ Charpentier, L’Encfyhale, April 1908.

Since the passing of the French law of 1898 relating to compensa¬
tion for accidents to employees, increasing interest has attached to
the connection between head injury and insanity, what at one time
had a purely setiological value having now medico-legal importance.
Large numbers of cases have been investigated, and the general
trend of opinion appears to be in favour of the belief that, except
in rare instances, head injury is not a cause per se of insanity, but
iu nearly every case merely an exciting factor. With this opinion
Drs Dupouy and Charpentier are in agreement, and the present
paper is a careful and minute description of a single and very

370

ABSTKACTS

interesting case of traumatic insanity terminating in recovery.
Before discussing the case the authors outline the development—
mainly in France—of alienist thought on this matter from the
time of Pinel and Esquirol up to to-day, and the effect of the law of
1898 in producing what Prof. Brissand has baptised recently under
the name of sinistrosis, this resulting from an icUe fixe that every
accident in the course of labour constitutes a damage to be
followed by compensation. They recall, from the remarkable
Etudes cxptrimentales sur les traumatism.es ciribraux of Duret, the
statement that “ if the lesion (traumatic) be slight and consist of a
small effusion of blood or of a zone of vascular irritation, the
functions of the centres concerned are exalted; if the lesion be
destructive the functions are abolished,” and accepting a strict
parallel between mental proces. es and the nervous processes with
which Duret’s experiments were concerned, the authors advance
the following propositions:—

1. The traumatism reveals the special inherent predisposition

of the individual suffering the head injury. The more
marked the predisposition the less the injury needed to
determine the same mental disorders.

2. Head trauma may disclose hysterical or epileptic phenomena

in a potential hysteric or epileptic, delirium tremens in a
chronic alcoholic, or mental confusion in the subject of
auto-intoxication (hepatic, renal, etc.).

3. Slight lesions determine exaltation of the intellectual

functions; destructive lesions abolition of these functions.

4. Post-traumatic dementia is always the result of profound

and extensive cerebral lesions. This form of dementia
may, in predisposed individuals, simulate true general
paralysis.

The case the authors describe responds to the statement of
Duret, that after slight lesions the functions are exalted, and,
further, that the traumatism reveals the special inherent predis¬
position. The case was that of a man of 38 years who was knocked
down by a cyclist, sustaining a blow upon the head, followed by
unconsciousness and bleeding from the nose and mouth. He
remained in a semi-comatose condition for three days, and on the
fourth recovered consciousness, but was agitated, restless, and
abusive to his wife, continually laughing and making absurd
statements, euphoric, disoriented in both space and time,
markedly amnesic (retro-anterograde amnesia), paramnesic, and
incoherent in speech, with confabulation and auditory hallucina¬
tions. He had transitory and alternate irregularity of the pupils,
which were otherwise normal, hand tremor, increased superficial
and deep reflexes, and general hyperaesthesia. The accident

ABSTRACTS

371

occurred on September 22,1907, and his mental condition remained
practically unchanged till the end of October, after which he
steadily improved, and was discharged from the asylum of St Anne
recovered, with only slight euphoria remaining. The patient had
been an alcoholic, and some of his symptoms were due, in the
authors’ opinion, to this former alcoholism. He had had typhoid
fever, followed by hepatic insufficiency (indicated by slight
jaundice, pruritis, hypoazoturia and in dican uria), the marked
mental confusion being due to trauma in the subject of auto¬
intoxication, in harmony with their statement 2. Examination of
the cerebro-Bpinal fluid at the beginning of the illness showed that
there had been some subarachnoid hemorrhage, whilst eight
weeks later lumbar puncture gave negative results.

R. CUNYNGHAM BROWN.

CHRONIC PSTCHOPOLYNEURITIS. Dupre and Charpentier,
(333) L'Endphale, April 1908, p. 289.

It is instructive to analyse cases of Korsakoff’s syndrome in which
cure has been incomplete, for such cases present a combination of
the physical symptoms of chronic polyneuritis with a peculiar
mental enfeeblement, characterised by defect of memory, incapacity
for retaining impressions, disorientation, chronic confusion and
impairment of work a-day activity, such as to render the patient
quite incapable of doing anything for himself. A case of this
description is narrated by the authors, where a woman presented
these symptoms in characteristic manner ten years after an attack
of influenza complicated by alcoholism. S. A. K. Wilson.

ON IDIOCY SECONDARY TO DISEASE OF THE CEREBRAL
(334) VESSELS. (Ueber eine zu “Idiotie” fuhrende Erkraukuug
(Angiodystrophia cerebri.) 0. Ranke (of Wiesloch), Zeitschr.
f. d. Erforsch. u. Behandl. d. Jugend. Schtvachs., 1907, Bd. i.,

p. 122.

The clinical and anatomical record of the case of a 9£ year old
idiot, without gross paralysis or epileptic phenomena. Histo¬
logically the nerve-cells of the cortex presented marked degenera¬
tive changes, the glia showed proliferation with marked regressive
changes; the cerebral vessels were profoundly altered, being to a
large extent replaced by rigid, highly refracting tubes with com¬
plete absence of nuclei.

The histological picture was that of a primary vascular disease
with secondary parenchymatous and interstitial changes.

C. Macfie Campbell.

372

ABSTRACTS

THE VICISSITUDES OF A CASE OF MENTAL TORTICOLLIS.

(335) (Les p4rip4ties d’un torticolis mental.) Meigs, Nouv. Icon, dc
la SalpHribre, Nov-Dec. 1907, p. 461.

This is a long and detailed account of a case of mental torticollis
observed for a period of six years, in which a perfect cure has
resulted from treatment by exercises of various kinds. The
description of the case is interesting, and well merits careful
reading in the original. At one period in the history the symptoms
were so aggravated as to appear hopeless to any one with less
confidence in his methods than M. Meige, but in the end the
patient was restored to normal health, and he has continued
absolutely well for two years (since January 1906).

S. A K. Wilson.

THE MENTAL TORTICOLLIS OF BRISSAUD: FAILURE OF
(336) SURGICAL TREATMENT. (Torticolis mental du Brissaud:
insuccds du traitement chirurgical.) Sicard and Descomps,
Nouv. Icon, dc la Salpitribe, Nov-Dec. 1907, p. 459.

It may be remarked that the title of this brief paper is misleading,
inasmuch as the surgical treatment adopted for this case of
retrocollis, viz., division of the muscles trapezius, splenius, com-
plexus and inferior oblique, on both sides, is a form of surgical
interference which is admittedly unsatisfactory. The remarks of
the authors on the futility of surgical procedure are rather
uncalled for, since no attempt was made to treat the patient by
division of the posterior primary divisions of the upper cervical
roots. S. A. K. Wilson.

GROUPING OF HOMOSEXUALS. (Einteilung der Homosexuellen.)

(337) Nacke, Allg. Zeitschr. f. Psychiatr., Bd. Ixv., Ht. 1, S. 109.

After some preliminary remarks on the unrecognised frequency
of this affection, Nacke discusses the definition of it and the
modes whereby it may be grouped. He just divides the cases into
pure homosexuals and bisexuals, and then adopts a chronological
classification into the childhood, puberty and adult life cases,
according to the time at which the perversion becomes manifest;
of the three last, the second is by far the largest group.

Ernest Jones.

ABSTRACTS

373

DIAGNOSIS OF HOMOSEXUALITY. (Die Diagnose der Homo-
(338) sexualit&t.) Nacke, Neurolog. Centralbl., April 16, 1908,
S. 338.

Nacke here relates the principal characteristic points of this
perversion, the diagnosis of which is often so difficult. He lays
especial stress on the study of the dreams of doubtful cases.

Ernest Jones.

SIMULATION OF INSANITY. (Zur Frage der Simulation von
(339) Geisteskrankheit.) Riehm, Allg. Zeitschr. f. Psychiatr., Bd.
lxv., Ht. 1, S. 28.

This article, 80 pages strong, does not lend itself to abstracting.
It consists almost exclusively in an account of two interesting
cases, which are described at great length. Ernest Jones.

THE COOPERATION OF THE ALIENIST IN THE CARE AND
(340) TRAINING OF DEFECTIVES. (Die Mitwirkung des
Psychiaters bei der Fursorgeerziehung. ) O. Kluge (of Pots¬
dam), Zeitschr. f. d. Erforsch. u. Behandl. d. Jugend. Schwachs.,
1907, Bd. i., p. 311.

Kluge discusses the social and pedagogical aspects of the question
of dealing with defectives, and at the end of his communication
he formulates in outline the principles which should guide those
responsible for carrying out reforms.

Among those who require care and special training are cases
with all degrees of mental enfeeblement up to complete idiocy,
and of mental disorder up to well-defined insanity. Such children
should be examined as soon as possible by an experienced alienist,
and their future training should be under similar supervision.
For efficient treatment the children should be separated according
to their age, degree of mental impairment, and degree of educa¬
bility. As to the nature of the institutions suitable for the
different classes, and the advantages of a central bureau, the
author goes into some detail. C. Macfie Campbell.

374

REVIEWS

IReviews

THE MAJOR SYMPTOMS OF HYSTERIA. Fifteen Lectures given
in the Medical School of Harvard University. By Pierre
Janet, M.D. New York: The Macmillan Company, 1907.
Price 7s 6d net.

In this series of lectures, delivered in the Harvard Medical School
in October and November 1906, Professor Janet presents the
subject of hysteria with the same lucidity and charm of style
which characterise his French works. It is seldom that one has
the pleasure of reading in English a scientific book which combines
to such a degree accuracy of expression with simplicity and
vividness of phrase.

The author begins by discussing somnambulism, “the most
typical, the most characteristic symptom of hysteria.” Illustrative
examples are given of the simplest type of somnambulism, where
the patient is absorbed with the enacting of some emotional
situation. Here the system of ideas relative to an event has
emancipated itself, and develops on its own account, and to an
exaggerated degree.

From such monoideic somnambulisms it is but a step to fugues
and polyideic somnambulisms and conditions of double personality,
where a much more complex group of systems, of thoughts and
feelings, becomes dissociated and develops in an independent
manner. In these conditions the dissociation of a psychological
system is associated with amnesia, not only of the somnambulic
episode, but occasionally of the emotional event leading to the
dissociation.

As systems of thought become dissociated, so may functional
systems of movements, and these may show an analogous inde¬
pendent and exaggerated development, giving rise to tics and
choreas on the one hand, and on the other hand to paralyses and
amesthesias which play the same role as the amnesias of somnam¬
bulism.

In all these phenomena functions are not destroyed but only
suppressed, no longer at the disposal of the will and consciousness
of the subject, but dissociated from that congeries of psychological
systems which is called the personality. Just as on the motor side
are observed contractures and paralyses, tics and choreas due to
the abnormal functioning of a psychological system which has
attained some independence, so on the sensory side groups of
sensations become split off and attain a certain independence, and
thus we have tics, pains, hallucinations on the one hand and

REVIEWS

375

various anaesthesias on the other. These remarks apply not only
to the more complex and highly elaborated functions at play in
the adaptation of the individual in everyday life, they apply also to
the anorexias, vomitings, dyspnoeas where there is an analogous
emancipation of the cerebral and psychological functions relative
to the visceral organs. This emancipation leads on the one hand
to an exaggeration of the function, on the other to a disappearance
from consciousness of certain organic wants and reactions.

Having devoted one lecture to each of the following subjects,
Monoideic Somnambulisms, Fugues and Polyideic Somnambulisms,
Double Personalities, Convulsive Attacks—Fits of Sleep—Artificial
Somnambulisms, Motor Agitations—Contractures, Paralyses, Pro¬
fessor Janet devotes his eighth lecture to the Psychological
Conception of Paralyses and Anaesthesias. In this lecture he
demonstrates the essential unity of the mechanism in the above
disorders, and shows how certain systematic paralyses are due to
the dissociation and abnormal independence of certain systems of
movements grouped by education; these paralyses are the result
of psychological dissociation, which is likewise at the basis of
hysterical choreas and tics.

The following four lectures discuss the Troubles of Vision, the
Troubles of Speech, the Disturbances of Alimentation, Tics of
Respiration and Alimentation. Having thus presented the major
symptoms of the disorder, Professor Janet devotes two lectures to
an analysis of the mental status of his patients in order to discover
the fundamental stigmata of the hysterical. He concludes that
the most important mental stigma of hysteria is suggestibility.
The term suggestion has been rather loosely applied in the dis¬
cussion of hysteria, and Janet takes considerable pains to give it a
precise meaning. Suggestibility is not exaggerated docility, it
requires for its occurrence two conditions—the preservation of
automatism and the diminution of personal synthesis; suggestion
designates “ a very special fact, the complete development of an
idea which takes place without the will and the personal perception
of the subject ”; it implies a malady of the personality, a diminu¬
tion of personal synthesis. A second stigma of equal importance
is a characteristic “ disposition to indifference, to abstraction, to
quite exaggerated absent-mindedness.” What is not in the field
of attention is for these individuals non-existent; there is no
penumbra round the central field of attention. To a certain
extent it is this very absence of indistinct, but ever present and
controlling, shadowy background which permits of the uncontrolled
development of ideas, i.e. of suggestion, in the hysterical. A third
stigma is the phenomenon of transfers and equivalences, the
replacement of one accident by another, which it would be a
mistake to consider as always due to suggestion. Professor Janet

376

REVIEWS

brings these three stigmata—suggestion, absent-mindedness and
alternation—under the one conception of “ retraction of the field of
consciousness.”

Resides these stigmata the hysterical have symptoms common
to the large group of neuropathic individuals, and depending upon
a lowering of the higher functions of the mind. The essential
stigma of hysteria, therefore, is a lowering of the mental level,
which takes the special form of a retraction of the field of con¬
sciousness. This lowering of the mental level is specially apt to
occur at certain physiological periods, e.g. puberty, after exhausting
diseases, after the strain of emotion.

In the last chapter Professor Janet reviews the typical
symptoms of hysteria and the definitions of it, which have been
attempted, and enunciates five laws in which he sums up his con¬
ception of the disorder. The fifth law is thus expressed: “ We
remark a very curious fact, which we recognise without always
being able to account for it. The dissociation bears on the
function that was in full activity at the moment of a great
emotion.”

This law is of such fundamental importance in the pathogenesis
of hysteria that further elaboration along this line would have
been extremely welcome, but in these lectures Professor Janet has
confined himself strictly to a symptomatic analysis of hysteria.
There is no more finished study of a complex mental disorder than
this series of fifteen lectures. C. Macfie Campbell.

BISMARCK IM LICHTE DER NATURWISSENSOHAFT. Von

Georg Lomer. Halle a. S., Carl Marhold, 1907, pp. 160.

Price, 3 M.

In this book the author presents to the reader Bismarck’s person¬
ality from the “point of view of anthropology, psychology, and
medicine.” Political events are referred to only in so far as is
necessary for the understanding of Bismarck’s development.
Behind the man of steel and iron we find the man of highly
sensitive and sometimes overstrung nature, who at a com¬
paratively early age began to suffer from various disorders, largely
nervous in origin. After passing the sixties these disorders
became more marked and periods of nervous irritability were
frequent. In his life one traces a certain rhythm, periods of
successful accomplishment and harmonious activity alternating
with periods of depression and lack of self-confidence.

His habits were in many points contrary to the rules of
hygiene, but the author vigorously repudiates the view that he

REVIEWS 377

was a chronic alcoholic or morphine habitud, although in later
life he frequently made use of opiates.

The author never digresses from the main theme, notwith¬
standing numerous temptations' to do so, and has given in com¬
paratively short compass an extremely interesting and well-
reasoned account of an outstanding personality.

C. Macfie Campbell.

EXPOSE DES TITHES ET TBAVATJX SOIENTIFIQUES DU
DOOTEUE PIERRE MARIE. Paris: Masson et Cie, 1908.

This collection of Professor Pierre Marie’s scientific works will be
welcomed by every neurologist. It is in itself a large volume of
247 beautifully printed and illustrated pages, and yet it contains
merely the references to or short abstracts of the work of this
great clinician. It will be of the utmost assistance as a guide
to the source of his original papers. Alexander Bruce.

UNIVERSITY OF PENNSYLVANIA. Contributions from the De¬
partment of Neurology and the Laboratory of Neuropathology
for the year 1906. Vol. ii., Philadelphia.

We again acknowledge receipt of the second volume of this
valuable collection of reprints from the Department of Neurology
of the University of Pennsylvania. It does not call for detailed
review, as most of the papers have been already abstracted in
the Review, but it forms a remarkable tribute to the energy and
scientific zeal of the Philadelphia School.

Alexander Bruce.

ARC HIV FUR GESOHIOHTE DER MEDIZIN. Herausgegeben von
der Puschmann-Stiftung an der Universitat Leipzig unter
Redaktion von Earl Sudhoff. Bd. i., Heft 1. Mit sieben
Abbildungen. Leipzig: J. A Barth, 1907.

The name of the editor of this new Archiv is a sufficient guarantee
of the serious nature of the undertaking. That there is room for
such a journal no one will deny, and it will be much welcomed by
those who, while taking an interest in the history of medicine,
have insufficient time or lack of the necessary training to indulge
in these somewhat recondite studies. The new journal is not
intended to be a mere review or critical oigan, but rather to be

378

REVIEWS

an organ for the publication of original work in this branch, and
the original contributions may appear in any of the four chief
European languages. To judge from the variety of the communi¬
cations in the first three numbers and the solid contribution
which they make to the subjects treated, this Archiv will be a
valuable addition to contemporary periodical literature.

C. Macfie Campbell.

BOOKS AND PAMPHLETS RECEIVED.

Haberman. “ Zur Differentialdiagnose der Poliomyelitis anterior acuta.”
Inaug. Dissert. Karger, Berlin, 1908.

Schlesinger. “Uber Meningitis cerebrospinalis epidemics im hoheren
Lebensalter” ( lVim. vied. IVchmchr.). Moritz Perles, Wien, 1908.

Alfred Petr4n. “ Uber Spiitheilung von Psychosen.” Eine mono-
graphische Studie. Norstedt & Soner, Stockholm, 1908.

Rivers. “The Influence of Alcohol and other Drugs on Fatigue.”
Edward Arnold, London, 1908, 6s.

R. T. Williamson. “Diseases of the Spinal Cord.” Oxford Medical
Publications. Henry Froude and Hodder & Stoughton, 1908, 15s.

Frankl-Hochwart. “Die nervosen Erkrankungen des Geschmackes und
Geruches.” Alfred Holder, Wien, 1908.

Jose Ingegnieros. “ Nuova Classificazione dei Deliquenti.” Remo
Sandron, Milano, 1908, L. 1.50.

A. S. Dogiel. “Der Bau der Spinalganglien des Menschen und der
Saugetiere.” Fischer, Jena, 1908, M. 24.

University of Pennsylvania. “Contributions from the Department of
Neurology for the Year 1907.” Vol. iii. Philadelphia, 1908.

Ludwig Edinger. “Vorlesungen Uber den Bau der nervosen Zentral-
organe des Menschen und der Tiere.” Zweiter Band. Siebente, unge-
arbeitete Auflage. Vogel, Leipzig, 1908, M. 15.

IReview

WeuroloG£ anb flbs^cbiatc^

Original Hrticles

A CASE OF DISEA8E OF THE POST-CENTRAL GYROS
ASSOCIATED WITH ASTEREOGNOSIS.

By PURVES STEWART, M.A., M.D., F.R.C.P.,

Physician to the Out-Patients at Westminster Hospital, to the West End
Hospital for Nervous Diseases, and to the Royal National Orthopaedic
Hospital

In view of the modern localisation of the cortical motor centres
entirely in front of the Rolandic fissure, the chief interest of the
following case consists in the symptoms associated with a focal
lesion of the left post-central gyrus.

The patient was a butcher, aged 51, whose previous history
was uneventful. He never had a serious illness or accident, nor
was there any history of venereal disease. About 1892 or
1893 he began to suffer from occasional headaches and from
constant buzzing noises in the right ear. In 1901 he had
paroxysms of intense pain in the right hand, occurring without
apparent cause, spreading up to the elbow and lasting about half
an hour at a time. These attacks ceased after two or three
weeks. In 1904 the headaches became more severe, always
unilateral,' but not constantly on the same side, starting in the
temporo-occipital region of one or other side, and extending up
to the vertex. The attacks of headache occurred two or three
times a day, lasting for ten or twenty minutes at a time. In
the intervals between the headaches he had constant tenderness
R. OF N. & P. VOL. VL NO. 7—2 E

380

PURVES STEWART

over the corresponding side of the head and neck. In November
1905 he had an attack of violent causeless vomiting, lasting for
two hours, and another in March 1906. There was no diplopia
or affection of vision, nor at this period was there motor weak¬
ness of any limb.

He first came under my observation in April 1906. At
that time all he complained of was diffuse right-sided headache.
The optic discs were normal, hearing was slightly less acute in
the right ear than the left; the cranial nerves were otherwise
normal. The sensory, motor, and reflex functions were all
normal on examination. The heart, lungs, abdominal organs
and urine were free from signs of disease.

«S

(copied)

“7

Fig. 1.—Written with right hand, September 7, 1907,

In Avgust 1907 he began to have a difficulty in finding his
words. A fortnight later a subjective tingling sensation appeared
occasionally in the index and middle finger of the right hand,
lasting for five or ten minutes at a time. The headache now
became localised to the left parietal region, and his gait became
unsteady and staggering. Memory became impaired and speech
slow and hesitating, with some indistinctness of articulation.
There was no vomiting, no diplopia, and no attacks of uncon¬
sciousness or convulsions.

When examined again on September 7, 1907, his speech was
still slower and more hesitating. In writing he made frequent
mistakes of spelling, missing out letters (see Fig. 1). He could
understand and execute both spoken and written commands.
There was no difficulty in naming objects shown to him. The

DISEASE OF THE POST-CENTRAL GYRUS 381

optic discs and other cranial nerves were normal save for the
slight deafness on the right side previously noted. There was
now, however, slight weakness of the right lower face on volun¬
tary movement. There was no anaesthesia or atopognosis. The
upper and lower limbs were normal in all movements. The
knee-jerks and ankle-jerks were normal and equal; the plantar
reflexes could not be elicited. The pulse was somewhat feeble,
100 per minute and of low tension.

By October 3 the headache in the left parietal region had
become much worse. There was no vomiting. The patient
was emotional and more deeply aphasic. He had difficulty in
finding his words, and spoke with much hesitation. He wrote
to dictation fairly well, and could read aloud. The weakness
of the right lower face was as before. The optic discs were
normal. He was now found to be clumsy with the right upper
limb, and seemed disinclined to use it. There was astereognosis
of the right hand, as tested with objects such as a watch or a
safety-pin. The right grasp was slightly less energetic than the
left, otherwise the movements of the right upper limb were
normal. The lower limbs were equally powerful. The supinator-
jerks and knee-jerks were normal and equal.

On October 16 the left-sided headache was worse than ever.
Speech was still more impaired. The patient had difficulty in
finding his words, and sometimes used meaningless syllables.
He also seemed mentally dull. The optic discs were normal.
There was no hemianopia or restriction of the visual fields.

Motor Functions .—The weakness of the right lower face was as
before. There was now total flaccid paralysis of the right hand,
and marked, though not total, paralysis of the right elbow and
shoulder. In walking, the right leg was now dragged slightly.

Sensory Functions .—Astereognosis of the right hand was still
complete. There was no cutaneous anaesthesia or atopognosis.
Unfortunately on this occasion joint-sense was not tested. The
supinator-jerk and knee-jerk were increased on the right side;
there was no ankle clonus. The plantar reflexes could not be
elicited. Energetic treatment by mercury and iodide of potas¬
sium had been carried out during many weeks.

Under these circumstances the intensity of the headache
and the steadily progressive motor aphasia right hemiplegia, in
spite of the absence of optic neuritis or vomiting, suggested a

382

PURVES STEWART

progressive intra-cranial lesion. The patient was therefore sent
to Mr Ballance with a view to an exploratory operation over the
left hemisphere. The motor aphasia suggested a lesion of the
inferior frontal gyrus, whilst the history of sensory fits referred
to the right hand, together with the absence of motor convulsions,
seemed to point to the post-central gyrus as probably implicated
also.

Accordingly, on October 22, Mr Ballance performed an osteo¬
plastic resection of the skull in the left fronto-parietal region.
A week later the bony flap was turned down and the dura was
opened; it was not adherent. There was no abnormal intra¬
cranial pressure. The post-central gyrus was seen to be

Fig. 2. —Showing position of diseased areas in cortex as seen at operation.

The interrupted line indicates the oeteo-plastic flap.

markedly diseased in its middle third and adjacent part of the
lower third (see Fig. 2), the diseased patch being of a sodden
appearance, yellow in colour, destroying the cortex superficially.
This yellow area was sharply limited in front by the Rolandic
fissure with the vessel coursing therein; posteriorly it was
bounded by the intra-parietal sulcus. This area of diseased
cortex was removed. In front of the pre-central convolution,
which was healthy in appearance, there was an irregular some¬
what stellate area of opacity in the pia-arachnoid covering the
posterior ends of the second and third frontal gyri, apparently &
similar but less active stage of the same process noted in the
post-central gyrus. The postero-parietal lobule and the re¬
mainder of the post-central gyrus healthy in appearance.

The wound healed uneventfully. On November 5, a week

DISEASE OF THE POST-CENTRAL GYRUS 383

after the operation, speech was still hesitating and the patient
had difficulty in finding his words. He could not speak in
sentences but only in isolated words, occasionally misplacing
syllables. He could read sentences aloud but did not appear
to understand them perfectly. He could repeat words and
sentences dictated to him and understood vocal commands.
With the left hand he could not write spontaneously nor to
dictation, but could copy moderately well.

Motor Functions .—There was marked weakness of the right
lower face, both at rest and on movement. The external ocular
movements were normal and the tongue was protruded straight.
There was total paralysis of the right fingers and thumb, flexion
of the right wrist was feeble, extension impossible; supination
could be performed, but not pronation. The right elbow and
shoulder could be feebly moved. There was a moderate degree
of atrophy in the interosseal muscles of the right hand. The
right upper limb was now slightly rigid at all joints. In walk¬
ing the right foot was slightly scraped on the ground, but all
ordinary movements of the lower limbs were equally performed
on both sides in the recumbent posture.

Sensory Functions .—There was no anaesthesia to lightest
touches with cotton-wool, or to pin-pricks, on either side of the
face, trunk, or limbs of either side. In the right hand there
was some atopognosis with cotton-wool touches, the patient re¬
ferring the touches wrongly in a proximal direction ; with pin¬
pricks there was no atopognosis. Joint-sense was normal at
the right shoulder and elbow, lost at the right wrist and digital
joints. There was still astereognosis of the right hand, when
tested with objects such as a pin, a coin, or a chain. The right
supinator-jerk was much brisker than the left; in the lower
limbs the knee- and ankle-jerks were slightly increased on the
right side; there was no ankle clonus, and the plantar reflexes
were both flexor in type.

On November 22 he was examined again, prior to leaving
for his home in the country. Speech had begun to improve.
He understood everything that was said to him, but spoke in
hesitating fashion, mostly in single words, in “ telegraphic ” style.
He could read aloud simple sentences such as “ Shut your eyes,”
but did not always attempt to carry them out, though sometimes
he executed written commands such as “ Put out your tongue,”

384

PURVES STEWART

“ Smile,” “ Give me your left hand” He could repeat sentences
dictated to him fairly well, but occasionally misplaced syllables.
He could sing songs ; for example, “ Auld Lang Syne ” or “ God
Save the King,” the airs being correctly rendered, but some of
the words were occasionally repeated twice. He read the daily
papers and understood the news. When asked what he had
been reading, he replied, “ Cricket match, Australia, draw ” (all
of which statements were correct).

Motor Functions .—Weakness of the right lower face was still
present on voluntary movement; there was no difference on
emotional movements. He could feebly move the right upper
limb at all joints; the right grasp was very feeble. The inter¬
osseal wasting was still well marked. The lower limbs seemed
equally powerful in the recumbent posture, but in walking the
right foot was slightly scraped.

Sensory Functions .—He could feel the lightest cotton-wool
touches and pin-pricks equally acutely on both sides of the face,
trunk and limbs, except on the right hand, where touches seemed
slightly less distinct. Joint-sense was normal at the right
shoulder, elbow, and wrist, lost at the digital joints. Astereo-
gnosis of the right hand was as before, the patient failing to
recognise a watch, a pin, a shilling, a key or a chain, by touch,
all of them being promptly recognised by the left hand and
correctly named.

The right supinator-jerk was markedly increased, the right
knee and ankle-jerks slightly brisker than on the left side;
the plantar reflexes remained flexor in type. The abdominal
reflexes were absent.

The patient was examined again on May 6, 1908, over five
months after the operation, when his condition was as follows :—

He understood everything said to him; he also read in¬
telligently letters and newspapers. When given written requests,
he read them aloud before executing them. Spontaneous speech
was still hesitating and with occasional mistakes of pronunciation,
e.g. “ sesterday ” instead of “ yesterday.” He repeated correctly
sentences dictated to him. He wrote fairly well with the left
hand, both to dictation and on copying, and was able to add up
accounts (see Fig. 3).

Motor Functions .—There was still slight weakness of the
right lower face. He could execute all movements of the right

DISEASE OF THE POST-CENTRAL GYRUS 385

upper limb, not quite as powerfully as with the left. Part of the
impaired movement of the limb seemed due to adhesions in the
right shoulder-joint. The distal joints were less arthritic, and

H OSJslIflfl

copied.

asked to write his Christian name

dictated.

Asked to write down when he came.
He replied “yesterday,” but could
not wnte it.

Addition sum.

v5" V

"Fig. 8. —Written with left hand, May 6, 1908.

the interosseal atrophy which followed the operation had now
disappeared. The lower limbs were both powerful and the gait
practically normal

Sensory Functions. —Cotton-wool touches and pin-pricks were
felt equally on both sides on the face, trunk, and limbs. There

386

PURVES STEWART

were occasional mistakes in topognosis in the right fingers. Heat
and cold were equally felt on both sides. Joint-sense was im¬
paired in all the digits, less impaired in the thumb than in the
other fingers; it was normal at the wrist, elbow, and shoulder.
Astereognosis was still complete in the right hand, when tested
with a bottle, a watch, a chain, a pencil, and a penny. He
recognised all these objects promptly with the left hand and
named them.

The deep reflexes in the right upper limb were markedly
increased; in the right lower limb they were slightly brisker
than on the left side. There was no ankle clonus and the
plantar reflexes were flexor in type. The abdominal reflexes were
still absent.

On May 8 the patient was shown at a meeting of the Clinical
Section of the Royal Society of Medicine.

The termination of the case was independent of his cerebral
condition. About the middle of May the patient developed
acute right-sided abdominal pain, together with vomiting and
collapse. Medicinal means having failed to relieve him, laparo¬
tomy was performed by Mr Ballance on the loth May, the gall¬
bladder and right kidney being explored with negative results.
The patient died on May 17.

The autopsy was performed by Dr C. R. Box, to whom I am
greatly indebted for the following note of the conditions found
post-mortem.

The surface of the left cerebral hemisphere had been exposed
and explored six and a half months before death. The upper
part of the large osteoplastic flap had sunk inwards for half an
inch. The dura was closely adherent under the flap, and the
brain was extricated with difficulty, undergoing some laceration
in the process.

There was considerable shrinkage of the convolutions of the
convex aspect of the left frontal lobe and of part of the parietal
lobe, as indicated in the diagram. When the pia-arachnoid was
stripped off the shrunken convolutions, they were found to pre¬
sent a bright yellow discoloration. This pigmentation was
extensive and penetrated in some places for quite quarter of
an inch; it was in the convolutions, not in the membranes, and
appeared to be the residue of an old extensive superficial red
softening which had occurred some time previous to the opera¬
tion. Immediately subjacent to the lower and upper parts of the
wasted area there was also some softening of the white matter

DISEASE OF THE POST-CENTRAL GYRUS 387

but it did not extend to any great depth. Owing to the shrink¬
age of the cortex, the Sylvian fissure was opened up and the
insula exposed (see Fig. 4).

The arteries of the base were quite healthy. The trunk of
the left middle cerebral was slit open, up to the area of atrophy,
but no obstruction was discovered, nor any trace of past disease.
The artery could not be traced over the shrunken area owing to
the thickening and matting of the membranes. The wasted area

Rol.

Fio. 4.—Diagram of condition post-mortem, after removal of the membranes.
The two areas of superficial softening are indicated by dotted shading.

was entirely in the domain of the middle cerebral artery, but did
not involve the whole of its distribution.

The basal ganglia of both sides appeared healthy. Coronal
sections, after hardening, showed that there was no implication
of the white matter of internal or external capsule by the soften¬
ing process. There was no evidence of disease of the right
hemisphere.

The mouth, fauces, larynx, phamyx, bronchi and oesophagus
were healthy. There was an extensive and very acute pleurisy with
turbid exudation on the right side, where there were also some
old basal adhesions. The lower lobe and part of the upper lobe
showed extensive collapse, and, in addition, near the root of the
lung, were some patches of recent broncho-pneumonia. The left
pleura was healthy, and the left lung highly cedematous from
apex to base. The pericardium contained a slight excess of

388

PURVES STEWART

serum. The myocardium was soft, friable, and light brown in
colour; there were no valve lesions; the right auricle was dis¬
tended with recent clot.

There was an extensive sub-peritoneal blood-extravasation
encasing the right kidney. This kidney had been explored and
sutured; its pelvis was distended with red blood-clot. The
supra-renal capsules were moderately adherent, and there was a
slight but definite degree of cortical atrophy in each. The small
renal arteries were thickened. The spleen was greatly enlarged
and very flabby, its parenchyma being semi-diffluent. No lesions
were discovered in the intestines.

As regards the aphasic phenomena in this case, it should be
noted that the third left frontal gyrus was extensively diseased.
The patient was slightly dull mentally, and his mistakes in
spoken and written speech consisted mainly in impairment of
words spoken or written by himself. Cortical word-memories
being impaired, he had difficulty in understanding complicated
sentences, whether spoken or written ; he also had a degree of
motor agraphia proportional to his vocal speech-defects. He was
neither word-deaf nor word-blind.

The absence of motor convulsions was doubtless due to the
absence of disease of the cortical motor cells of the pre-centra!
gyrus. The marked monoplegia of the right upper limb which
preceded the operation was at first sight difficult of explanation,
in view of the superficial integrity of the pre-central gyrus at
the operation. At that time I suggested that there might be a
focus of sub-cortical disease implicating the brachial pyramidal
fibres in their downward course. Autopsy proved this surmise
to be correct, inasmuch as there was a narrow band of partial
softening crossing the pre-central gyrus (see Fig. 4).

It is interesting to note that the paralysis of the upper limb
was flaccid in type before operation, but subsequently became
spastic, with increase of deep reflexes. The transient atrophy of
the intrinsic hand muscles, which followed the operation, is also
interesting and at present unexplained.

Perhaps the most interesting features of the case are its
sensory phenomena. These may be divided into—(1) an irri¬
tative, and (2) a paralytic group.

(1) The irritative phenomena consisted in paroxysms of pain
in the right hand, constituting the earliest symptom of the

DISEASE OF THE POST-CENTRAL GYRUS 389

disease some fifteen years ago. Two months before operation
paroxysms of tingling reappeared in the index and middle finger
of the right hand and coincided with the rapid advance which
then supervened in the other symptoms. We are, I believe,
justified in regarding these symptoms as a variety of sensory fit,
due to the irritative lesion of the post-central gyrus. An almost
identical case was recorded by Mills and Weisenburg 1 in
1906, where autopsy showed an area of syphilitic disease in the
post-central gyrus, extending slightly across the Rolandic fissure
to the precentral gyrus and also partly into the inferior parietal
gyrus.

(2) The destructive phenomena comprised atopognosis and
loss of joint-sense in the right hand, with astereognosis. These
symptoms appear to be the result of the lesion of the post-
central gyrus. The sensory area for the upper limb in the post-
central gyrus seems to correspond in position with the motor
centre in the pre-central gyrus, the two centres facing each other,
as it were, on opposite sides of the Rolandic trench.

Loss of joint-sense and atopognosis are fairly well recognised
symptoms of cortical lesions in the central convolutions. As to
the question of astereognosis, some writers, notably Mills and
Weisenburg, have endeavoured to limit the astereognostic
function to one special cortical area, separate from the other
cortical centres for cutaneous, joint, and muscle-sense. Mills
and Weisenburg go so far as to suggest the postero-parietal
lobule as the so-called “ stereognostic centre,” quoting in support
of their view the case of lesion in that region, to which reference
has already been made. But we should note that the faculty of
stereognosis, or the recognition of the shape of solid objects, is
not a primitive sensation, but a complex psychical process, which
is arrived at by the combination and comparison of various
sensory impressions:—cutaneous, muscular, and articular, from
the hand. Moreover, stereognosis implies the recalling of
visual and other memories and a comparison of these memories
with the actual sensations felt at the moment in the hand. If
any of these primary sensations be absent, a stereognostic judg¬
ment may be impossible, even though the cortex be intact.
There are many morbid states in which we meet with the
1 Journal of Nervous and Mental Diseases , 1906, p. 617.

390 DISEASE OF THE POST-CENTRAL GYRUS

clinical syndrome of astereognosis. No case of astereognosis
has been observed without impairment of some of the primary
sensations. Thus, for example, it is a common phenomenon in
cervical tabes, where the patient complains that he cannot
recognise objects, such as coins or keys, in his pockets. Again,
in some lesions of the optic thalamus, astereognosis in the
contra-lateral hand is well marked. And in cortical lesions of
the sensory areas, as in the present case, there may be complete
astereognosis. In this case the postero-parietal lobule was in¬
tact, the lesion not extending behind the post-central gyrus.
There is, therefore, no need to postulate a special stereognostic
centre, whether in the parietal lobe or elsewhere.

A CASE OF SPASMODIC SYRINGOMYELIA (?).

By ALEXANDER BRUCE, M.D., F.R.C.P.E.,

Physician to the Royal Infirmary, Edinburgh.

C. G., aged 50, unmarried, employed as a time-keeper on the
Forth Bridge, was sent to me by Mr Cathcart on account of a
peculiar flexion of the ring and middle fingers of the left hand
and of a heaviness and rigidity of the left arm.

When 1 first saw him in my waiting-room, my attention was
arrested by his remarkable attitude. A powerfully built, healthy-
looking man, he sat with his left arm flexed at the elbow and
supported by his right hand, his left hand presenting an appear¬
ance recalling that of the “ finger-post ” of the sign-painter, the
two middle fingers firmly flexed in the palm, the fore-finger and
thumb pointed almost straight forward, and the little finger very
slightly flexed. The position is indicated in Fig. 1, from a
photograph which was taken some time subsequently.

The attitude at once recalled to me that shown in the illus¬
trations in Guillain’s thesis on the spasmodic form of syringo¬
myelia (1), first noted by Pierre Marie. In view of the rarity of
this condition, and on the possibility that this may be an early
example of it, the following notes of the case may probably prove
of interest.

Previous Occupations .—The patient had been employed as a

A CASE OF SPASMODIC SYRINGOMYELIA (?) 391

farmer from the age of 16 to 22, as a law clerk from 22 to 27,
as a labourer from 27 to 43, and since that time he has acted as
a watchman or time-keeper on the Forth Bridge, in which
capacity he has undoubtedly been exposed to much severe
weather.

His previous health has been uniformly excellent, apart from
a compound fracture of both bones of the right leg caused by the
fall on it of a sugar barrel twenty-four years ago. Examination
of the cardiac, respiratory and genito-urinary systems showed
them to be quite normal. His family history reveals nothing
that can have any possible bearing on the case.

His present illness appears to have commenced about the
beginning of 1907. During the month of February he observed
that when at work objects would fall from his left hand in an
unaccountable way. He stated that his left hand became numb,
but on closer questioning it was found that there was at first no
real numbness, but rather a curious incapacity to estimate and
regulate the amount of pressure necessary to hold an object in
the hand. He said that even when he felt as if an object were
about to fall from his hand and endeavoured to grasp it tightly,
it might drop notwithstanding this attempt. He could not hold
anything in the unaided left hand for any length of time. Apart
from this apparent loss of muscular sense, or loss of the power to
regulate the force of the contraction of the muscles of the hand,
there was at first no stiffness or malposition of the fingers, and
no real weakness in the hand. After this condition had lasted
for between two and three weeks, a slight numbness was noted
along the ulnar side of the forearm and hand, and shortly after¬
wards he wakened one morning to find that the middle and ring
fingers of the left hand were firmly flexed into the palm, and
that the position of the fingers, thumb and hand was much as is
shown in Fig. 2, and as will now be described. Shortly after
this the rigidity of the arm and forearm appear to have de¬
veloped, but its onset did not attract his immediate attention.

Position .—The patient always supported the left forearm
with his right hand, because, as he said, “ the left arm felt heavy
and the shoulder dragged.”

The arm was apposed to the side of the thorax, the elbow
flexed at nearly a right angle, the shoulder slightly raised and
drawn forward, and the hand held either pointing forwards or

392

ALEXANDER BRUCE

across the trunk (Fig. 1). The wrist was slightly over-extended ;
the thumb and fingers, as already said, presenting almost the
position of a finger-post, the thumb and forefinger being extended
in a direction almost parallel to each other, the ring and middle
finger firmly flexed, and the little finger partially flexed.

The ring and middle fingers were firmly flexed at the meta-
carpo-phalangeal and proximal inter-phalangeal joints, and ex¬
tended at the distal inter-phalangeal joints. The pulps of the
finger-tips were firmly pressed into the palm. The little finger
was usually kept slightly flexed at the metacarpo-phalangeal
joint, and almost fully extended at the two inter-phalangeal
joints.

The index finger was slightly flexed at the metacarpo¬
phalangeal joint, and was completely extended at the two inter-
phalangeal joints. It was slightly adducted towards the ulnar
side.

The thumb was almost parallel and close to the index finger.
Its metacarpo-phalangeal joint was straight; the inter-phalangeal
joint was slightly over-extended. The thenar eminence was of
normal size; it was slightly drawn inwards (in opposition), and
the tip of the second finger lay on its base. The interosseous
spaces and the hypothenar eminence were normal.

Movements.

(a) Voluntary :—

The little finger was capable of slight voluntary movements
of extension, flexion, and of abduction and adduction at the
metacarpo-phalangeal joints. On one occasion patient succeeded
in feebly flexing the finger and maintaining it in a position of
flexion for some time.

The ring and middle fingers .—With great difficulty the tips
of the fingers could be raised half an inch from the palm.

The index finger could be slightly extended and flexed at the
metacarpo-phalangeal joints, but not at the inter-phalangeal joints.
It could not be adducted or abducted.

The thumb could be slightly flexed and extended at the
metacarpo-phalangeal and inter-phalangeal joints. When the
second and third fingers were passively raised from the palm,
patient could slightly abduct the thumb.

A CASE OF SPASMODIC SYRINGOMYELIA (?) 393

(b) Passive :—

The little finger was capable of a wide range of passive move¬
ment, the only limitation being due to the flexed position of the
second and third fingers. It could be flexed and its tip placed
below that of the ring finger. It could be adducted and abducted,
and there was no feeling of traction resistance to any movement.
When the finger had been flexed on the palm, it immediately
sprang back to its usual position when the pressure was
removed.

The ring and middle fingers .—The attempt to extend these
fingers was met with a steady and increasing resistance, due
either to involuntary spasm or to shortening of the muscles.
As the limit of possible movement (about one inch of the tips
from the palm) was reached, pain was complained of in the
flexor muscles of the fore-arm and in the palm of the hand,
but the joints were in no way painful. The flexor tendons in
the palm stood out prominently as in a case of shortened muscle.
As soon as the traction on the fingers was removed they recoiled
to their previous position. There was neither general nor local
contraction of the palmar fascia.

The index finger .—Passive movement was possible over a
considerable range, and the degree of resistance was very much
less than in the case of the second and third fingers.

The thumb could be flexed and extended at all its joints,
and abducted, adducted, and opposed at the carpo-metacarpal
joint. There was some resistance to its movements, but much
less than in the case of the second and third fingers.

Wrist .—The wrist was generally maintained in a position
of slight hyperextension. It could be slightly extended and
flexed, but with great difficulty. The flexion could not be
carried further than to put the back of the hand and forearm
on a straight line. Relaxation was followed by an immediate
recoil to a position of rest in extension. The extension could be
slightly increased. The difficulty of movement was obviously
due not to any lesion of the joint, but to muscular resistance.
One had the feeling as if the muscles were too short to permit
of the proper range of movement. While moving the wrist the
muscles appeared to be put into a condition of spasm. Very
slight ulnar and radial deviation were possible. Voluntary
movement was greatly limited. Passive movement produced

394

ALEXANDER BRUCE

pain in the muscles of the forearm when the limit of the
possible movement was approached.

Elbow .—The elbow was kept flexed at an angle of 135
degrees. It could be passively extended to about 145 degrees, and
could be flexed to 70 degrees. Voluntary movement had a range
of about 45 degrees, flexion being possible to 75 and extension
to 120. Slight pronation and supination were possible.

Shoulder .—The upper arm was kept closely apposed to the
side of the chest. The shoulder was slightly raised and drawn
forward. The arm could be abducted passively to about 45
degrees. When this angle was reached the triceps muscle passed
into spasm, and further abduction became impossible. Anterior
and posterior movements were greatly restricted, and voluntary
movement was very slight.

There was a slight curvature of the spine, the convexity
being to the left in the cervical, and to the right in the lower
thoracic region.

It was repeatedly noted that the degree of muscular rigidity,
whether estimated by direct palpation of the muscles or by the
resistance to passive and voluntary movement, varied within
considerable limits from time to time. At one time the muscles
might yield before the hand fairly easily ; at another they could
not be compressed at all.

It was generally noted that when the muscles were in a
condition of comparative relaxation, any attempt at passive
movement of them almost at once brought about the state of
spasmodic rigidity. A similar result followed when they were
massaged.

He slept as a general rule lying upon his left side, the weight
of the body resting to a certain extent upon the left elbow. The
forearm stood up so as to form about a right angle with the
upper arm, and was almost invariably left outside the bed¬
clothes. It was generally supported by the right hand. This
was noted during the whole of his residence in hospital. His
attitude might occasionally be varied, the patient lying on his
back and right side, but this did not often happen. The attitude
of the fingers remained the same as that noted when the patient
was awake, and any attempts—made so as not to waken him—
to straighten the fore and middle fingers met with the same re¬
sistance as was present during the day.

A CASE OF SPASMODIC SYRINGOMYELIA (?) 395

The right arm, forearm, and shoulder appeared larger than
the left. The measurements were :—

Bight Ann. Left Arm.

Wrist , . . 7£ inches. Wrist. . . 7f inches.

Middle forearm . 9| „ Middle forearm . 10^ „

Below elbow .11 „ Below elbow .Hi „

Above . . 10i „ Above . . 10$ „

Middle upper arm Ilf „ Middle upper arm 12§ „

Just below axilla . 13 J „ Below axillla . 13i „

Reflexes. —The deep reflexes in the left upper extremity
were all greatly affected, the supinator and biceps being both
absent, and the triceps-jerk slight. This abnormality appeared
to be due to the rigidity of the opposing muscles. The deep and
superficial reflexes were normal in the right upper extremity and
in both lower extremities.

Electrical Reactions .—These were examined by Dr Harry
Rainy, and were found to be somewhat peculiar. There was no
true reaction of degeneration, but both the faradic and galvanic
reactions were reduced. With both forms of stimulation much
stronger currents were required to produce a reaction than over
the corresponding nerves and muscles on the right side, and the
resulting contraction was less in extent than on the opposite
side. On galvanic stimulation of the muscle there was no
alteration of the polar reaction. One’s impression on making
the examination was that the electric current was diffused by
the infiltrated tissue on the left side, and that the muscles, being
already in a high degree of spasm, and being powerfully resisted
by the opponent muscles, were not in a condition to contract
fully. Currents of such strength as to be decidedly painful did
not alter the character of the contractions.

All forms of sensibility were normal in the right arm,
the head and trunk, the lower extremities, and in the left
upper arm.

Sensibility. —The examination of the various forms of sensi¬
bility of the left forearm was a matter of considerable difficulty,
as patient’s answers varied a good deal from day to day, and
indeed during a single examination. Repeated and careful ex¬
aminations by Dr Kelman Macdonald elicited the fact that there
were more or less constant departures from the normal, which
were much as represented in' the annexed figures.

2 F

396

ALEXANDER BRUCE

A. Sensibility to Touch.

(a) Areas of diminished per¬
ception.

(b) Areas of erroneous local-

isation.

thesia.

(d) Area where touch per¬
ceived but not localised.

B. Sensibility to Pain.

(e) Areas of complete anal¬
gesia.

(/) Area of diminished per¬
ception.

($r) Areas of erroneous local¬
isation.

(h) Area of hyperalgesia.

C. Sensibility to Heat and Cold.
(^) Areas of complete absence
of perception.

A CASE OF SPASMODIC SYRINGOMYELIA (?) 397

After the date at which the chart was taken, of which the
figs, are a reduced copy, no further reference to the sensibilities
was made in the patient’s presence, and no examination was
undertaken until a period of six weeks had elapsed. Then on a
fresh examination nearly the same condition was ascertained to
be present. It will be seen from a comparison of the figs, that
the disturbances were in each instance mainly on the ulnar side
of the forearms and on the hands.

It will be seen also that there is a preponderance of loss of
sensibility to pain and to temperature as compared with touch—
an imperfect dissociation symptom.

It is possible that the variation in the results of the ex¬
aminations may have been due to the overlapping of the various
areas of the distribution of the adjacent nerves, which may have
allowed a strong stimulus to be perceived by the nerves from
the adjoining area although they may not have been capable of
perceiving a slight impression.

On palpation it was felt that the right shoulder, pectoral
and scapular regions, as well as the upper arm and forearm, had
a peculiar firm, brawny feeling, somewhat recalling that of rigor
mortis, or of an early stage of sclerodermia with fibro-myositis.
On endeavouring to pinch up the skin over the subjacent tissues
in the above-mentioned regions, one could not catch hold of it
so easily as on the corresponding parts on the opposite side of
the body. Either the fingers slipped over the skin, or they had
to grasp a larger mass of tissue in order to raise the skin. This
arose evidently from infiltration of the cutis vera and sub¬
cutaneous tissues. On pressing deeply, one felt also that the
muscles were unduly firm.

The boundaries of the area of infiltrated skin were not
sharply marked off from those of normal skin, but they corre¬
sponded fairly well to a line drawn horizontally outwards from
the apex of the axilla to the spine, and from this point upwards
to the vertebra prominens. In front the area corresponded, as
far as could be estimated, to the pectoral region. The whole of
the upper arm showed much the same condition ; but the in¬
filtration of the skin and subcutaneous tissues was somewhat
less dense.

The skin of the fingers, especially of the forefinger, showed a
markedly glossy and slightly livid appearance. So also did the

398

ALEXANDER BRUCE

ulnar border of the little finger, on which there were one or two
small recent cicatrices. The nails appeared normal

The left pupil was somewhat larger than the right, and it
dilated in a dim light to a considerably greater extent than did
the right one. When contracted by a strong light, however,
they were almost equaL

The mental condition of the patient was that of an intelli¬
gent working-man. He impressed one as a man of sound common-
sense and judgment, and did not betray any neurotic tendency
except some depression such as was natural from the dread that
his condition was incurable.

Progress .—The patient remained in Hospital from 3rd
December 1907 to 29th February 1908. The affected arm and
shoulder were treated with massage and electricity, ionisation
with chloride of sodium from the negative pole, and with static
electricity (by Morton’s wave-currents). The result was a con¬
siderable diminution of the infiltration of the skin and sub-,
cutaneous tissues of the arm, shoulder and back. A certain
diminution of the rigidity of the muscles was also noted, both
voluntary and passive movements at the various joints becoming
somewhat more free than on admission. The arm could be
voluntarily abducted from the side to 45 degrees ; the elbow could
both passively and voluntarily be almost straightened. Move¬
ments at the wrist were also improved, but to a much lesser
degree. The fingers could be passively separated from the palm
for a distance of about two inches, but they recoiled to their
initial position almost immediately after the traction was
removed.

The left biceps muscle appeared to increase steadily in size,
and all those who saw it were much struck by the contrast
between it and its fellow. It stood out in relief, as is shown in
Figs. 3 and 4, and on palpation it was evidently larger and
much firmer than the right one. It was also noted that
massaging the muscles of the left arm and forearm rapidly made
them harden up, and on several occasions it appeared that
the muscles of the right upper arm tended to become too readily
firm when they were massaged, as if there were a slight degree
of spasm. There has, however, been as yet no appearance or
suggestion of the occurrence of any further change involving the
right arm.

A CASE OF SPASMODIC SYRINGOMYELIA (?) 399

The sensory condition has remained practically unaltered.

The gait has remained unaltered. The reflexes in the lower
limbs are not exaggerated or in any way modified from the
normal. The head droops somewhat forwards. The back is
slightly rounded, and there is the same degree of scoliosis as was
noted at first. The left shoulder is always slightly raised, and
the free edge of the trapezius somewhat unduly prominent.

The diagnosis is a matter of great difficulty. The most
probable one is that of a very early case of the spasmodic form
of syringomyelia, first described by Pierre Marie in 1900. It
was suggested that the condition might be a purely functional
one, and every reasonable care was taken to exclude this possi¬
bility. The following facts seem to militate against this view :
(1) the steady persistence of the condition of the left hand and
arm during sleep; (2) the failure at any time to find a relaxa¬
tion of the spasm when the patient thought he was not under
observation; (3) the mental character of the patient, which was
one obviously of sound judgment and common sense, without
the slightest suggestion of any neurotic element; (4) the con¬
dition of the skin and sub-cutaneous tissues of the left arm and
shoulder, as well as the cyanosis of the forearm and the glossy
skin of the fingers; (5) the greater circumference of the left
arm as compared with the right, and the gradual increase under
observation of the firmness and size of the left biceps muscle ; and
(6) the character of the electrical reactions.

The spasmodic form of syringomyelia, which was first
described by Pierre Marie at a meeting of the Faculty of
Medicine in Paris in 1900, and which has been further studied
at the Bicetre Hospital by his pupil, G. Guillain, presents in its
fully-developed condition the following symptoms :—

(1) The arms are firmly apposed to the anterior part of the
side of the thorax, the hands almost meeting in front of the
pubis, the shoulders raised and inclined forwards and downwards
{thorax, en bateau), and the back rounded (somewhat as in
paralysis agitans).

(2) The hands show a marked spastic flexion of the three
last fingers into the palm, while the thumb and forefinger remain
extended and slightly flexed towards each other like a pincers
{main en pince) and are capable of being used as such.

400

ALEXANDER BRUCE

(3) The upper limbs are in such firm spasm that they can
scarcely be moved. The lower limbs are markedly spastic.

(4) The deep reflexes are exaggerated, and the plantar reflex
gives an exteusor response.

(5) The disease may develop one or many years after an
injury, or may come on without cause.

(6) The evolution is slow, and the disease may last for more
than twenty years, proving fatal from some complication, such
as bladder trouble, ulcerative cystitis readily developing and
frequently leading to septic infection. Death may arise also
from broncho-pneumonia or general nervous exhaustion.

Guillain has collected five cases in his thesis, and has de¬
scribed two additional cases in conjunction with Alquier (2) and
Raymond (3). Raymond and Fran^ais (4) report an eighth
case, and we have the record of a doubtful case by Verger (5).

A comparison of my case with those described by Guillain
shows that the condition of the left hand and upper extremity
corresponds almost exactly with that illustrated by his figures.
The position of the hand is almost identical, with the exception
of the fact that the little finger is not flexed into the palm,
as in all his cases. The position of the forefinger and thumb,
with the ability to use these to a certain extent, is quite similar.
There is the same hyper-extension of the wrist, and the same
resistance to both passive and active movement—a resistance
obviously due to muscular spasm. (It is somewhat to be
regretted that Guillain has not given a more precise description
of the condition of the muscles themselves.) There is the same
tendency for the fingers to recoil like a spring after they have
been forcibly extended, and the same tendency to irregular
spasmodic action of the hand at an early stage, as noted in his
case 3.

The indefinite, varying dissociation symptoms are also some¬
what similar to those described in one of his cases.

On the other hand, it is to be noted that there is no inter¬
ference with the gait, with the tonicity of the muscles of the
lower extremities, nor with their deep and superficial reflexes,
and that there is no bladder trouble. These facts would, of
course, be opposed as much to the diagnosis of pachymeningitis
with spasm as to that of spasmodic syringomyelia.

I have searched in vain the accessible literature of sclero-

Plate 20.

Fig. 1.

Fig. 2.

Plate 21.

Fig. 4.

A CASE OF SPASMODIC SYRINGOMYELIA (?) 401

dennia and myosclerosis for evidence that they may be associated
with mnscular spasm, such as presented by my patient It must
apparently be one of an early stage of spasmodic syringomyelia
in which one limb is as yet alone affected. If not, it must be
some independent and as yet apparently undescribed condition.

I have in conclusion to thank Dr Harry Rainy, Dr Hugh
More, and Dr Kelman Macdonald for valuable assistance in the
study of this case.

Litxratubi.

1. Georges Guillain. “ La Forme Spasmodique de la Syringomyeiie.”
Steinheil, Paris, 1902.

2. Alquier et Guillain. “ Etude anatomo-clinique d’un cas de Syringo¬
myelic Spasmodique.” Rev. Neurol, 1906, p. 489.

3. F. Raymond et Guillain. “Un Cas de Syringobulbie. Syndrome
d’Avellis au cours d’une Syringomyeiie Spasmodiqae.” Rev. Neurol, 1906,

* p. 41.

4. Raymond et Fran^aia. “Syringomyeiie Spasmodiqae avec Attitude
P&rticulifere des Membres Sup4rieurs.” Rev. Neurol , 1906, p. 360.

6. Henry Verger. “ Sur un cas de Syringomyeiie Spasmodique Doulour-
euse k evolution rapide.” L’EncdphaU, 1907, p. 21.

Drscbiftion of Platm.

Fia 1. Usual attitude of patient. Left arm firmly apposed to aide of thorax.
Forearm flexed at a right angle to arm and supported by left hand.
Slight hyperextension of wrist. Flexion of middle and ring fingers.
Slight flexion of little finger. Forefinger extended at two inter-
phalangeal joints and flexed at metacarpo-phalangeal joint Left
shoulder somewhat higher than right. Greater volume of left shoulder
and arm.

Fio. 2. Attitude of left hand.

Figs. 3 and 4. Side views of left and right upper limbs to show the
prominence of the left biceps muscle.

abstracts

PHYSIOLOGY.

THE “FLY-0ATCHING REFLEX” IN THE FROG. J. A. Gunn,
(341) Quart. Jour, Experiment. Physiol., Yol. i., No. 2, April 1908.

Schradir has shown that in the frog the snapping for food is a
reflex from sight stimulation, and that a frog deprived of its
cerebrum will catch flies under suitable conditions. He has also
shown that if the brain be destroyed down to the fore part of the

402

ABSTRACTS

medulla oblongata, a somewhat different snap reflex is developed,
the frog in this case snapping if his hand or nose be touched. The
author points out that similar reflexes occur in a frog poisoned
with yohimbine, namely, it snaps if its nose or hand be touched,
or if a bright object be brought near its nose.

Qe considers that these reflexes are produced by yohimbine,
either by its paralysing the upper part of the central nervous
system and simulating the effects of operation, or by its action on
the medulla oblongata facilitating the elicitation of a normally
latent reflex. There are evidences in favour of both explanations.
However produced, the phenomenon is a striking illustration of
the selective action of a toxic agent on the nervous system.

Author’s Abstract.

ON THE STRUCTURE AND CONDUCTION OF SUPRANUCLEAR
(342) AUDITORY TRACTS. (Ueber Ban und Leitung dor supra*
nuklearen Hdrleitung.) RothmanN, Beitr. z. Anal., etc., des
Ohres., Bd. 1, H. 3, p. 232.

The paper is an abstract of the literature on this subject The
first part deals with the anatomy, and is too detailed to
abstract. The second portion is concerned with the physi¬
ology. The conclusions reached are that unilateral destruc¬
tion of the central auditory tracts in no case causes
unilateral deafness. The bilateral destruction of the posterior
corpora quadrigemina interferes greatly with the hearing, but
permits of a portion of the auditory fibres reaching the cortex.
Bilateral destruction of the corpora geniculata interna entirely
destroys the hearing. In the cortex only bilateral destruction in
the region of the temporal convolution will lead to permanent loss
of hearing in dogs and monkeys. W. G. Porter.

AXON BIFURCATION IN REGENERATED NERVES. W. A.

(343) Osborne and Basil Kilvington, Joum. Physiol, Vol. xxxvii.,
No. 1, p. 1.

When an efferent axon is cut and offers more than one path
along which to regenerate, Langley and Anderson showed that
it can divide into at least two separate and distinct axons. The
authors of the present paper find that the axon bifurcation takes
place, not at the region where the regenerating stump is sprouting,
but at the point where the multiple path is offered.

If a sensory path be offered to a regenerating motor nerve, as
well as its own proper path, bifurcation takes place just as if both

ABSTRACTS

403

the offered paths had been motor. One branch of the bifurcating
axon reaches the proper ending in the muscle, the other branch
travels down the sensory path, and can be detected as far as the
stimulation test can be applied

In the adult dog afferent nerve fibres cannot regenerate along
motor paths. One case, however, seemed to be an exception to
this rule. The radial nerve was cut (in a dog), about an inch of
the posterior interosseous nerve was excised, and then the central
end of the radial was sutured to its own distal end and to the
distal end of the posterior interosseous. There was thus a motor
(posterior interosseous) and an afferent (radial) path offered to an
afferent nerve (radial). Stimulation was carried out 113 days
after the primary operation. The radial was cut 1£ inch above
the point of suture, and on being stimulated on the peripheral
side of this point marked contraction of the extensors was pro¬
duced. The radial was then cut distal to the point of stimulation,
but still contraction of the extensors was obtained. On dividing
the posterior interosseous no contraction was caused by stimulat¬
ing the radial either peripheral or central to the suture. The
radial nerve, though it contained no fibres carrying nerve im¬
pulses into muscle cells, could nevertheless, when offered a motor
path along which to regenerate, supply this motor path with
efficient axons. The explanation offered by the authors is that in
this particular instance motor fibres were actually present in the
radial, though incapable of making any peripheral muscular
connection, the aberrant course being due to a developmental
anomaly.

If a deficient sensory path is offered to regenerating sensory
fibres, no coalescence of sensory axons can be detected.

Sutherland Simpson.

ON RECIPROCAL INNERVATION OF ANTAGONISTIC MUSCLES.

(344) ELEVENTH NOTE—FURTHER OBSERVATIONS ON SUC¬
CESSIVE INDUCTION. C. S. Sherrington, Proc. Roy. Soc.,
Vol. lxxx., p. 53.

In a spinal animal after a sufficient interval has elapsed to allow
of recovery from “ shock,” or in a decerebrate animal (transection
through anterior part of hind-brain) within a few hours after the
operation, the “ flexion-reflex ” obtained from the limb by excita¬
tion of an afferent nerve or of some appropriate skin-point is found
to be diphasic; the movement of active flexion is followed by a
movement of active extension. During the active flexion the
extensor muscles are relaxed by central inhibition ; during the
active extension the extensor muscles contract. This is termed
“ successive induction.”

404

ABSTRACTS

The contraction of the extensor muscles never occurs during
the continuance of the external stimulus, but only after that has
ceased entirely or been greatly reduced in intensity, and only then
if the original stimulus is stronger than a certain minimal. The
intensity of the contraction after-phase is proportional, within
limits, to the strength and duration of the stimulus.

In the first phase of the reflex the extensor muscles abandon
the maintenance of a posture, or the execution of a movement
in which they were engaged; in the second phase they restore
that posture to the limb, or re-establish movement in the
abandoned direction. The active movements, therefore, of flexion
and extension alternating one with another do not require alter¬
nation of two external stimuli, one evoking flexion, the other ex¬
tension ; one and the same stimulus intermittently applied or
merely suffering periodic variations of intensity, provided the
variations exceed a certain amount, suffices fully for the double
phases of the reflex movement. The reflex movement of stepping,
therefore, with its two opposite phases of flexion and extension, is
excited by one single form of stimulus, that stimulus being the
one which directly excites flexion. This suggests an explanation
of the fact that flexion is much more extensively represented in
the receptive field of the limb than extension. The direct stimular
tion of any afferent limb nerve excites as its immediate result
flexion of the limb itself, not extension. Similarly in the motor
cortex, especially for the hind limb, the primary representation
of flexion greatly preponderates over that of extension, the reason
being that reflex flexion of the limb of itself induces as a sequence
extension, so that no local stimulus is required for extension.

Sutherland Simpson.

PATHOLOGY.

CONTRIBUTIONS TO BRAIN PATHOLOGY. (BeitrSge zur Pathologic
(345) des Gehirns.) Hochhaus, Deutsche Zeitsch. f. Nervenheilk .,
1908, Bd. xxxiv., p. 185.

The first case here recorded was one of multiple gliomata of unusual
magnitude. The main tumour was of enormous size, and there
were two smaller accessory gliomata. The disease commenced in
March 1901 with headaches, giddiness, and impairment of vision.
Under treatment by potassium iodide, with mercurial inunction,
there wad temporary improvement. But after a year the same
phenomena reappeared in more marked degree. The patient
became blind from optic atrophy, paresis of external ocular muscles

ABSTRACTS

405

developed, and in August 1902 paralytic phenomena appeared in
the left trigeminal area and in the left side of the body. Attacks
of unconsciousness, with convulsions, developed, and after various
remissions and exacerbations the patient died in August 1903.
At the autopsy the right side of the brain was increased in
volume, especially in the region of the temporal lobe, from which
a gliomatous tumour projected downwards, compressing the right
crus cerebri. The infundibulum and optic chiasma were embedded
in tumour-tissue. The main tumour measured nearly 20 cm. in
length, occupying the whole right hemisphere. Two smaller
tumours were also found, one in the right temporal lobe, the other
in the right frontal lobe. These smaller tumours were independent
of the main mass of the growth, though of the same microscopic
structure.

The second case was one of infantile hemiplegia in a child
aged 2} years. After measles the child was suddenly taken ill
■with unconsciousness and left-sided convulsions, followed by right
hemiplegia. No definite history of fever was obtainable. The
child died of broncho-pneumonia about three weeks from the onset
of the illness.

Autopsy showed marked oedema of the meninges, with distinct
meningo-encephalitis in the region of the.central gyri of the left
side. Purves Stewaet.

THE SPINAL COED AFTER (a) NERVE-GROSSING AND AFTER
(346) (b) NERVEGRAFTING. (Rttckenmarksbeftmde (a) nach Ner-
venkreuzung und (b) nach Nervenpfropfong.) G. Bikeles,
Near. CentnUbl., May 16, 1908.

A short paper in which Prof. Bikeles states the results of
nerve-crossing and nerve-grafting in the same animal. In a
dog, on the right side the median-ulnar nerve was divided and
its peripheral portion grafted on to the intact radial nerve above
the branch to the triceps. Eighty-four days later a crossing of
median-ulnar and radial nerves on the left side was made, median-
ulnar central stump to peripheral radial and vice versa. Ten
months after the grafting ( i.e . seven months after the crossing), 6 cm.
of each median-ulnar nerve were resected 2 to 3 cm. below the
site of graft and cross. One month later the animal was killed
and the cord examined (Nissl, Thionin). On the left side (crossing)
there was degeneration of the cells in the anterior horn corre¬
sponding originally to the radial. On the right side (grafting), no
pathological alteration of radial cells, but only in the median-ulnar
area, i.e. that whereas the resection of the median-ulnar on the
side of the crossing caused a degeneration of the radial area in the

406

ABSTRACTS

cord, thus demonstrating the functional continuity of central radial
stump and peripheral median-ulnar portion, the lack of changes in
the radial area on the side of the grafting shows that the median
stump grafted on to the radial nerve never entered into functional
union. Where the choice is open, therefore, crossing is to be
preferred to grafting. R. Cunyngham Brown.

A SIMPLIFICATION OF NISSL’S STAIN AND ITS APPLIOA-
(347) TION TO BERI BERI. (Eine Vereinfachung der Nisslschen
F&rbung und ihre Anwendung bei Beri-Beri.) Ernst Roden-
waldt, Monatschr. /. Psychiat. u. Neur., April 1908, Bd. xxiii.,
S. 287.

Starting from Giemsa’s view that the active stain produced by
the combination of methylene blue and Venetian soap could only
be azure, the author suggests the replacement of Nissl’s stain by
1:750 watery azure, to which just before use 40 per cent, of
saturated calcium carbonate has been added. He stains for only
one minute, and without warming. After differentiating in anilin
alcohol he passes the section through absolute alcohol, then xylol,
origanum oil, Canada balsam. (In the reviewer’s experience more
permanent results may be obtained by using the xylol after the
oil and omitting the absolute alcohol stage.)

In a few lines he describes the findings in the spinal cords of
two cases of beri-beri. Degeneration was found in the cells of
Clarke’s column, and of the anterior horn, the antero-medial group
being, however, spared. The “fish-eye” stage was that most
frequently found. Ernest Jones.

PSYCHOLOGY.

EXPERIMENTS TO DETERMINE OO-OONSOIOUS (SUBOON-

(348) SOIOUS) IDEATION. Morton Prince, Jowm. of Abnorm.
Psychol., April-May 1908, p. 33.

Dr Prince is well known as the investigator of the remarkable
case of multiple personality known as Miss Beauchamp. The
present paper is a description of experimental evidence obtained
with a view to deciding between two theories of subconscious
manifestations. The first of these—the psychological—regards
subconscious manifestations as the expression of subconscious
ideas more or less dissociated from the personal consciousness;
the second—the physiological—regards them as the result of

ABSTRACTS

407

physiological processes without any association with ideas what¬
soever. The question for Dr Prince was—Could a problem,
obviously requiring ideation, be solved by a subconscious (co-
conscious) personality while the personality predominant at the
time was unaware of the process taking place ? He had a case of
multiple personality, B-A, in which the one personality, A, was
completely unconscious of the other, B, whereas B had full know¬
ledge of A, and claimed also to have a distinct life of her own
going on all the time that A was to the fore. The substantiation
of this claim would, of course, support the psychological interpre¬
tation of the phenomena. The paper contains an account of the
tests which Dr Prince imposed upon B, to see whether she could
make good her claim. It may be mentioned that she stood the
tests, which were chiefly arithmetical in nature, triumphantly.

Margaret Drummond,

MEASURE OF INTELLECTUAL FATIGUE IN CHILDREN OF
(349) BOTH SEXES BY MEANS OF THE ASSTHESIOMETER.
(Mesure de la Fatigue intellectuelle chez les Enfants des
deux Sexes avec l’Esth&iomdtre.) Schuyten (Anvers), Rev.
de Psychiat. et de Psychol. Experiment ., April 1908.

This article is to form part of a volume on Feminine Education,
which is to appear shortly. It opens with a defence of the
aesthesiometer as an indicator of fatigue, a defence supported by
special experiments designed to test the question.

Subsequently experiments were performed on school children
to determine the annual curve of aesthesiometric fatigue. This is
shown to ascend throughout the whole school year, a slight descent
marking each of the two holiday periods. To test whether this
result was really to be attributed to school work, the author tried
a similar series of experiments on young people attending evening
classes, and he gives figures to show that no such steadily increas¬
ing fatigue is here indicated.

In considering the results obtained, comparisons are made
between boys and girls, between the more intelligent and the less
intelligent children, and between the right half and the left half
of the body.

Accounts are given of sesthesiometric researches with school
children as subjects, made by Yannod at Berne and Yasousabouro
Sakaki at Tokio.

The writer considers that the results of his work are gravely
condemnatory of the whole school system.

Margaret Drummond.

408

ABSTRACTS

AN EXPERIMENTAL STUDY OF SLEEP (PART L). Boris Sidis,
(350) Joum. of Abnorm. Psychol ., April-May 1908, p. 1.

The writer begins with an account of the various theories of Bleep,
classifying them under the following headings:—(1) Physiological
Theories, subdivided into Mechanical and Chemical; (2) Patho¬
logical; (3) Histological; (4) Psychological; (5) Biological. A
study of the conditions inducing sleep follows. It is pointed out
that these conditions are similar to those relied upon to induce a
subconscious and particularly a hypnotic state. The writer finds
that subjects whom he is endeavouring to hypnotise frequently
pass into ordinary sleep. Limitation of the field of consciousness,
limitation of voluntary movement, and, possibly most fundamental
of all, monotony, are conditions tending to bring about either sleep
or hypnosis, according to predisposition. But while fixation of the
attention is an important factor in the induction of the hypnotic
state, its relaxation is favourable to the onset of sleep.

Dr Sidis then discusses certain peculiar subwaking states,
which he terms hypnoidal; these are unstable in character, pass¬
ing easily into the ordinary waking state on the one hand, on the
other into either sleep or a light hypnosis. They are characterised
by a high degree of suggestibility, and by the formation of hallu¬
cinations. The method used to induce these states is described.

Guided by the phenomena observed in his study of the hyp¬
noidal states in his human subjects, Dr Sidis determined to carry
out a series of experiments on the induction of sleep in animals.
The animals employed in this special research were frogs, guinea-
pigs, cats, dogs, infants, and adults. This first part of the mono¬
graph concludes with an account of the experiments on the frogs
and the guinea-pigs. Margaret Drummond.

CLINICAL NEUROLOGY.

A CONTRIBUTION TO THE PATHOLOGY OF MYASTHENIA
(351) GRAVIS. Report of a Case with Unusual Form of Thymic
Tumour. F. S. Mandlebaum and H. L. Culler, Joum. of
Exper. Med., May 1908, p. 308.

From a review of the 46 cases which have been published with
more or less complete autopsies, the authors conclude that thymic
neoplasms have been noted too frequently (11 cases) to be ignored
as a possible etiological factor. In their own case an unusual
type of tumour, to which they give the name of perilymphatic
lymphangio-endothelioma, was present. They consider it probable

ABSTRACTS

409

that the disease is a manifestation of a toxemia of indeterminate
origin, and that the action of this toxic agency is not confined to
the muscular system, but the organism is generally affected as evi¬
denced by the widespread presence of lymphocytic infiltrations
(lymphorrhages) throughout the body. They record these latter
from various voluntary muscles (very well marked), tongue, liver,
adrenals, and some of the perivascular lymphatics of the medulla.
No degenerative changes were found in medulla or cord, al¬
though the infiltrations would indicate the involvement of the
central nervous system in the toxaemia. The change in the muscle
fibres are purely degenerative, the result of the toxaemia, and not
dependent upon a primary myositis; these degenerative changes
bear no relation to the site of the lymphocytic infiltrations.

The article is illustrated by some excellent photographs of
lymphorrhages and of the thymic tumour.

J. H. Harvey Pirie.

HYPOTONIA. (Die Hypotonie.) Albert Knapp, Monatschr. /.
(352) Psychiai. u. Neur., Bd. xxiii., Erganzungsheft, S. 16.

In this monograph, 80 pages long, the whole problem of hypotonia
is handled in such a thorough and extensive manner as to render
abstraction of the same impossible. First the clinical side is dealt
with in detail, stress being especially laid on the diagnostic value
of the phenomenon and its independence from other signs which
are frequently associated with it. A long and interesting dis¬
cussion of the theory of the subject follows, in which the author
inclines to the pre-Baslian attitude concerning the importance of
the peripheral reflex arc. He says, for instance, “ The thesis may
be laid down with all certainty that up till now no case of com¬
plete interruption of the continuity of the spinal cord has been
observed in which the loss of muscle-tone and reflexes could not
be attributed to anatomical or functional disturbances in the
lumbar reflex arc.” This, of course, does not exclude action of the
higher centres and paths, but injury of these can affect the muscle
tonus only via indirect injury of the lower reflex arc.

Ernest Jones.

▲ TYPICAL FORM OF TABETIC GAIT. (Eine typische Form der
(353) tabischen Gehstonmg.) H. Haenel, Deutsche Zeitsch. /. Nerven-
heilk., 1908, Bd. xxxiv., p. 279.

The gait in tabes is not always of the typical stamping kind, with
banging of the heels. Variations in type occur according to the
preponderating or exclusive affection of one or another group of

410

ABSTRACTS

muscles. Haenel describes a common variety of gait which in
certain respects may be regarded as typical, and which is useful
for the study of normal progression.

For the purpose of walking, in order to advance from the
standing posture, the centre of gravity, which lies over a point
midway between the two feet, has to be shifted exactly over one
foot: only then does the other advancing foot become free to move
forward. What is the motor process executed during this shifting
of the centre of gravity ? A muscle can never “ push,” it can only
“pull”; it exerts power by the process of shortening, not by
lengthening. To bend the upper part of the trunk towards the
right side in the standing posture, we must first contract some
muscle or group of muscles whose fixed point is further to the
right than its movable point. The spinal and lateral abdominal
muscles, in this respect, are not the efficient group which they
might at first sight seem to be, inasmuch as they run more or
less parallel with the spinal column and only produce a lateral
bending of the vertebrae, not a displacement en masse. Inasmuch
as lateral movement of the spine upon the pelvis is impossible,
the pelvis moves together with the superposed part of the trunk;
it has therefore to be approximated to the thigh. This again is
impossible, since the neck of the femur prevents any shortening,
so that all that the pelvis can do is to change its angle towards
the neck of the femur. The fixed point, then, is not the great
trochanter, but the foot which is fixed. The chief joints around
which rotation occurs are in the region of the ankle joint, and
especially the calcaneo-scaphoid joint.

The gastrocnemii, which in the lying position depress the foot,
in the erect attitude raise the whole body. The peronei which
ordinarily elevate the outer border of the foot, when the border
is fixed by the contraction of antagonists and the weight of the
body, in the erect posture tend only to draw the upper end of the
leg outward. The extended knee-joint permitting of no lateral
movement, this movement of the leg is directly transferred to the
thigh. With a flexed knee the vastus extemus acts as an accessory
muscle in the same sense. The hip-joint is capable of movement
in many axes, and therefore the pelvis does not follow the thigh
directly, but by the help of the short hip-muscles. Now the
rotators of the hip pull the pelvis forwards or backwards. The
lateral elevators of the hip become lateral depressors, and so on,
different muscles coming into action according as the pelvis makes
different angles with the femur. The gluteus maximus is specially
important for this movement of the pelvis. It is, in fact, the most
specifically human muscle we possess, being almost completely
absent in the lower animals—even in the anthropoid ape. It is
of special significance for the erect attitude. Whereas with most

ABSTRACTS

411

other muscles the fixed point varies according to the movement
performed, with the gluteus maximus the fixed point is normally
at the femur, preventing the pelvis and trunk from falling
forward.

In order to perform the apparently simple movement of lifting
one leg, the patient must therefore set a large number of muscles
into action, the chief axis of rotation being around the ankle and
calcaneo-scaphoid joints. In a tabetic patient in the recumbent
posture or with a loosely-hanging leg, we can often detect a distinct
pseudo-paresis of the peronei muscles, i.e. a drooping and dragging
of the outer border of the foot, since there is deficient innervation
of the peronei from faulty sensory impressions and later also from
diminished muscular tonus. This is shown in an ataxic patient
by the tendency for the foot to crumple inward. Such a patient
if he tries to lean to the right depresses his shoulder and bends
the vertebrae in concave fashion to the right, but the upper end
of the right leg tends to move inward instead of outward. Thus
he merely rotates his trunk around a sagittal axis passing through
his centre of gravity, instead of shifting the centre of gravity to one
side as he ought to do. If, therefore, he tries to swing the left leg
forwards, the left foot, being not yet unloaded, clings to the ground
and requires a great effort to raise it. To correct this, all we
require to do is to show the patient that he must incline the fixed
leg outwards instead of inwards, when he at once succeeds in over¬
coming the pseudo-paresis of the peronei

This deficiency of outward movement of the lower limb is the
first of the characteristic abnormalities of the tabetic gait; a
second, less commonly recognised, but equally important, is located
in the short muscles between thigh and pelvis, especially between
trochanter and pelvis. These are the three glutei and the tensor
fascia lake , which act as abductors of the “labile” leg, the
pyriformis, obturator intemus, gemelli, and quadratics femoris, which
are outward rotators, and the obturator extemus, assisted by the
pectineus and adductor brevis, acting as inward rotators. In tabetic
patients these muscles become disordered comparatively early in
the disease, there is difficulty in holding up the extended limb
steadily, and in the lateral position there is special difficulty in
raising the upper leg, pseudo-paresis being specially marked. This
latter posture is also convenient for demonstrating the different
action of the external rotators, by asking the patient to flex his
knee, keeping the heels together, and then to raise the upper knee.
We also observe well in this posture the hypotonia of the short
hip muscles, the great trochanter being unduly prominent, as if
the muscles had sagged away from it.

If we examine a tabetic patient in the standing posture, so
long as the knees are extended, abnormal lateral movements of the
2 a

412

ABSTRACTS

pelvis are impossible; the most that is seen is a tendency to sway
around the vertical axis (less commonly around the frontal axis,
since the gluteus maximus and ilio-psoas are generally least affected).
It is quite different when the patient tries to stand on one leg.
In health we immediately feel the gluteus medius and tenor fascia
latce contract, whilst the pelvis is tilted downwards on the same
side and upwards on the opposite side. As a result the sole of the
opposite foot is raised from the ground. In a tabetic patient
things are quite different. Even supposing he performs properly
the outward movement of the fixed leg, yet the short hip muscles
do not contract, the pelvis falls over to the opposite side, the
stepping lower limb is lengthened instead of shortened, and there¬
fore he has to flex it at the hip and knee. In order to raise the foot
from the ground he must bend it further still at these joints. The
unsupported leg loads the pelvis still more on that side, the centre
of gravity, badly adjusted, tends to fall over, and the patient
has to put his foot hastily again to the ground; he cannot lift the
leg slowly up and place it down again. He therefore seeks for the
support of both feet to maintain his centre of gravity. As soon as
the stepping leg touches the ground again it is suddenly extended,
the bent knee snaps into the straight posture, and the pelvis
becomes again horizontal. This movement goes on alternately
with each leg, the limb being placed on the ground bent and then
the pelvis brought horizontal by an additional movement, more a
passive movement of knee-extension by the quadriceps than of
actual gluteal contraction.

Pseudo-paresis of the peronei, though well marked in many
cases, can be voluntarily corrected by the patient, if he is shown
how to direct his attention to that leg; it may even be masked
by compensatory over-action of peronei. Not so with pseudo¬
paresis of the gluteus medius ; even by voluntary effort the patient
cannot abduct properly the upper leg in the lateral posture.

Haenel then enters into useful details of re-education move¬
ments to be practised by tabetics. For successful results personal
supervision by the physician is essential. Purves Stewabt.

JUVENILE TABES DORSALIS; Notes of Five Oases. Sydney
(354) Stephenson, Lancet , May 16, 1908, p. 1401.

Juvenile tabes, like the adult form, may assume various clinical
guises. One group, in which fall the cases described in this com¬
munication, is characterised chiefly by amblyopia due to optic
atrophy, together with change in the pupillary reflexes and aboli¬
tion of the knee and ankle jerks. They correspond to the cases of
“ pre-ataxic optic atrophy ” in the adult, and come, as a rule, first

ABSTKACTS

413

under the observation of the ophthalmic surgeon. Of the five
cases recorded, principally with regard to the ocular manifesta¬
tions, four are almost certainly cases of tabes, the fifth might be
an instance of hereditary cerebellar ataxy.

J. H. Harvey Pirie.

THE SYMPTOMS AND DIAGNOSIS OF JUVENILE TABES.

(355) Ernest Jones, Brit. Jowm. of Children's Diseases, April 1908.

A review of our present knowledge of the subject. About thirty
undoubted cases are on record. Juvenile differs from adult tabes
in the greater frequency of urinary symptoms, of headache and
amblyopia, in the slight extent to which girdle pains and ataxy
are present. More than a third of the parents of these cases
suffered from metasyphilis. The differential diagnosis from pseudo-
tabes, hereditary nervous diseases, and cerebro-Bpinal lues is
discussed. Author’s Abstract.

A CASE OF INFANTILE PARALYSIS SIMULATING MEN-

(356) INGITIS—TENDON TRANSPLANTATION. A. Jefferis
Turner, Austral. Med. Gaz., March 20, 1908.

A boy, 3 years of age, took acutely ill in Brisbane at a time
when there was a small epidemic of infantile paralysis in that
town. He was unconscious for several days, with total flaccid
paralysis of the limbs on both sides. He developed a squint and
slight head retraction, and for three weeks symptoms of cerebral
irritation persisted and increased. The fluid obtained by lumbar
puncture was quite clear. Improvement gradually set in, and
two months after the onset he was “ in fair general condition, but
with extensive flaccid paralysis of spinal type.” His mental con¬
dition was unimpaired.

Two years later the boy was again seen, and it was found that
his right arm was his only unparalysed limb.

The left arm was placed in a splint, as was also the left leg,
while the transplantation of tendons was done in the right leg
with marked success. A. Dingwall-Fordyce.

SUBACUTE COMBINED CORD DEGENERATION, WITH REPORT

(357) OF OASES. J. Grinker (of Chicago), Jowm. Am. Med. Assn.,
April 4, 1908.

Lichtheim first described the disease in 1887, pointing out the
association of pernicious anaemia and spinal cord disease.

Putnam in 1891 showed conclusively that cord lesions are as
often associated with other conditions of ill-health with or without
anaemia.

414

ABSTRACTS

Many names have been applied to this disorder—subacute
combined sclerosis, subacute ataxic paralysis, combined cord de¬
generation, diffuse spinal cord degeneration—but the author prefers
subacute combined cord degeneration.

The chief symptoms are—(1) sensory, due to posterior tract
degeneration, and (2) motor, due to pyramidal tract, and, later,
anterior horn degeneration. The symptoms develop somewhat
as follows:—Slight impairment of subjective sensation in the legs;
tingling, numbness, or prickling in feet, or calves of legs; dull
ache in the lower spine; slight inco-ordination in lower extremi¬
ties ; gradually the parsesthesia and inco-ordination extend to the
upper extremities. Superficial reflexes usually normal, deep re¬
flexes invariably exaggerated; ankle clonus. Babinski, Oppenheim,
and Gordon’s reflexes are present. The “ spastic ataxia ” in the
limbs gradually develops and complete paraplegia follows; the
cranial nerves, except optic, are rarely involved.

The terminal stage develops in from six months to six years,
the deep reflexes are abolished, sphincter paralysis appear, and
death from intercurrent disease or exhaustion closes the scene.

Reported cases may be conveniently divided into three
groups :—(1) Those in which pernicious anaemia was present from
the first; (2) those in which grave anaemia was found associated
with subacute combined cord degeneration at some time, but not
constituting its most important symptom; (3) those in which
anaemia was either slight, absent, or constituted a minor symptom.
In 17 cases, 14 were men and 3 women, nearly all were over 40
years, and syphilis had occurred in but one of the 17. Nearly
all first exhibited subjective sensory disturbances, disorders of
co-ordination, and, later, motor weakness. Only 4 began with
typical pernicious anaemia; others showed little anaemia, or, if
pernicious, it was not an early symptom. Post-mortem examination
showed discrete patches of degeneration in the posterior and
lateral columns of the spinal cords, most commonly in the cervical
and dorsal regions. In differential diagnosis, spinal syphilis and
multiple sclerosis offer the most difficulties; of the etiology little
is known, the treatment is entirely symptomatic.

C. H. Holmes.

FALSE LOCALISATION OF PAIN SENSATION IN A CASE OF
(358) COMPRESSION OF THE CORD. (Uber falsche Lokalisa-
tion der Schmerzempfindung bei Rtickenmarkakompreasion.)
Renner, Deut. Zeittchr. f Nervenheilk., Bd. 34, H. 3 and
4, S. 210.

The case was that of a man with a tumour compressing the oord
at the level of the 7th dorsal vertebra. At the corresponding

ABSTRACTS

415

level was a band of hyperaesthesia of the skin. All painful
stimulation of the legs, genitals, or lower part of the body was
referred to this hyperaesthetic zone. Such cases are probably to
be explained by irradiation and false projection from the cortex.
(For abstract of a similar case reported by M. Lewandowsky, see
this Review for 1906, p. 703.) J. H. Harvey Pirie.

ACUTE PARAPLEGIA FOLLOWING ANTI RABIO INOCULA-
(359) TION. (Uber akute P&raplegien nach Wutschutzimpfimgen.)

Ed. Muller (Breslau), Dewt. Zeitschr. f. Nervenheilk., Bd. 34,
H. 3 and 4, S. 252.

In this paper the author adds another to the two dozen cases,
which have been recorded, of acute paraplegia following on pre¬
ventive inoculation for rabies. His case is recorded in detail; an
analysis of the previously recorded cases is given; the following
is a summary of the facts known about this interesting condition.

There is undoubtedly a typical disease of the nervous system
quite different from true human rabies, associated with anti-rabic
inoculation; its chief characteristics are acute paraplegia and
severe disturbances of micturition and defamation; the prognosis
is very favourable. The site of the disease is chiefly the spinal
cord, but the bulbar axis and peripheral nerves may also be
affected. Age and sex appear to have no special incidence.

The onset is quite acute—one to two weeks after the first in¬
oculation is the rule. Frequently there are premonitory symp¬
toms indicative of a toxic infectious process (fever, general un¬
easiness, headache, loss of appetite, pain in back and limbs, etc.);
also slight psychical disturbances—nervous unrest and depression.

Along with severe disturbances of the bladder and rectum,
there appears at the onset a paresis of the lower limbs, rapidly
becoming more and more complete. This is often associated with
marked muscular pain and stiffness, especially in the lumbar
region. Sensory irritation, in the form of paraesthesise or rheu¬
matic, lancinating and neuralgic pains, is also observed.

Usually the paresis of the lower limbs increases in a short
time till every trace of voluntary movement is lost in the leg
and thigh muscles. Concurrently, there is complete retention of
urine and faeces.

Muscular tonus in the lower limbs is usually diminished, and
the tendon reflexes are lost. The skin reflexes (abdominal, cremas¬
teric, and plantar) usually also disappear ; Babinski’s sign may be
evoked by strong plantar stimulation. Sensory disturbances vary.
Gross disturbances may not be present, but after the original signs
of irritation, there may be marked diminution of sensibility, or

416

ABSTRACTS

even extensive complete segmentary anaesthesia for all forms of
sensation; hypertesthesia of the muscles to pressure may be
noted.

In most cases the paralysis is limited to the lower limbs, but
not infrequently there follows rapidly paresis of the muscles of
the trunk and upper limbs, going on to complete paralysis. Here,
also, before the paralysis, there is a feeling of stiffness in the
muscles. The process may involve the bulbar region, with
development of serious bulbar symptoms. Facial paralysis and
paresis of some of the external eye muscles (pupil and fundus
being normal) are the most frequent signs, but more serious may
be the respiratory and cardiac disturbances (especially tachy¬
cardia). Difficulty in swallowing, aphonia, and salivation have
been described.

In spite of the rapid development and even appearance of
bulbar signs, the prognosis is very favourable; death only rarely
follows on long-lasting paraplegia. Usually the remote bulbar
symptoms, especially those characteristic of the hydrophobic con¬
dition, fail to appear. Above all, there is lacking the peculiar
tonic convulsions of true rabies, the spasm of the pharynx and
glottis and of the respiratory muscles. Rapid recovery begins
after a few days or weeks at most, and is usually complete, though
perhaps not for some months. In contrast to poliomyelitis, there
is never any atrophic paralysis. Treatment is limited to careful
nursing and cessation of the inoculations.

J. H. Harvey Pirie.

TWO OASES OF ACUTE MENINGITIS OF THE CONVEXITY.

(360) Josephine Hemenway, Arch, of Pcd., March 1908.

Case I. was a child aged twenty months; the main symptoms
were sudden general convulsion, unconsciousness, dilated pupils,
slight nystagmus, internal strabismus, temperature 100°, exag¬
gerated knee-jerks, leucocytosis 24,200; no other pnysical signs
were present; lumbar puncture negative; broncho-pneumonia in
third week, which cleared up in seven days. Lumbar puncture
in fifth week showed increased tension, was otherwise negative.
Emaciation ; return of signs in lungs; death on seventy-third day.

Autopsy: Meningitis limited to parietal and frontal lobes,
superior and lateral aspects; broncho-pneumonia; smears and
cultures from meninges and lung both showed Fraenkel’s Pneumo¬
coccus.

Case II. — Case showed symptoms similar to those in Case I.,
and was diagnosed as one of convexity meningitis.

The patient recovered.

ABSTRACTS 417

Conclusions regarding acute convexity meningitis drawn from
these two cases and others observed at the hospital—

(i) Pneumococcal meningitis is usually most marked on the
convexity.

(ii) It occurs as a primary condition or secondary, generally
to pneumonia.

(iii) There are no symptoms due to basal or spinal lesions.

(iv) Lumbar puncture may be negative.

(v) The nervous symptoms are usually general, and followed

by mental symptoms. John M. Darling.

EPIDEMIC OEBEBBO-SPINAL MENINGITIS IN ADULTS. (Ueber

(361) Meningitis cerebrospinalis epidemics im hSheren Lebensalter.)

Hermann Sohlesinger, Wien. Med.' Wchenschr., April 1908,
p. 726.

Dr Sohlesinger makes a few introductory remarks on the rarity
of this disease among adults, and old people; he thinks that the
atypical course of the disease in these older age limits has not
been sufficiently emphasised, and on that account he believes that
some of those cases may have been overlooked. Dr Sohlesinger
goes so far as to say that there is a distinct senile type of the
disease, differing from that in children by being more gradual in
onset, and he notes particularly the slight degree of rigidity of the
neck and its early disappearance.

He does not consider Cheyne-Stokes breathing as being neces¬
sarily an unfavourable symptom. There is an interesting series
of his own cases in adults, showing how their symptoms varied
from the normal type.

Dr Sohlesinger lays stress on the importance of the bacterio¬
logical examination of the fluid obtained by spinal puncture, and
points out the frequent occurrence of cases of tubercular menin¬
gitis during epidemics of cerebro-spinal meningitis. The treatment
in adults corresponds to that in children.

He lays special stress on repeated spinal puncture, and dis¬
cusses the value of the different serums in use for the disease.

Duncan Lorimer.

PRELIMINARY REPORT OF A CASE OF CEREBRO-SPINAL

(362) MENINGITIS OF STREPTOOOOOUS ORIGIN APPARENTLY
CURED BY SUBDURAL INJECTION OF ANTI-STREPTO¬
COCCUS SERUM. George L. Peabody, N.Y. Med. Bee.,
March 14, 1908.

Patient was a man aged 37 years, and was admitted to hospital
on 2nd January, fourteen days after the onset of his illness

418

ABSTRACTS

Illness commenced with a chill after exposure to cold and wet.
His condition on admission suggested cerebral trouble, and his
fever was of the type usually found in cases of sepsis. Lumbar
puncture on the day after admission showed slightly turbid
cerebro-spinal fluid under considerably increased pressure. Culture
revealed the presence of a gram-positive coccus of doubtful identity.
Lumbar puncture was repeated on 10th January and cultivation
showed definite streptococcus after forty-eight hours. On 12th
and 13th January 10 c.c. of antistreptococcus serum were in¬
jected subcutaneously. No improvement followed. On 14th, 15th,
16th, 17th, 19th and 21st January, 10 c.c. of antistreptococcus
serum were injected into the subdural space. After the second
subdural injection, the cerebro-spinal fluid was sterile. The
temperature fell to normal in eight days after commencement
of subdural injections, and remained normal till time of reporting
the case (February 17th). Other symptoms also abated, and
patient is now apparently quite well. John M. Darling.

MENINGOCOCCUS HYDROCEPHALUS. Francis Huber, Arch, of
(363) Pediai., March 1908.

Epfusion may take place at any stage in the course of epidemic
cerebro-spinal meningitis or meningo-encephalitis. The effusion
may be into the sub-arachnoid space—the “external” type; or
into one or both ventricles—the “ internal ” type—or there may be
a combination of both varieties.

The amount of enlargement of the head and the shape of the
enlarged head are influenced by the degree and extent of sutural
union. In the infant, within one or two weeks of the onset, the
anterior fontanelle bulges and pulsation diminishes or ceases, the
veins of the skull become prominent, and the cranial diameters
increase. This is associated with disturbance of nutrition and
innervation throughout the rest of the body. In very young
infants the increase in the size of the skull is uniform. In older
infants the non-united parts of the skull yield most easily. Again,
the collection of fluid may be most marked in the anterior cornua,
and the eyes may be pushed downwards and forwards; or the
posterior cornua may be most affected and give rise to bulging
behind with retraction of the head and arching backward of the
spine. If the sutures and fontanelles have been obliterated, the
head may be normal or very little increased in size.

The clinical manifestations are briefly those:—Within a week
or two of the onset of the meningitis, in spite of low or irregular
temperature, the patient remains apathetic or comatose, with
Jw current vomiting, occasional convulsions, emaciation, retractio

ABSTRACTS

419

of the abdomen, dilated pupils, distension of the veins of the head
and forehead, perhaps strabismus, stiffness and retraction of the
head, paroxysmal headaches, hydrocephalic cry, and neuralgic
pains in the nerve trunks. The pulse in the young is rapid; in
the older it may be slow and irregular. Incontinence of urine
and faeces, and muscular paralyses or tremors are frequent. The
symptoms often temporarily improve.

Treatment is unsatisfactory, with the possible exception of the
iodides. Sometimes the process is cut short by nature. A few
grow up with little or no mental change. Cases are recorded
where patient was subsequently exceptionally bright. In others
reminders occur, such as paroxysmal headaches and pains, or
patient may become idiot, epileptic, blind, etc.

As regards operative interference, lumbar puncture gives the
best results in external cases. Drainage into the retro-peritoneal
tissue has been tried in the combined variety with no ultimate
success. In the internal cases, ventricular drainage has been
resorted to, but encouraging results are reported in only one case.
The results of surgical measures have up till now been unsatis¬
factory, but earlier diagnosis and interference might improve
them. John M. Darling.

A CASE OF SYPHILITIC MENINGITIS, WITH AUTOPSY. (Un
(364) cas de mdningite syphilitique, avec autopsie.) G. Ballet et
A Barb#, Rev. Neurol., Ap. 15,1908, p. 337. (Soc. de Neurol.)

A servant girl, aged 21 years, was admitted to hospital on
June 25, 1907, for severe headache. No other nervous symptoms
were present, but there was a roseola on the face and trunk. A
chancre had not been noticed. Lumbar puncture on June 28th
showed an enormous lymphocytosis. Daily injections of biniodide
of mercury, associated with the oral administration of 60 grains of
potassium iodide, were instituted. It was not till her discharge in
the beginning of September, when she had received sixty injec¬
tions, that the headache and lymphocytosis disappeared. She was
re-admitted in October for intense headache, which, in spite of
specific treatment, rapidly became worse. Typical symptoms of
meningitis developed, and death took place on October 25th.

At the autopsy a lymphocytic infiltration was found in the
thickened pia mater. The subarachnoid spaces were also the seat
of a diffuse embryonic infiltration. The lymphocytes were most
abundant in the neighbourhood of the blood-vessels, which showed
evidences of periarteritis and periphlebitis. Points of caseification
were found on the lower surface of the hemispheres. Neither the
spirochseta pallida nor the tubercle bacillus could be detected.

J. D. R0LLE8T0N.

420

ABSTRACTS

AN ATTEMPT TO CLASSIFY CEREBELLAR DISEASE, WITH
(365) A NOTE ON MARIE’S HEREDITARY CEREBELLAR
ATAXIA Gordon Holmes, Brain, Part cxx., 1907.

Sixty-six publications referring to cases of primary cerebellar
disease are reviewed in this paper with a view to a classification
on the basis of morbid anatomy and pathogenesis. The nature
and extent of the pathological changes were ascertained by post¬
mortem examination in each case.

I. Primary parenchymatous degeneration of the cerebellum .—
Under this head are grouped a number of cases which showed
symptoms of a more or less similar nature—reeling gait, inco¬
ordination, nystagmus, slow articulation, etc.—and where the
main pathological changes found post-mortem were smallness of
the cerebellum, as a whole, and atrophy or disappearance of the
Purkinje cells, with or without degenerative changes in the
molecular and granular layers.

The author considers that the pathological changes which were
found by Herringham and Andrews in the cerebella of a litter of
four kittens suffering from cerebellar symptoms, and which they
regarded as degenerative in origin, were in reality probably
developmental abnormalities.

II. Olivo-ponto-cerebellar atrophy. —This class includes cases
described by Thomas as of “a type characterised anatomically
by atrophy of the cerebellar cortex, of the bulbar olives, and of the
grey matter of the pons; by total degeneration of the middle
cerebellar peduncles, by partial degeneration of the corpora
restiformia, and by relative integrity of the central nuclei of
the cerebellum; clinically, by the cerebellar syndrome. It is
neither hereditary, familial, nor congenital. It comes on at an
advanced age and progresses slowly. It falls into the group of
primary cell atrophies.”

A case published by Schweiger where the clinical diagnosis
was disseminated sclerosis is regarded by the author as really
falling into this class, the spinal lesion being a coincidence only.

III. Progressive cerebellar disease due to vascular or interstitial
changes. —Four cases are cited under this head in which there were
symptoms of cerebellar disease, and where post-mortem examina¬
tion showed sclerotic and vascular changes in the cerebellum.

IV. Acute cerebellar lesions. —This group includes cases of
acute ataxia occurring frequently in children during and after
infective illness. Histological examination has been possible only
at long periods after the onset. The disease is due probably, in
some cases, to an acute inflammatory lesion of the nature of
encephalitis, and in others to an acute toxic degeneration of the
cortical nerve elements.

ABSTRACTS

421

V. Degeneration of the spino-cerebellar tracts, the cerebellum being
normal or small only. —In this class of case, and in Class VI.,
there is no affection of the cerebellum, but they are included here
as their most prominent symptoms have been described as those
of cerebellar disease. (1) Cases which do not belong to any
recognised type. (2) Cases of Friedreich’s disease. The author
regards the presence of a cerebellar lesion in this disease as an
exceptional coincidence.

VI. Cerebellar symptoms associated with congenital smallness of
the central nervous system. —Falling into this class are the cases of
three brothers described by Nonne, and of two brothers described
by Miura. In these cases symptoms suggesting cerebellar disease
appeared in early manhood. Post-mortem the central nervous
system was found to be small, but no histological change could be
detected.

Note on “ Hereditary Cerebellar Ataxia ” of Marie. —No form of
disease exists to which the term “hereditary cerebellar ataxia”
can be aptly applied. A number of obscure cases, with some
symptoms in common, were grouped by Marie and others under
this title. Classification must be on the basis of morbid anatomy
and pathogenesis. The term should not be retained.

John M. Darling.

ACUTE BULBAR PARALYSIS WITH AH UNUSUAL SYMPTOM.

(366) A. Gordon (of Phila.), Med. Bee., Feb. 29, 1908.

A woman of 40 years suddenly and without prodromata became
unconscious, and remained comatose three days. She regained
consciousness, but was totally aphasic, the face was drawn to the
right, the speech improved, but never became normal. Five
months later a second attack, in which she was not unconscious;
the tongue was protruded and caught between set teeth for twenty-
four hours; face drawn to the left. Gradual relaxation took place,
there remained inability to swallow, to move the tongue, or to
masticate; absolute loss of speech and voice; breathing was
difficult.

Nearly a year later the following symptoms persist:—She can
make only monotonous and identical sounds; no word, syllable, or
letter can be uttered; face deviated to the left; left naso-labial
fold deepened; tongue tremulous, its movements are limited and
reactions of degeneration are present; uvula flaccid; pharynx
anaesthetic; swallowing difficult; blowing and whistling impos¬
sible ; the right facial muscles show partial reactions of degenera¬
tion ; the grips are normal, gait normal, knee-jerks exaggerated,
paradoxical reflex on right side, no Babinski, no sensory dis-

422

ABSTRACTS

turbances, no eye symptoms. Intelligence well preserved. She
understands spoken or written words — no agraphia. Heart
shows apical cystolic murmur; no history or evidence of specific
disease.

Gordon suggests the following for differential diagnosis:—
Acute and chronic bulbar paralysis; pseudo-bulbar palsy; amyo¬
trophic lateral sclerosis with irregular bulbar onset; and hysteria.
The latter diagnosis he excludes. He considers the exaggerated
knee-jerks, with the presence of paradoxical reflex, in favour of
the diagnosis of amyotrophic lateral sclerosis, but seems to
consider acute bulbar paralysis the most tangible diagnosis.

C. H. Holmes.

ADVANCES IN THE DIAGNOSIS OF CEREBRAL TUMOURS.
(367) (Fortschritte in der Diagnostik der Gehimtumoren.) Knapp,

Muench. Med. Wchnscrft., May 12 and 19, 1908.

The surgeon’s difficulty in dealing with cerebral tumours depends
often not so much on the inaccessibility of the growth as on the
impossibility of exactly localising it. Tumours growing in one or
other of the well-known cerebral centres give least trouble in
diagnosis; these produce direct “ focal symptoms ” ( Herdsymptome ),
and the early surgery of brain tumours confined itself almost
exclusively to growths of the cortical motor region.

But removal of a tumour involving, e.g. t the motor or sensory
speech-centres, usually results in a corresponding aphasia.

This drawback does not, however, apply to operations in the
so-called “ indifferent ” or “ mute ” ( stumm ) regions of the brain;
thus the removal of tumours from these parts is a much more
attractive task for the surgeon, and it behoves neurologists to
devise means for their diagnosis.

Since focal symptoms are absent in these cases, we must
concentrate our attention on the “distal symptoms” (Fern-
symptome), and try to bring more order into our classification of
these.

The author gives instances to show how often what are
apparently the most unequivocal focal symptoms may lead us
astray in diagnosis.

Although it is by no means clear how the distal symptoms
are produced—whether by pressure, displacement, traction, or
destruction of neighbouring parts, by disturbance of their blood-
supply, or the like—still, the fact remains that the diagnostic
significance of these distal symptoms is great, and, in default of
a rationale of their production, we must base our grouping of them
on clinical experience.

ABSTRACTS

423

The author quotes instances of the successful employment
by himself of this empirical method, detailing especially certain
phenomena referable to the oculomotor nerve (ptosis, mydriasis,
etc.), which occur in tumours of the temporo-sphenoidal lobe.

Another method for localising brain tumours to which he refers
is that of cranial auscultation, instituted by Phleps. The vertex
is struck by a tuning-fork, and, whereas in a normal brain the
sound is conducted equally well to both sides of the skull and
may be heard with similar clearness over any corresponding points
of the two hemispheres, the presence of a tumour at any one point
lessens its audibility there; this succeeds best when the tumour
is close under the skull-cap, and especially if it be somewhat
calcified or otherwise hardened.

Thirdly, the Rontgen rays may be used, but their employment
is not often feasible, as there is seldom much difference in con¬
sistence between tumour and brain-substance; such growths as
can be shown are usually those which have eroded or displaced the
cranial bones or have undergone calcification.

The fourth method, which we owe primarily to Neisser, is
puncture of the brain through the intact skull, with aspiration.
The first puncture determines whether there is actually a tumour
in the supposed site, or whether there be some other form of
brain-disease. The nature of the growth beiug ascertained, a series
of further punctures is made, in order to discover its exact situa¬
tion and extent. Brain-puncture is almost painless and can be
performed quite easily in the out-patient department: it is only
to be carrried out, however, when definite localising symptoms
have been found on clinical examination. The case is then handed
over to the surgeon with an explicit written statement as to the
findings.

The surgeon often has great difficulty during the operation in
knowing when he has completely extirpated the tumour; to
overcome this difficulty the author has a continuous series of
small sections from the brain examined microscopically during the
operation, and the surgeon continues cutting until the pathologists
inform him he has entered healthy tissue on all sides.

Arthur J. Brock.

ACUTE SUPPURATION OF THE SPHBNOIDAL SINUSES, WITH
(368) INTRAOBANIAL AND ORBITAL COMPLICATIONS.
(Akute Keilbeinhfthleneiterong mit intrakranieller and or-
bitaler Komplikation.) G. Trautmann, Arch. /. Laryng., Bd.
xx., Ht. 3, S. 381.

Thi patient, a boy set. 15, was seized with sudden fever, headache,
and vomiting; the following day swelling of the right upper lid

424

ABSTRACTS

was noticed. The mucous membrane of the nose was red, and
there was some crusting and mucoid secretion. The fundus of
both eyes was normal Temperature and pulse raised. On the
third day the swelling of the lid was more marked, protusion
of the eyeball, delirium in the evening, neck stiff and swollen.
Diagnosis—probably thrombus of cavernous sinus following on
nasal infection. The following day the upper lid of the left eye
was also swollen. Lumbar puncture on the fifth day gave a
negative result; on ophthalmoscopic examination the veins on
each side were dilated and the edge of the disc was slightly
blurred. Operation—both frontal sinuses were opened, radical
mastoid operation performed on the left side (there was a large
dry perforation in the membrane on this side), lateral sinus and
dura of the middle cerebral fossa exposed, and cerebrum punc¬
tured. Nothing abnormal was found. Death on the eighth
day.

Sectio—empyema of both sphenoidal sinuses, purulent phlebitis
of the cavernous sinuses, pus in the left orbit, and to a less extent
in the right orbit.

The paper begins with an abstract of previously reported cases.

W. G. Porter.

REPORT OF A CASE OF CEREBRAL ABSCESS WITH MASKED
(369) 8YMPTOM8. R. E. Coughlin, N.Y. Med. Joum., April 11,
1908, p. 691.

The case was that of a young woman with a marked family
history of tuberculosis; a history of pain in her right ear without
any discharge of pus two years previously; a pain in right
occipital and parietal region coming on two months before admis¬
sion to hospital, this pain being constant, unrelieved by treat¬
ment, and worse at night; forcible vomiting; vertigo ; leucocytosis
of 18,000; low tension pulse; death without location of her
disease. The necropsy revealed an irregular burrowing abscess in
the left hemisphere just external to the lateral ventricle. The
burrowing pus could be traced to a small opening entering the
right ear. J. H. Harvey Pirik.

DISSEMINATED SCLEROSIS COMMENCING WITH FAILURE
(370) OF VISION. R. T. Williamson, Lancet, May 2, 1908.

In this article a description is given of a form of disseminated
sclerosis which commences with failure of vision. A long period,
often months, or even years, may elapse before other symptoms of

ABSTRACTS

425

the disease develop. The visual failure is due to a patch of
sclerosis in the optic nerve or chiasma. Frequently after the
visual defect has become marked there is decided improvement;
in other cases the visual failure persists, and partial or marked
optic atrophy may develop. At the early stage there is often
pallor of the temporal half of the optic discs, with a central
scotoma in some cases. At a later period other signs in favour of
disseminated sclerosis may be detected, such as the extensor type
of the plantar reflex, the irregular and shaky character of the
handwriting, even when tremor of the hand on movement can
hardly be detected. The patients are usually under forty years
of age* In course of time the characteristic symptoms of dis¬
seminated sclerosis may gradually develop. Short notes of cases
of this form of the disease are given. A micro-photograph of a
section of the optic nerve and a drawing of a section of the optic
chiasma, from one of the cases, are reproduced in the article. In
this case there was a patch of sclerosis in the optic chiasma, which
extended into the optic nerve. Author’s Abstract.

A CASE OF JACKSONIAN EPILEPSY, WITH AUTOPSY. (Su
(371) di un caso di epilessia jacksoniana, con autopsia.) G. Sanna
Salaris, Riv. Ital. di Newropat. Psichiat. ed Elettroter., May
1908.

The case is that of a man, 28 years of age, having a syphilitic
history, who developed attacks of local epilepsy, involving the
left side, and leaving a hemiparesis in their wake; they occasion¬
ally became generalised, in which case consciousness was lost,
though this did not occur when the convulsions remained unilateral.
Patient died in the status epilepticus.

The autopsy revealed a whitish, leathery gumma, of the size of
a pea, situate in the fissure of Rolando on the right side, and
attached to the pia mater. In the sub-cortical substance immedi¬
ately below the gumma was an area of softening, of the size of a
pigeon’s egg, surrounded by a capsule of fibrous tissue.

This tumour had probably originated in a specific inflammation
of one of the coats of an arteriole; in its growth it had finally
obliterated the vessel, thereby bringing about softening of the
area supplied by it. The first convulsive manifestation had
probably been due, not to direct irritation of the cortical motor
centres by the gumma, but rather to irritation depending on the
partially obstructed blood-supply. The gumma itself was too
H mall to have caused the hemiparesis directly; this must have
been due to the larger subjacent focus of softening, which involved
considerably more of the corresponding motor fibres.

426

ABSTRACTS

The local epilepsy might conceivably depend either on direct
cortical irritation by the gamma, or on the circulatory disturbances
produced by it in the brain; it is known that epileptic convulsions
confined to certain muscular groups, or even when generalised,
may be related to alterations in the circulation or chemism of
the brain produced by tumours which are situated in parts more
or less distant from the Rolandic motor areas.

Arthur J. Brock.

TROPHIC DISORDERS IN HYSTERIA (Contribution k , l’dtude
(372) des troubles trophiques dits “ hystdriques.”) A M. Bono (de
Rome), Tribune nUdicale, April 11, 1908, p. 213.

This paper, which was inspired by Babinski, is based on observa¬
tions made in the Paris hospitals during a period of seven months.
Among the large number of hysterical patients who haul come
under his observation Bono had not met with a single case of
trophic disorder, e.g., pemphigus, ulceration, or gangrene, of fever,
of hsematemesis or haemoptysis, which could be undoubtedly
attributed to hysteria. The writer thinks that the attribution of
such symptoms to hysteria is the result of an error in diagnosis,
an error due either to defective observation on the part of the
physician or to simulation on the part of the patient. Numerous
illustrative examples are given. Bono also addressed inquiries to
many of the leading medical men in Paris as to whether they had
seen undoubted cases. The almost invariable reply was that they
had not seen a single definite case of hysteria which proved the
existence of these disorders. Among neurologists who answered
to this effect were Gilbert Ballet, Brissaud, Duprd, Landouzy,
Pierre Marie, and Sicard, and among dermatologists Brocq, Darier,
Hallopeau, Jacquet, and Thibierge. Bono concludes that if such
disorders exist they must be so exceptional that they need not be
taken into account. J. D. Rolleston.

THE CLINICAL VALUE OF THE DISSOCIATION OF THE
(373) CUTANEOUS AND TENDON REFLEXES IN HYSTERIA
(Essai sur la valeur clinique de la dissociation des rdflexes
cutands et tendineux dans lliystdrie.) A Fa yet, Thhes de
Lyon, 1906-1907, No. 39.

Dissociation of the patellar and plantar reflexes, i.e. exaggeration
of the knee jerk and diminution or abolition of the plantar reflex,
is very frequent in hysteria, and should be regarded as a stigma
of this neurosis. The centres for these reflexes are distinct, the

ABSTRACTS

427

centre for the knee jerk being situated in the mesencephalon and
that for the plantar reflex in the cortex. The exaggeration of the
patellar reflex is attributed to the removal of the inhibitory action
of the cortex, the functional disturbance of which in hysteria is
also the cause of the suppression of the plantar reflex.

J. D. Rolleston.

FREOD’8 THEORY OF HYSTERIA. (Die Freudsche Hysterie-

(374) theorie.) C. G. Jung, Monatschr. f. Psychiat. u. Neur., April
1908, Bd. xxiii., S. 310.

This paper, which was read before the International Congress in
Amsterdam, suffers under the obvious disadvantage that it attempts
to codify Freud’s scattered contributions to the theory of hysteria,
while Freud himself has refrained from such a task. Jung adopts
the historical method, tracing the development of Freud’s views
from the first paper in 1893, in which was established the
fact that hysterical symptoms are individually traced to a pre¬
viously experienced psychical trauma. Underlying each symptom,
therefore, is a disagreeable mental “complex” (feeling-invested
idea) which is repressed (verdrangt) and split off from the
patient’s main stream of consciousness. The stimulus arising
from such complexes is “ converted ” into various symptoms,
bodily and mental. The mechanisms by which such conversion
occurs have been closely analysed by Freud, who showed that
resuscitation of the repressed memory was followed by disappear¬
ance of the corresponding symptom. In later years Freud has
gone deeper into the study of the origin and formation of such
complexes, and sees in precocious sexual excitement, the memory
of which has been repressed, and which is often of a perverse
character, the necessary basis on which they develop. As the
paper itself is an extremely condensed account of Freud’s views,
and is of little use in replacing a study of the original contribu¬
tions, it does not lend itself to further abstraction.

Ernest Jones.

POST-TRAUMATIC, TRANSITORY DISTURBANCES OF OON-
(375) 80I0USNE8S. (Posttraumatische, transitorische Bewusst-
seinsstorungen.) Earl Wendenburg, Monatschr. f. Psychiat.
u. New., Bd. xxiii., Erganzungsheft, S. 223.

The main thesis of this article is that poriomania may be caused
not only by epilepsy, hysteria, and dysphoric degenerative con¬
ditions, but also by traumatic neurasthenia. Besides discussing
2 H

428

ABSTRACTS

similar cases recorded in the literature, the author relates the case o!
a student, aged 25, who, after a fall that was followed by unconscious¬
ness for three hours and was alleged to cause a fractured skull—the
evidence for this is most inconclusive—suffered from a number of
symptoms usually grouped as neurasthenic. In addition there
was marked continuous and anterograde amnesia, which sometimes
caused him to forget many hours of his life at a time. This last
symptom points strongly to the hysterical nature of the case—
though no physical signs of hysteria were present—but unfor¬
tunately no psycho-analysis was made. Two months after the
accident the patient found himself in a train in the east of Italy
with evidence in his pockets showing that he had been travelling
for three days in a secondary state. The symptomatology and
diagnosis of such cases is discussed, and the author comes to the
conclusion mentioned in the first sentence above.

Ernest Jones.

SPEECH DISTURBANCES IN FUNCTIONAL PSYCHOSES.

(376) (Sprachstonmgen bei funktionellen Psychosen.) Albert

Knapp, Monatschr. f. Psychiat. u. Near., Bd. xxiii., Ergan-

zungsheft, S. 97-124.

After a few words on the commoner—aphasic, etc.—speech dis¬
turbances met with in the psychoses, Knapp discusses four groups
of such disturbances as have not hitherto been described in this
connection. Thirteen personally studied cases are described in
detail. The first group is that of stammering (Stottem), which
could not be distinguished clinically from usual stammering except
by its transitory occurrence. The cases were of diverse nature,
but all showed abnormal psychomotor phenomena, and Knapp re¬
gards the stammering thus as being also a parakinesis. The same
applies to the second group—scanning speech—which was most
often combined with the first set of disturbances. The third and
most important group was that of syllable-stammering (Silben-
stolpern), which was very similar to the speech change found in
general paralysis. The fourth group was that of infantile speech
in which blesitas—replacement of one consonant by another—
occurred (Stammeln). Ernest Jones.

HEADACHE AND EYE-STRAIN. Wm. Crawford (Hamilton, Ont.),
(377) Canadian Practitioner and Rev., March 1908, p. 155.

The author discusses the varieties of headache that may be brought
about as the result of eye-strain. The first and most frequent
variety is brow-ache or supra-orbital headache over one or both

ABSTRACTS

429

eyes. The next is that of deep orbital site, the pain being concen¬
trated in the eyeball. This occurs most frequently where the
defect is astigmatism. The fronto-occipital is another form, and may
be most acute in the morning, following on a previous day’s eye-
strain, particularly that due to astigmatism with axes deviating
from the vertical.

To distinguish a headache due to eye-strain from one brought
about by other causes, it is the author’s opinion that a fairly safe
rule is to keep in mind the fact that eye-strain headache is aggra¬
vated by eye-work and lessened or relieved by rest. The headache
may or may not be accompanied by asthenopia. The smaller
ocular defects, such as hyperopic astigmatism of one-half to three-
quarters of a diopter, or a like amount of mixed astigmatism, give
rise to the most troublesome headaches, especially if the axis be at
an angle or against the rule. And here the vision may be nearly
normal. The causes of asthenopia are disordered innervation,
caused by errors of refraction, and anomalies of the extra-ocular
muscles, and are also due reflexly to nasal obstruction, dental
caries, and other nose and throat affections. The larger refractive
defects usually result in suppression of the visual image or in squint.
The eye defects may be unsuspected, and often go for years
uncorrected, especially in children. Many cases of congenital
astigmatism do not suffer from headache until they reach adult
age, when the condition may manifest itself. Uncorrected
refractive errors and muscular anomalies are prolific causes
of disease conditions in the eyeball itself. Very many grave
conditions, such as retinitis, chronic iritis, etc., may be produced
or aggravated by uncorrected ocular or muscular defects. The
improvement in the general health brought about by the correc¬
tion of an ocular defect is dwelt on briefly. The author believes
that cases of epilepsy have been cured by like treatment, and that
the symptom of vertigo is often relieved in this way. Cases of
gastric disturbance are believed to have been due to ocular defects,
the correction of which led to improvement in the gastric con¬
dition. The lowering of general body-tone due to eye-strain is
thought to have a distinctly deleterious effect in many cases by
bringing about a condition of lessened resistance on the part of
the organism. Four cases are given in abstract showing the
beneficial results accruing from the correction of ocular defects
The author believes that 50 per cent, to 80 per cent, of cases seen
in ophthalmic practice suffer from headache. Most eyes have
a slight refractive error, but only in those cases where the eyes
are overworked, or the patient is below par, is correction needed.
Some such patients require only temporary correction during the
time that the eyes are being given an unusual amount of work.
The comparative frequency of eye troubles in school children is

430

ABSTRACTS

commented on, and it ia noted that hyperopic errors greatly out¬
number emmetropic and myopic conditions in children. Myopia,
however, which is comparatively rare before the beginning of the
educational process, advances steadily in percentage with the
progress of the pupil in the school. The importance of the eye
examination in school children is next touched on. The early
presbyopes form a class which is often overlooked, and their troubles
are readily corrected by the use of a weak lens for close work.
Many people who have reflex symptoms of eye-Btrain such as
headache or nervousness rarely suffer from local conditions of the
eyeball, such as blepharitis, etc. Anomalies of the extra-ocular
muscles are a fruitful cause of eye-strain, and can often be
corrected by proper treatment directed to the refractive error.
“ The demands of modern business, the struggle for existence,
make demands on no other organ of the body to so great an
extent as on the organs of vision, and they in turn demand from
the general system a large amount of nerve force.”

Fitzgerald.

80IATI0A. M. L. Barshinger, N.Y. Med. Rec., April 25, 1908.

(378)

The favourite seat of sciatica to begin with is the sciatic notch.
Now the sciatic nerve leaves the pelvis through the sciatic notch
lying on the bone in front, and with the pyriformis muscle resting
on it behind. With a history of rheumatism, gout, or exposure
and pain referred to the sciatic notch, it is reasonable to presume
that the muscle is the seat of a local irritation, as happens in other
parts of the body. The pyriformis muscle then presses on the
sciatic nerve owing to contraction following the irritation, and,
in addition, the congestion and swelling of the muscle nips the
nerve as it passes through the unyielding constriction. The
pyriformis may be affected only secondarily by extension from
adjacent muscular structures. Women suffer from true sciatica
less than men, owing to the structure of their pelvis. The nerve
becomes secondarily affected by continued pressure.

The aim of treatment, therefore, should be to free the nerve
as soon as possible from compression. This may be done by
means of mechanical vibration carried out until the muscle is
quite released, i.e. till the pain disappears. Radiant energy
applied by means of a high-power lamp—for example, the leuco-
descent—increases the supply of blood to the part, and facilitates
the removal of irritating material. Static electricity—the wave
current followed by sparks—is very effective. Galvanism and the
Roengten rays are also of use. John M.' Darling.

ABSTRACTS

431

ADIPOSIS DOLOROSA. Jule B. Frankenheimer, Jour. Amsr. Med.

(379) Assoc., March 28,1908.

Dr Frankenheimer gives a full report of a typical case of this
disease, which improved considerably under treatment with
thyroid tablets. He then proceeds to a general consideration of
the recorded cases (about 45).

Etiology .—Cases have occurred in different members of the
same family. Women are more commonly affected than men, in
the ratio of six to one. The age incidence is variable. In men
the majority of cases occur between the ages of 30 and 40, and in
women between 30 and 50. Neuropathic and alcoholic histories,
syphilis and trauma were noted in a few cases. Disturbance of
the sexual organs was frequently found. The menopause seems
to predispose to the disease.

Pathology .—Notes of five autopsies only were available. The
fatty tissue was of normal structure. One case showed interstitial
neuritis and sclerosis of the columns of Goll (probably a concomi¬
tant affection). The thyroid gland was enlarged and calcareously
infiltrated in two cases, partially atrophied in two cases, and
normal in one case. The pituitary body showed enlargement and
gliomatous degeneration in two cases, and adeno-carcinoma in one
case.

Clinical Manifestations .—There are four cardinal symptoms,
viz.:—

1. Accumulation of fat, usually localised.

2. Pain and tenderness in the fatty swellings.

3. Asthenia.

4. Psychic disturbance (apathy and depression, irritability,

dementia).

Other symptoms are headache, disturbance of sensation, vaso¬
motor phenomena (lessened perspiration, cyanosis, ecchymosis,
trophic ulcers, etc.). Death is usually due to some intercurrent
affection. Exacerbations are common.

Conclusion .—The sex incidence is practically the same as that
of exophthalmic goitre and myxcedema. The involvement of the
thyroid gland is demonstrated by the pathological findings, the
presence of myxoedematous symptoms and the positive therapeutic
results of treatment with thyroid extract. Further study is
necessary to prove that disturbance of the genital organs is a
factor in the production of the disease.

It is suggested that “ adiposis dolorosa, like acromegaly, is a
dystrophy, the one affecting the fatty, the other the osseous
structures; and that there is present a toxaemia dependent on a
dysthyroidismus and the disturbed function of the pituitary body
and the genital organs.” John M. Darling.

432

ABSTRACTS

THE TOE-REFLEX (A SPECIAL PATHOLOGICAL TENDON-
(380) REFLEX). [Der Zehenreflex (ein speziell pathologischer
Sehnenreflex.)] G. J. Rossolimo, Neur. Centralbl., No. 10,
1908.

Five years ago Rossolimo published an investigation containing a
description of a new reflex, which he named the deep reflex of the
great toe. It takes the form of a bending downwards of the great
toe on stimulation of the plantar surface, and is seen in cases of
disease of the pyramidal tracts of the cord. It was found to be
present in many cases when Babinski’s sign could not be elicited.
Experience at that time showed that it was a more certain index
of organic cord disease, and further investigation, the results of
which are given in this paper, confirms this.

This second paper states the results arrived at from an investi¬
gation of 91 cases of organic disease of the central nervous system
with affection of the pyramidal tracts. The duration of the
disease, the condition of the motor functions, the muscular tonus,
and especially the state of the various known reflexes, were all
carefully studied. To elicit the particular reflex he draws atten¬
tion to, the finger is gently stroked on the plantar surface of the
toe, and after a longer or shorter time a muscular contraction is
observed causing flexion or abduction of the toe. The patient may
be sitting or lying with the knee bent and the muscles relaxed.
There are variations and degrees of the reflex. The great toe, the
other four toes, or sill five, may show movement, the last being
the most common. The spontaneous movements of the toes, the
muscular tonus, the condition of the other reflexes, and the time
after the onset of disease at which the reflex makes its appearance,
were all carefully observed. The author comes to the following
conclusions:—

1. The toe-reflex is observed only in affections of the pyramidal
tracts, unlike many other pathognomonic reflexes (Babinski’s sign,
incresised patellar and Achilles tendon reflexes) which are also
occasionally present in the neuroses.

2. It can be seen in many cases in which Babinski’s sign is
absent.

3. Its intensity is variable, from hardly perceptible bending to
marked clonus.

4. Unlike other tendon reflexes, whose pathognomic value lies
in the increase of reflexes normally present, the toe-reflex, like
Babinski’s sign, is pathognomic in its mere presence, as it is absent
normally.

5. Owing to its rare appearance before the disease of the

pyramidal tracts has been in existence three weeks, it is a more
distinctive sign than Babinski’s. James Middlemass.

ABSTRACTS

433

PARATHYRBOGENIG LARYNGOSPASM. (Ueber Parathyreogenen
(381) Laryngospasmus.) Friedrich Pineles, Wien. Klin. Wochcnsckr .,
Nr. 18, 1908.

The writer states that glottic spasm is due to irritation of all the
recurrent laryngeal fibres with preponderance of the closers of the
glottis. The causes may he stated as follows:—

1. Diseases of the larynx—severe catarrh, foreign bodies,

polypi.

2. Tumours in the neighbourhood of the larynx, aortic

aneurysm, mediastinal growths, caseated bronchial

glands.

3. Reflex causes from nose, alimentary canal and genital

organs.

4. Neuroses—hysteria, neurasthenia, tetany.

It is easy to understand the presence of glottic spasm in cases
of tetany, as, in this condition, we have to deal with a state of
general muscular spasm, and, in the tetany of children, glottic
spasm forms the most striking feature of the disease. Frankl-
Hochwart has only recorded 8 cases of laryngeal spasm out of
122 cases of tetany among adults, and states that the con¬
dition is rare in them as compared with children. Pineles
has come to the conclusion that all human tetany is caused
by the same poison—the “ parathyreopriver ” tetany poison—
which, after removal of the parathyroid glands, develops its in¬
jurious influence on the organism. Pineles has found records of
only two cases of glottic spasm in patients whose thyroid glands
have been removed—the cases of Eiselsberg and Dienst; in the
latter the patient was pregnant. Laryngospasm was present in
all of the four cases of thyroidectomy observed by Pineles himself,
and he therefore concludes that this symptom has been overlooked
by other observers: in two out of the four cases glottic spasm re¬
mained after the other symptoms of tetany had passed off, thus
closely resembling the condition in infantile tetany. Under the
heading “ Parathyreogener Laryngospasmus ” Pineles records two
cases of Hoffmann’s and four new cases of his own—thus bringing
up the number of his own observations to nineteen. Case 3, a
female, aged 32, had a child which also suffered from glottic spasm.
The author considers that glottic spasm is much more common in
idiopathic (parathyreogenic) tetany than would appear in the
literature of the subject; and further holds the view that “ parathy¬
reopriver ” and “parathyreogener ” tetany are so much alike that
there can be no doubt as to the common origin of the two con¬
ditions. He gives two cases of tetany in children in which the
mothers also suffered from this condition—one of the mothers

434

ABSTRACTS

having glottic spasm. It has been proved experimentally in
animals that the larynx of the young reacts more quickly and
intensely to the “ parathyreopriver ” tetany poison than that of
older animals; also that section of both recurrent nerves produces
more severe dyspnoea in the young than in the old. Children are
also more affected by double paralysis of the glottis-openers than
are adults. These facts explain why the “parathyreopriver”
tetany poison produces glottic spasm more frequently in children
than in adults. J. S. Fbaser.

INJURIES OF THE VAGUS NERVE AND THEIR OONSB-
(382) QUEN0E8. (Die Verletznngen des Nervns vagus und ihre
Folgen.) H. Reich (of Tubingen), Beitr. sur klin. Chir., Bd.
lvi., H. 3, 1908.

The author first discusses accidental injuries of the vagus nerve,
of which he has gathered eleven cases. In all the cases severe
respiratory disorders were observed. The descriptions given by
the author are frequently obscure and leave in doubt whether the
symptoms are due to direct involvement of the vagus (impairment
of the sensibility of the lung and subsequent pneumonia), or to
difficulty of breathing owing to hsematomata or inflammatory pro¬
cesses in the region of the trachea. The second part of the
communication is more important, and deals with sections and
resections of the vagus (forty-four cases). Most of the cases were of
tumours, usually malignant, which were either intimately con¬
nected with the vagus anatomically or had caused its degeneration,
so that complete extirpation of the tumour was only possible with
resection of the vagus, either intentional or unintentional; in no
case was the section bilateral.

The clinical results of such operative interference with the
vagus are divided by the author into immediate and remote.
Only in five cases were there any irritative cardiac symptoms;
these always consisted of tachycardia, lasting from a few hours
to fourteen days. The tachycardia was never of serious import
Similarly, the author attributes little importance to the few
disturbances of breathing which are described. The pneumonias,
which occur later, are demonstrated by the author by means of
fully analysed case-histories to stand in indirect setiological
relation to the lesion of the vagus. Paralysis of the vocal cords
due to paralysis of the recurrent is always present on the operated
side. The author does not refer the mild disorders of the gastro¬
intestinal tract to lesions of the vagus. In his discussion, how¬
ever, he leaves it an open question how far the primary disease
had already caused a slow degeneration of the nerve, and cornea

ABSTRACTS

435

to the logical conclusion that the onset of vagus symptoms pre¬
supposes the integrity of the nerve. The author does not consider
that there is any mortality associated witli unilateral section of
the nerve. It is different with irritation of the vagus. One
frequently meets here symptoms varying from slight lowering of
the blood pressure to momentary asystole with severe symptoms
and even with fatal result. More frequent, and as a rule more
severe, are symptoms due to the influence of irritation of the
nerve on the respiration, which frequently comes on abruptly and
may lead to the most severe asphyxia. Naturally the irritative
symptoms are most marked when heart and lung are simul¬
taneously affected. The above interpretation of the clinical
phenomena is confirmed by experiments on animals.

The main results of this thorough work can be briefly sum¬
marised. Section of the vagus without irritation is not dangerous;
there only remains permanent paralysis of the vocal cords. The
cardiac symptoms are quite unimportant; the symptoms of the
other organs are not to be referred to the section of the vagus.
If the vagus be accidentally cut, an attempt to suture it should
be made. In contrast with section of the vagus, traumatic irrita¬
tion of the vagus is followed by most severe cardiac and pulmonary
symptoms. Animal experiments confirm this view. Irritation
of the vagus can kill by stopping the action of the heart and lung.
The other conclusions belong to clinical surgery.

Goldstein (C.g.B.).

A CASE OF INTERMITTENT EXOPHTHALMOS. (Bin fall von
(383) intermittierendem Exophthalmos.) Max Meissner, Med.

Blatter, April 25, 1908, S. 193.

T ins unusual condition, of which i-ome forty cases are on record,
was observed in a man of twenty-four, who, for about five months,
complained that on stooping his right eye “ fell out.” At first,
this only happened on severe exertion, latterly it had become
more frequent. Under ordinary circumstances no difference could
be made out between the two eyes, and both appeared sound in
in every way. When he stooped for a couple of minutes, there
was slight swelling and redness of the lids and marked proptosis
of the right eye. On resuming the upright position, the exoph¬
thalmos disappeared completely in about one minute. When
present, vision was blurred, and ophthamoscopically there was
marked venous pulsation. Similar proptosis could be produced
by forcible expiration with nose and mouth closed, by manual
compression of the right jugular vein, and to a less degree by
forcibly turning the head to the right. For some time forcible

436

ABSTRACTS

pulsation could be felt in the eyeball when protruded, latterly this
had disappeared. No cause could be found, and the pathogenesis
of the condition seems to be as uncertain as when first described by
Sattler in 1880. J. H. Harvey Pirie.

ON THE MORE RECENT RESULTS OF INVESTIGATION IN
(384) SYMPATHETIC OPHTHALMIA. (Ueber nenere Untersuch-
nngsergebnisse bei der sympatischer Ophthalmia) Georg
Lenz, Berl . Klin . fFchnsch ., April 27.

In regard to the important question whether any special signs
may be recognised in the primarily affected eye which would lead
us to expect a sympathetic inflammation in its fellow, the author
holds that such a specific anatomical picture does actually exist.
The pathogenic agent he believes to be a specific micro-organism
which passes from one eye to the other by way of the general
blood-current; it confines its attacks to the uveal tract, just as
the tetanus bacillus does to the nervous system.

This theory as to the mode of transmission of the materus
morbi from eye to eye involves abandonment of the theory that
it passes by the optic nerve, as also the “ ciliary-nerve theory ” of
Schmidt-Rimpler, according to which sympathetic inflammation
is set up by an irritation conveyed through the ciliary nerves.

Arthur J. Brock.

REFLEX NYSTAGMUS INDUCED AS A MEANS OF DIAGNOS¬
ES) mO THE FUNCTIONAL CONDITION OF THE VESTI¬
BULAR APPARATUS. (Le Nystagmus rlflexe provoqul
comme mlthode de diagnostic des 6tats fonctioneUe de
l’appareil vestibulaire.) E. Lombard and E. Halphkn,
Prog. Med., 3° Serie, T. xxiii., No. 16.

The nystagmus discussed in this paper is of vestibular origin.
The amplitude of the nystagmus is markedly increased if the
eyes are turned to the side to which the nystagmus is directed.
The direction of the nystagmus may be horizontal, vertical, or
rotary.

A spontaneous nystagmus occurs, it may be observed, where
the labyrinth is intact, and it is present in nearly all the acute
affections of the labyrinth. Induced nystagmus is much more
valuable as a diagnostic sign, it can be set up by rotation, by
the application of the galvanic current, of compressed air and
of heat and cold within the meatus.

If the endolymph in a canal is made to flow towards the

ABSTRACTS

437

ampulla, nystagmus is induced in the opposite sense. Hence if
the subject be rotated to the right, nystagmus will occur to the
right during rotation and to the left after; but if the labyrinth is
diseased, the nystagmus may not appear, or may be modified.

If cold water is injected in the right ear of a normal subject
with head erect, rotatory nystagmus appears to the left; with hot
water the direction is to the right; but if the head be bent to
the opposite shoulder, injection of cold water induces horizontal
nystagmus to the right.

A number of illustrative cases conclude the paper.

W. G. Porter.

AMBLYOPIA FOLLOWING ON ACCESSORY SINUS SUPPURA-
(386) TION. (Amblyopie infolge von Nebenhohleneiterungen der
Naso.) R£rai, Wien. Med. Wchnsehr., 1908, Bd. lviii, S. 1066.

The patient, a male set. 39, had had for three years a tendency to
colds in the head. A year ago polypi were removed from both
sides of the nose. Six months later he began to suffer from pain
in the forehead and temples and from failing sight in the left eye.
This gradually got worse. The temporal side of the field of vision
was lost, and the sight in the right eye also began to fail. Oph¬
thalmoscopic examination showed bilateral optic neuritis, retro¬
bulbar, probably due to ethmoidal suppuration. The middle
turbinal was removed, and the ethmoid labyrinth was cleared out
on both sides. The sphenoidal sinuses appeared normal. Four
weeks later there was marked improvement of vision. Rdthi
draws attention to the importance of cases such as this, where
there is no swelling of the lids or exophthalmos to point to the
nasal cause of the condition. W. G. Porter.

ROUSSEAU’S DISEASE* (La maladie de Jean Jacques Rousseau.)

(387) Poncet et Leriche, Bull, de VAcad. de Mid., 1907, p. 607.
CALVIN’S DISEASE. (La maladie de Galvin.) Poncet et Leriche,

(388) Lyon midical, 1908, p. 801.

In these studies in pathography the writers have done good
service in substituting for the vague term neuro-arthritism a more
definite conception of the infirmities from which Rousseau and
Calvin suffered.

In a recently discovered testament of Rousseau a complete
description of all his symptoms is given, permitting of a precise
diagnosis of his disease, which the writers hold to be congenital
stenosis of the bulbo-membranous portion of the urethra. There

438

ABSTRACTS

has hitherto been too great a tendency to attribute Rousseau’s
urinary troubles to his mental condition. Instead of considering
him as “ a psychasthenic with bis bladder in his head,” the writers
think that many of his eccentricities were aggravated, if not
actually produced, by a prolonged dysuria. Rousseau undoubtedly
was neurasthenic and suffered from obsessions, and it is very
probable that he had arterio sclerosis and was prematurely senile,
but Poncet and Leriche think that the condition of his urinary
passages fully accounts for all his morbid symptoms. In the
subsequent discussion Landouzy stated that the neuro-arthritism
and neurasthenia of Montaigne were secondary to renal lithiasis.
Neuropathologists, he thought, were too apt to be satisfied with the
diagnosis of neurasthenia without searching for the causal disease,
which remained in the background often in a larval or atypical
form.

Tuberculosis of insidious evolution and protracted course, but
relatively benign in its local manifestations, played the chief part
in the pathological history of Calvin. Overworked, badly
nourished, and living in deplorable hygienic surroundings, Calvin
suffered from an early age from repeated colds and violent
migraine. Subsequently he developed pleurisy and haemoptysis.
On several occasions he had severe colic and diarrhoea, which may
have been due to tuberculous ulceration of the intestines. Three
years before his death, which occurred at the age of fifty-five, he
suffered from gout and nephrolithiasis. Haemorrhoids, pruritus
ani, perineal eczema, and anal fistula added to his distress, which
was aggravated by the calumnious interpretation which his
enemies made of these local phenomena. J. D. Rolleston.

PSYCHIATRY.

CLINICAL AND jBTIOLOGICAL ASPECTS OF “ ZWANG ”
(389) PHENOMENA. (Zur Klinik und Aetiologie der Zwangser-
scheinungen, fiber Zwangshallucinationen und fiber die Bezie-
hungen der Zwangsvorstellungen zur Hysteria.) R. Thomsen,
Arch. f. Psychiat. u. Nervenkrank., Bd. xliv., S. 1-5.

The author first details eleven cases, giving, however, no analysis
of the psychological processes concerned. He defines a “ Zwangs-
vorstellung” in Westphal’s original sense as an idea which forces
itself on consciousness, and which is not conditioned by any
affect (!). In contradiction to Janet, Loewenfeld, and others, he
emphasises the intimate relation of such phenomena to hysteria

ABSTRACTS

439

and considers that the majority of the cases belong here. He
takes no account of the modern work done on the subject.

Ernest Jones.

THE PSYCHOSES OP INFLUENZA. R. Dods Brown, Scot . Med .
(390) and Surg. Jour., June 1908, p. B09.

The author is of opinion that mental disorder conies on more
frequently after influenza than after any other febrile affection.

Pfeiffer’s bacillus or its toxin seems to be the exciting agent
rather than the fever or the post-febrile exhaustion, because the
mental derangement may appear not only after severe cases of
influenza, but also after those of a mild type, and in those patients
whose illness has been of short duration. Moreover, it is found
that the mental symptoms may set in as early as the second or
third day of the disease.

A bacteriological examination was made of the cerebro-spinal
fluid of three patients suffering from acute mania, but in no case
was the influenza bacillus isolated. No apparent effect was pro¬
duced by inoculating mice with the same fluid.

Almost any form of psychosis may occur after influenza, but
mental depression is what is most frequently seen.

Contrary to what is usually found, melancholia was not in
excess of other forms of psychosis in the writer’s series of twenty
cases. These consisted of fifteen women and five men. There
were ten cases suffering from mental depression, five of whom
exhibited great agitation, restlessness and restiveness. Of the
remaining ten, nine were classified as cases of acute mania, and in
these there was complete or almost complete dissolution of mind
with hallucinations of sight and hearing, and in seven of them
there was great restlessness and violence.

The tenth case in the manic group was one of delusional
mania. The small percentage of melancholics in this series is
probably due to the relatively large number of female patients.

Associated with the depression there is very often a strong
suicidal tendency.

A noteworthy feature is that the most severe forms of mental
derangement after influenza occur in those patients with a pre¬
disposition to insanity.

Although there is a great liability to relapse in all these cases,
the prognosis as to recovery is good. Author’s Abstract.

440

ABSTRACTS

ADOLESCENT INSANITY. (Jugendirresein.) Koichi Miyake
(391) (Tokio), Arb. a. d. Neurol. Instit. a. d. Wien. Univ. t Bd. xvi.,
Teil 1, 1907.

This paper is preliminary to a detailed work on the subject, and
the material was obtained during three years’ experience in the
Clinique of Psychiatry at Tokio. The classification used is that of
Kraepelin.

Dr Miyake has observed 1733 cases of insanity. Of this
number 8 o per cent, were adolescents (ages from thirteen to
twenty-two). The largest number of those cases of adolescent
insanity were cases of dementia prsecox. From a total of 148,
120 patients are grouped under three of Kraepelin’s varieties of
dementia praecox, as follows:—dementia simplex, 11; hebephrenia
18; and katatonia, 91. An interesting analysis of all the cases of
adolescent insanity is included in the paper. No comparison of
the several forms of insanity is made with those found in Euro¬
pean countries to make the paper fulfil the author’s hope that its
study will serve as a study of racial psychiatry.

Hamilton C. Mark.

HOMICIDAL MELANCHOLICS. (Homizide Melancholiker.) Emil

(392) Raimann (Vienna), Arb. a. d. Neurol. Instit. a. d. Wien. Unit.,
Bd. xvi., Teil 2, 1907.

The writer of this article, while in attendance during two and a
half years at the Provincial Criminal Court in Vienna, noticed the
four cases which form the subject of his paper.

All the cases were afflicted with hypochondriacal melancholia,
and showed homicidal tendencies. These tendencies were not
blind impulses to attack surrounding objects, but were carefully
planned out and premeditated. Three of them ended in brutal
murder, and in the fourth case the victim was severely injured.
In each case suicide as well as homicide seems to have been
planned by the patient beforehand, and the failure to commit
suicide (although in two cases attempts were made) is commented
on. It is remarkable that some of the patients made actual
attempts to save their own lives after committing the murder.
In every case there was a family history of insanity, and in two a
personal history of alcoholism. The peculiarity of the murder in
each case was that the guilty person looked on it as an altruistic
deed, intended to spare the loved one some harm.

Hamilton C. Mark.

ABSTBACTS

441

EYE FINDINGS IN GENERAL PARALYTICS. (Angenbefnnde bei

(393) Paralytikern.) H. Davids, Monatsehr. /. Psychiat. u. Neur.,
Bd. xxiii., Ergangzunsheft, S. 1.

This article gives the results of a research undertaken to check
the recent conclusions of Baviart, Pansier, de Montiyel, etc. As,
however, it concerns only 26 patients—not a tenth of the number
of the other observers—the results are of only limited value.
The light reflex was affected in 92 3 per cent, of the cases, the
accommodation reflex in 57'7 per cent. Changes in the fundus—
especially the cloudy retina described by Uhthoff—were found in
only 23 per cent. Ernest Jones.

KORSAKOW’S DISEASE (Die Kors&kowsche Krankheit.) W.

(394) Serbsky (Moscow), Arb. a. d. Neurol. Inslit. a. d. Wien. Univ.,
Bd. xvi., Toil 1, 1907.

Professor Serbsky is of opinion that the discovery of Kor-
sakow’s disease is the greatest conquest that has been made
of late years in the world of Psychiatry, and in importance can
only be ranked with general paralysis. Both illnesses are well
defined, and are based on exact anatomical and pathological data,
although, unlike general paralysis, Korsakow’s disease is rare.
The paper is a historical analysis of the disease. The name of
Korsakow was first associated with it by Professor Jolly at the
International Medical Congress in Moskow (1897). The mental
symptoms now grouped under the heading of Korsakow’s disease
have long been noticed in connection with all forms of multiple
neuritis, no matter what their origin. To dispel a generally
accepted opinion that the polyneuritic psychoses associated with
septic processes are not due to septicaemia, but to alcohol, which
was largely prescribed by medical men in such psychoses, a
detailed summary of “A Case of Polyneuritic Psychoses with
Autopsy ” is given. The case in question formed the subject of
a paper by Korsakow and Serbsky. Details of cases of multiple
neuritis other than that of alcoholic origin are also included in the
paper, and a summary by Duprd of the numerous causes of the
disease. The latter summary is of a similar kind, but not so
well arranged as Gower’s classification of the causes of multiple
neuritis.

One feature not constant in Korsakow’s disease is referred to,
viz., retrograde amnesia. This, according to the author, is only
found in cases where, at the beginning of the illness, confusion of
mind and fantastic pseudo-reminiscences appear. In such cases
a deep-lying disturbance of the cortex is surmised.

442

ABSTRACTS

In differentiating Korsakow’s disease from other illnesses with
like symptoms of amnesia and pseudo-reminiscences, besides the
neuritic symptoms, an important characteristic of the disease may
be observed, viz., the retention of the patient’s character and per¬
sonality (except during the period of temporary confusion). The
patient retains his former sympathies and antipathies and is able
to judge and conduct his affairs properly—all circumstances being
otherwise favourable, and material at hand to aid the memory.

Korsakow’s disease does not represent an amnesia, but amnesia
in combination with neuritis and the retention of the patient’s
personality. Hamilton C. Mark.

8 Y PHILO MANIA AND SYPHILOPHOBLA (De la syphilomanie et

(395) de la syphilophobie.) C. Audry, Ann. de derm, et de syph.,
March 1908, p. 129.

After a brief review of the literature of this interesting subject,
which has received but scant attention from neurologists or
alienists, the author defines the terms syphilomania and syphilo-
phobia, and discusses their aetiology, symptomatology, prognosis,
and treatment. Syphilomania is the obsession of the idea of
syphilis in non-syphilitic subjects, or in those who have no
serious reason to believe that they are infected. In syphilomania
the obsession is permanent, irresistible, and incurable. It differs
from syphilophobiain that the idea of syphilis is confused and vague.
Rarely if ever neurasthenic, the subjects of syphilomania are
sometimes psychasthenic, but as a rule they are degenerates of the
ordinary type or victims of hysteria. Grave forms occur in which
the obsession is sufficiently imperious to determine dangerous
acts of insanity. Suicide, however, is rare, contrary to what
occurs in syphilophobia.

Syphilophobia is the obsession of the idea of syphilis in syphilitic
subjects, or in non-syphilitic subjects who have just grounds for
believing that they are iufected. Except in the grave forms the
obsession is not continuous. It may last or recur during a period
varying from six months to ten years or more, but the patient
enjoys periods of relative repose, during which the latent obsession
loses its power. The discontinuity of the fixed idea is an important
diagnostic feature which allows one to distinguish ordinary syphilo¬
phobia from syphilomania, or from acute grave syphilophobia.

Syphilophobes may be normal though impressionable indi¬
viduals or sufferers from psychasthenia or neurasthenia, but they are
never, or very rarely, degenerates. Unlike syphilomania, syphilo¬
phobia is most frequent in males. The general culture and social
position is higher than in syphilomania. Syphilitic infection and

ABSTRACTS

443

its evolution in a predisposed soil are not sufficient to determine
syphilophobia. A third factor is required, and is furnished by the
suggestion relating to the dangers of syphilis brought to bear upon
them, not only in quack advertisements, but also in the lay press
and on the stage. All syphilophobes can be made to recognise that
they are victims of a mental disorder against which they declare
themselves powerless to react. This consciousness of their con¬
dition is never found in syphilomania. In syphilophobia the fixed
idea is manifested in various forms, but is always related to a
precise though not exact notion of syphilis. Some dread the
external manifestations, some the nervous complications, others
are afraid of spreading the disease, or imagine they can find traces
of it in their wives or children. As a rule there is no relation
between the intensity of the syphilitic infection and the syphilo-
phobic reaction. A mild attack of syphilis may produce violent
syphilophobia.

The grave form of syphilophobia is one of the most redoubtable
complications of syphilis. Fortunately it is very rare. Audry
found it present in only 5 out of 5000 patients. As a rule it is a
late symptom, so that the question arises as to whether commenc¬
ing arterio-8clerosis does not play an active part in its production.

In the treatment of syphilophobia the daily life of the patient
should be carefully regulated, so that he should not be left a
moment unoccupied. Audry has sometimes obtained good results
by a substitution cure, i.e. by prescribing some absorbing occupa¬
tion to take the place of the fixed idea. J. D. Rolleston.

MENTAL DISEASES AMONG JEWS. (Uber die Geistesstfrungen

(396) bei den Juden.) Max Sichel, Neurol. Centralbl., April 16

1908.

To the Neurologisches Centralblatt of April 16th, Dr Max Sichel,
Assistant Medical Officer of the Frankfurt State Asylum, an
institution which, for several reasons, offers a favourable field for
such inquiries, contributes an interesting paper on the relative
frequency of insanity among Jews. It has been maintained by
many writers, e.g. Kraepelin, Mendel, Krafft-Ebing, Lombroso and
others, that the Jewish race suffers to a disproportionate extent
from mental maladies. Dr Sichel’s inquiries lead him to the
opposite view. Taking the statistics of his asylum from 1897
to 1907, he finds that, contrary to the general view, the proportion
of Jewish insane to Jewish population is rather less than the non-
Jewish proportion, but that wide differences exist in the propor¬
tions obtaining amongst the several clinical forms. In the
Frankfurt Asylum in 1906 and 1907 the Jewish admissions

2 I

444

REVIEWS

formed 6*5 per cent, of the whole, corresponding closely to the
proportion of Jews (6 8 per cent.) in the general population of
Frankfurt. If, however, from the total (Jewish and non-Jewish)
admissions all cases with alcoholic psychoses be deducted, the
proportion of Jewish admissions rises to 9*2 per cent, of the whole
admissions, non-Jewish alcoholic admissions forming 32 0 per cent,
of the non-Jewish, and the Jewish alcoholics only 1*5 per cent, of
the Jewish admissions, and this notwithstanding that the Jews,
Dr Sichel says, are large consumers of alcohol.

In every other clinical category—with the exception of epileptic
psychoses, in which the Jewish proportion is one-half that of the
non-Jewish—the Jews are relatively in excess, dementia praecox
being 28*1 per cent, as compared with 16*6 per cent, for the non-
Jewish; manic-depressive insanity, 11*7 percent, as compared with
27 per cent; general paralysis, 12*5 per cent, as compared with
8 3 per cent.; and hysteria, 10 9 per cent, as compared with 6*1 per
cent, for the non-Jewish.

Pilcz, in his paper on u Mental Diseases in Jews,” in which he
bases his discussion on the statistics furnished in Vienna, expresses
his doubts as to the value of any comparative statistical study
which leaves out of account the figures of those in private asylums
or in family care, and Dr Sichel’s facts, though interesting, are
open to the same objection. R. Cunyngham Brown.

■Reviews

NEW CLASSIFICATION OF CRIMINALS. (Nuova classiflcatione

del Delinquent!.) Josti Ingegneeros (of Buenos Aires), Biblio.
di Set. soc. e polii., N. 65. Remo Sandron, Milan, Palermo, and
Naples, 1907, pp. 80.

Prof.Ingegnieros criticises the fundamental conceptions of what he
calls the classical school of penal justice, according to which crime is
regarded as the anti-juridical conduct of individuals in whom free¬
will and responsibility are assumed, and to whom punishment is
meted out according to the gravity of their offence against abstract
ideals, with little consideration of the environment and psycho¬
physical constitution of the individual criminals. The author
—who might be described as a deterministic “whole-hogger,”
inasmuch as he denies free-will to the sane as to the insane or to
the moral imbecile—maintains that the ends of justice are de¬
feated and the issues obscured by such metaphysical conceptions,

REVIEWS

445

and would substitute for the ordinary penal sentences a scale of
reformative, repressive, and eliminative measures more in harmony
with modern criminology.

He treats of criminology under the headings of (1) the aetiology
of crime, that is the study of the determining factors of crime;

(2) clinical criminology, i.e. the morphology, psychology, and
degree of inadaptability to social environment of the criminal; and

(3) the therapy of crime. Under this last head, in the treatment
of which subject he makes the somewhat sweeping statement that
a strict determinism is the necessary outcome of biological science,
he of necessity does away with punishment in the sense of retri¬
bution altogether, and substitutes instead three degrees of
maximum, medium, and minimum penal repression. Under
maximum repression are included the “born” criminal, the in¬
sane criminal, the habitual and incorrigible criminal, the insane
criminal with psychoses which have acquired permanent form, and
alcoholic, epileptic, impulsive and incurable criminals. Under
medium repression are grouped the corrigible but habitual criminal,
the insane delinquent with curable psychoses, and the impulsive
criminal with educable inhibition. Under minimum repression
are included the occasional criminal, delinquents with transitory
mental disorders, and criminals with “ accidental disboulia.” From
the foregoing it is obvious that the author regards the criminal
act only in so far as it affords an indication of the psycho-physical
constitution of the individual actor or throws a light on his
previous training and environment, and that whilst the epileptic
convicted of petty larceny and the insane murderer would be
classed together for maximum repression, the murderers “per
disbouMe accidentali ” (a fairly large class) would be subjected to
only the lowest scale of repression. This small book is not a
study, but a by no means closely reasoned discourse, which, not¬
withstanding its title, contains no new idea.

R. CUNYNGHAM BROWN.

THE INFLUENCE OF ALCOHOL AND OTHEB DRUGS ON

FATIGUE. By W. H. R. Rivers, M.D., F.R.C.P. London:

Edward Arnold, 1908. Pp. 136. Price 6s. net.

This volume consists of the Croonian Lectures delivered at the
Royal College of Physicians in 1906, with some change of arrange¬
ment and the addition of some new matter derived from later
work. The drugs chiefly studied are caffeine and alcohol. Critical
accounts are given of the work done with these by previous
writers, and the author’s own investigations are clearly described.
The ergograph is used to show the course of muscular fatigue,
while mental fatigue is estimated by multiplication, typewriting,

446

REVIEWS

or MacDougaH’s new method of marking dote passed over a rotating
cylinder and seen through a slit. The history of the meagre
researches extant on the effects of strychnine, cocaine, tobacco,
and other drugs is given, and some fresh experiments with these
are described.

The special value of the new experimental work brought
forward in this volume is found in the care taken to separate the
specific effect of the drug from effects due to certain other factors,
such as interest and sensory stimulation. With this end in view
the drug was administered in such a form that it could not be
distinguished from control mixtures which were given on the
days when the drug was not taken. The subject of the experiment
thus always took some draught, but did not know till after the
records were completed whether the special drug studied was
contained in it or not. As a result of this precaution the records
of Dr Rivers show much less marked variations consequent on the
ingestion of the drug than do those of most previous investigators.
With alcohol, for example, except with large doses, the results are
purely negative, whereas former experimenters had always found
even small quantities followed by an immediate stimulating or
depressing effect on the muscles.

By the emphasis which he lays on the necessity for control
mixtures—a necessity which has been strangely ignored by most
other workers—Dr Rivers has taken a noteworthy step towards
the simplification of the problem before us. Apart from this
question of method, his careful rdsum^ of the results already
attained, his description of his own experimental work and the
conclusions he deduces therefrom, are of the utmost value both as
marking the level of knowledge already attained, and as indicating
the lines on which fresh research should proceed

Margaret Drummond.

NUCLEI OF THE HUMAN SPINAL COED. (Uber die Kerne dee

menschlichen Riickenmarks.) L. Jacobsohn, Aus dem Anhang
zu den Abkandl. d. Kbnigl. Preuss. A had. d. Wissenschft, vom Jdhre
1908, pp. 72, plates 9.

From an examination of serial sections of an adult spinal cord
the author classifies the various cells of the cord into the following
groups and sub-groups. Plates showing the characteristic arrange¬
ment for each segment accompany the article.

I. Motor nuclei of the anterior cornua.

(1) A medial group, the whole length of the cord down to
S4, sometimes divisible into antero-median and postero¬
median. Stray cells in the anterior commissure.

REVIEWS

447

(2) A lateral group. C1-D2 and L1-S3.

In the upper region—

(а) Antero-lateral.

(б) Internal intermedio-lateral or central and external

intermediolateraL

(cl Internal and external posterolateral.

In the lower region—

(a) Anterolateral.

(b) Postero-lateraL

(d) Anterior (in L3 and L4).

(e) Retrodorsal (near reticular angle).

Cells of the lateral group occasionally occur in the white
matter.

IL Sympathetic nuclei.

(1) Superior or thoracic lateral sympathetic nucleus, lower C8

to upper L3. Segmented arrangement, 2 parts—
apical in the lateral horn or corresponding region;
pre-angular in the angle between anterior and posterior
horns.

(2) Inferior or sacral lateral sympathetic nucleus, lower S2 to

coccygeal. Segmented like the upper, but the cell-
nests are shorter. An external wedge-shaped group,
and sometimes an inner group.

(3) Inferior or lumbo-sacral medial sympathetic nucleus,

L4 to coccygeal. In lowest sacral borders with (2).
At first confined to median border of anterior horn, in
S2 extends to anterior border of the horn, in lower S3
and S4 occupies whole anterior horn and central area.
All three groups show (a) cells in small compact groups;
(5) cells small, rounded, club-shaped or polygonal;
(c) homogeneous appearance and fairly darkly stained.

III. Large-cell nuclei of the posterior horn.

(1) Basal or spino-cerebellar (Clarke’s column), C8-L3.

Occasional cells both above and below. A continuous
columu.

(2) CentraL In centre of the posterior horn between its

base and the substantia gelatinosa and in the so-called
cervix and caput. Some cells in the cervical cord, few
in the dorsal, in lumbo-sacral more abundant—almost a
regular nucleus. Course of cell-fibres unknown.

(3) Pericornual.

(a) Apical. Whole cord except lower sacral; a few
cells on margin of the tip of the posterior horn.

(i b ) Reticular. On the outer margin of the horn, from
the tip to the reticular angle, S2-S4 especially.

448

REVIEWS

IV. “ Nucleus sensibilis proprius.”

Gierke’s cells. The small cells of the substantia gelatinosa.
Abundant and constant throughout the whole length of
the cord.

V. “ Tractus cellularum.”

Small cells scattered irregularly over the whole of the grey
matter. The term “ tract ” is used because no sharply-
defined groups or nuclei can be distinguished, but they
may be conveniently divided into the following three
series:—

(a) Antero-median. Along the inner border of the anterior

horn; may extend into the centre of the horn or into
the central area at the junction of anterior and
posterior horns.

(b) Postero-median. The smallest both in number and

size of cells. Situated in the region of Clarke’s
column, either actually among its cells or on any
side of it. May also extend towards the central area
of the grey matter.

the outer part of the posterior horn (anterior to the
substantia gelatinosa). In the region of formatio
reticularis and angle between anterior and posterior
horns, and extending from these into the central area
of the grey matter. J. H. Habvey Praia.

BOOKS AND PAMPHLETS RECEIVED.

H. Campbell Thomson. “ Diseases of the Nervous System.” Cassel &
Co., Ltd., 1908, 108. 6d.

R. T. Williamson. “ Disseminated Sclerosis, commencing with Failure of
Vision.” Lancet, May 1908.

Bemheim. “ NeurastWnies et Psychon4vroses.” Doin, Pans, 1908, 2 fr.

“Neurographs.” Vol. i., No. 2, 1908. Huntingdon, New York.* -

Weisswange. Ueber die Nervositat der Frauen und ihre Verhtitung.
Marhold, Halle, 1908, M. —25.

Karl Willmanns. “ Uber Gefangnispsychosen.” Marhold, Halle, 1906,
M. 1.20.

Josef Berze. “Uber das Verhaltnis desgeistigen Inventars zur Zurech-
nungs- und Geschaftsfahigkeit.” Marhold, Halle, 1908, M. 2.80.J

Balser, Aull und Waldschmidt. “ Der Alkoholismus. Seine strafrecht-
lichen und sozialen Beziehungen. Seine Bekampfung.” Marhold, Halle,
1908, M. 2.

“ Klinik fur psychische und nervose Krankheiten.” Bd. 3, H. 1. Mar¬
hold. Halle, 1908.

Bruno Lobo e Gasper Vienna. “ Estrutura da Celula Nervoza.” Bevil-
acqua, Rio de Janeiro, 1908.

Mairet. “ La Simulation de la Folie.” Coulet et fils. Montpellier, 1908.

Lenhard, Dannemann, Osswald und Kullmann. “ Die Fiireorge ftir ge-
fahrliche Geisteskranke.” Marhold, Halle, 1908, M. 1.20.

IReview

WeuroloGE anb flbsEcbiatr)?

Original articles

ANEURISM OF THE ANTERIOR CEREBRAL ARTERY*
WITH UNUSUAL PROLONGATION OF LIFE
AFTER RUPTURE: AUTOPSY.

(With Plates 22 and 23.)

By ALEXANDER BRUCE, M.D., F.R.C.P.E., Physician to the Royal
Infirmary, Edinburgh; J. H. HARVEY PIRIE, B.Sc., M.D.,
Clinical Tutor in the Royal Infirmary, Edinburgh; and W.
K.ELMAN MACDONALD, M.B., Ch.B., Resident Physician in
the Royal Infirmary, Edinburgh.

The following case of rupture of an intracranial aneurism appears
to us to be of sufficient interest from the clinical and pathological
aspects to merit publication :—

A. R, single, 33 years of age, smith, was admitted to the
Royal Infirmary on 18th April 1908 in a state of unconscious¬
ness, which was said to have lasted about two hours. At
11.30 A.M. he had become suddenly ill, and the foreman, who
had been called to see him, found him at his bench leaning
forwards and supporting himself by his extended arms. His
face was flushed, and beads of perspiration stood on his forehead.
He had been ill for three or four minutes, was quite conscious, and
said that he had had a similar attack one week before from which
he had recovered in a few minutes, as he expected he would be
able to do in this case. He complained of great pain in the
head and back of the neck, and of great giddiness. With
assistance he was able to walk out into the open air. He sat
down for about ten minutes, and, feeling better, started to walk
home in company with a boy. After he had gone about 300
R. OF N. & P. VOL. VI. NO. 8—2 K

450

BRUCE, PIRIE, and MACDONALD

yards, however, he was unable to proceed further, and the fore¬
man, on being called by the boy, found him lying unconscious in
the street, assisted him into a cab, and brought him immediately
to the Royal Infirmary, which he reached in a state of complete
unconsciousness.

When examined on admission, patient was lying on his
back with his arms by his sides and his legs extended. The
face was slightly congested, the eyelids half closed, and the
palpebral apertures equal in size. The pupils were contracted,
quite circular, and equal in size. They reacted to light only to
a slight degree, if at all. Both conjunctivas were quite in¬
sensitive to touch. The eyeballs were not prominent, and did
not move at alL The mouth was shut. There was a small
amount of frothy saliva between the lips. The lips were not
livid, but were blown out with each expiration. The breathing
was irregular both in rhythm and in depth of inspiration, but
there was no stertor. Coarse rhonchi in the lungs masked the
character of the breathing, but it was possible on auscultation to
hear a slight systolic murmur at the mitral area. There was no
abnormal percussion dulness, and no want of expansion of the
chest, and, as far as could be ascertained from sounds made on
respiration, no alteration of vocal fremitus or resonance.

The arms lay along the sides of the trunk, but there were
frequent spasms in which they were forcibly extended at the
elbow and drawn to the side of the chest, or even in front of it.
The forearms were very forcibly pronated, so that the backs of
the hands were directed towards each other. The wrists were
flexed, and the fingers were fully flexed, causing the hand to be
tightly clenched, the thumbs being strongly adducted against the
index fingers.

During these tonic spasms the lower extremities were
tonically extended, and there was slight extension at the ankle
joints and inversion of the feet. The lower extremities were not
affected during every seizure.

The spasms lasted a few seconds, were usually accompanied
by a loud expiratory effort and puffing out of the cheeks, but the
facial muscles were otherwise not involved.

The breathing was at the rate of about 30 per minute, and
was quiet in the intervals between the spasms. The mouth
was kept shut, and any attempt to open it was strongly resisted.

ANEURISM OF ANTERIOR CEREBRAL ARTERY 451

The head tended to rotate to the left side, and the chin was
approximated to the left shoulder. The attitude of the patient
after each spasm was almost exactly that represented by PI. 22,
Fig. I. 1 The position of the arms during the spasm is very
similar to that depicted in Fig. 175 in Yol. II. of Gower's
“ Diseases of the Nervous System,” 2nd Edition, which represents
the phase of tonic immobility or tetanism during the first or
epileptoid period of hysteria major, and is reproduced from
Richer’s “Etudes Cliniques sur l’Hystero-Epilepsie ou Grand
Hysterie.” The shoulders were less raised and the contractions
less intense, but the relative positions of the forearm and hands,
and the clenched attitude of the fingers, were similar in both
cases.

The reflexes in the lower extremities showed a slight
exaggeration. There was ankle clonus on both sides, but both
plantar reflexes were of the flexor type.

The axes of the two eyes were not parallel, there being a
slight divergent strabismus.

The pulse was about 70 per minute, regular in rhythm, of
good force and moderate expansion. The tension, as measured
by Gaertner’s tonometer, was 95 mm. Hg.

The temperature was 9 6‘4.

It was ascertained from his relatives that, with the exception
of the attack above referred to, his previous health had generally
been good, but that there was a slight tendency to tuberculosis
in his family history.

The condition remained more or less as above described from
about half-past twelve until three o’clock. The respirations
tended to assume the Cheyne- Stokes character. The tempera¬
ture remained about 96*6; the patient still lay on his back,
breathing noisily and rapidly. By 3.30 the pulse had risen to
100 ; the respirations were more definitely of a Cheyne-Stokes
character, and at the height of the cycle the arms and legs
tended to become rigid and the back to be arched. At that
time the temperature, which had begun to rise, had reached
98 2°, and by four o’clock had registered 100 8°. There was free

1 This is not a photograph of the patient himself, hut is one of the case
observed by one of us (A. B.), and described by Bruce and Drummond in the
Review of Neurol . and Psychiat., vol. ii., p. 737. It had been mislaid when that
case was published.

452

BRUCE, PIRIE, and MACDONALD

perspiration on the face and over the front of the chest. The
patient began to perform lateral and vertical chewing move¬
ments.

By 4.30 p.m. the temperature had reached 101*4°; the pulse
was 110; respirations 45 per minute on an average, varying
from 30 to 65 per minute according to the phase of the cycle at
which it was counted. The Cheyne-Stokes character was then
even more pronounced.

As the temperature was rising so rapidly and ominously, ice
was applied to the trunk and limbs, with the result that the
temperature fell from 101*6° to 97*6°, and the pulse from 120
to 90, the respirations remaining at 48 per minute. After the
application of the ice, the spasms and chewing movements
ceased. Loud rhonchi were heard over all the chest, obscuring
the heart sounds.

The urine, which had been drawn off by catheter previous to
the application of the ice, had a specific gravity of 1033, and
showed a trace of albumen, but no other abnormal constituent.

Lumbar puncture was performed, and 25 c.c. of a brownish
red fluid were drawn off under high pressure. This fluid was
obviously composed of blood and cerebro-spinal fluid mixed, and,
after standing in the test-tube, the solid elements began im¬
mediately to settle, and the precipitation was almost completed
in two hours. On examination it was found that albumen was
present in large amount. No sugar was present, but there was
a distant though partial reduction with Fehling’s reagent, a
greenish colour with flaky precipitate being produced on heating.
Blood was present, the guaiac test being positive. On microscopical
examination the films showed :

(1) Large number of crenated red blood corpuscles; (2) a
few polymorpho-nuclear leucocytes ; (3) a few lymphocytes ; and
(4) a few large mononuclear cells.

The red blood corpuscles were the most striking corpuscular ele¬
ments in the films. Many were perfect in shape and size, and many
were reduced to the merest broken-down shell of an erythrocyte.
All gradations between the two limits were found, very many of
the corpuscles being beautifully crenated, although the fluid was
microscopically examined as soon as it was obtained. The white
cells present were polymorphs, lymphocytes, and large mono¬
nuclears : none of those which were phagocytic showed any organ-

ANEURISM OF ANTERIOR CEREBRAL ARTERY 453

isms in their interior. In some films there were some staphylococci
(few) and a few rod-shaped organisms, but none were very definite,
and none were intracellular. Their presence was probably due
to accidental contamination. When the fluid was cultured, these
organisms proved to be staphylococci (albus and aureus).

At 8.30 the temperature was still 98*8. The patient was
perspiring freely. The pupils were moderately dilated, the right
being greater than the left. Their outline was not quite circular.
The jaws were firmly clenched.

At 9 p.m., the breathing was much quieter, and the spasms
had ceased since eight o’clock, with the exception of the chewing
movements and some movements of the tongue. The conjunctival
reflexes had returned on both sides.

By 9.20 the pupils had begun to react to light, and the
breathing had become more quiet and regular, altogether without
stertor. This improvement in the condition remained fairly con¬
stant until eight o’clock on the following evening, the 19th, when
the patient looked considerably improved, but about 9.30 p.m.
the face became more congested and cyanosed, the perspiration
stood in beads on his forehead, the temperature suddenly fell
from 98° to 96.8°, and by 10 p.m. it had fallen as low as 95°.
During the same time the respirations had increased from 38 to
48 per minute, and the pulse from 124 to 160, and at times it
became so frequent that it was difficult to count it. The arms
lay flaccid by the sides of the trunk, free from spasms or twitch-
ings of any kind. The pupils were dilated, but were circular
and equal. The contraction to light was practically gone, and
the conjunctive were quite insensitive. The coma was now
much deeper than on admission.

Hot water bottles were placed round the patient, and the
pulse gradually improved in strength and slowed down to about
150. The respirations became deeper and less noisy than they
had been, and the temperature began again to rise, becoming
normal by 11 p.m. By midnight the immediate danger seemed
to have passed, but the coma continued. Rhonchi, sonorous and
sibilant, were heard all over the chest, and slight percussion dul-
ness appeared at the bases posteriorly. Patient was fed with egg
and milk by means of the nasal tube.

By 4 A.M. of the 20 th, the patient had further improved.
His temperature was 97*6°; respirations, 32; pulse, 130. The

454

BRUCE, PIRIE, and MACDONALD

pupils both reacted slightly to light, and were circular. The
conjunctive were again sensitive.

A certain degree of improvement in the condition continued
until 4.30 p.m., when there was a slight aggravation of the
symptoms. By 8 p.m. it was noted that the lower extremities
were now quite flaccid, and no deep reflexes could be obtained.
The plantar reflex was difficult to elicit, but was of the flexor
type on both sides. The upper extremities were quite free from
spasms. The condition of the heart and lungs remained as before.

On the 21st it was noticed that the flaccidity of the lower
extremities was less marked, and that while there were no actual
spasms in the upper limbs, the tonicity of the muscles was slightly
increased.

At 6 a.m. there was a rise of temperature to 101, which was
met by the external application of ice and iced water. During
the forenoon the comatose condition gradually became less deep,
the eyes were opened, the eyeballs moved, and an impression was
made upon his relatives during their visits that he seemed to
recognise them. The upper and lower extremities showed some
degree of tonicity, and there was a slight, feeble response to
stimulation of any part. The deep reflexes again reappeared, and
were somewhat exaggerated. The superficial reflexes were all
present, the plantar reflex being still of the flexor type.

The improvement which had set in during this day was
maintained. The patient appeared to be conscious. Although
he was not able to speak, he followed with his eyes the move¬
ments of his relatives who came to see him. It was thought that
he made a voluntary attempt to expectorate the mucus accumulating
in his pharynx.

On the 22nd the plantar reflexes became extensor in character;
the rhonchi disappeared from the lung, and the percussion dulness
from the base. The systolic murmur could no longer be recog¬
nised in the mitral area. The urine passed by the patient
retained practically the same character as before.

From the 23rd to the 28th of April the patient lay in the
condition above described. There were no convulsions and no
spasms of any kind. The temperature varied somewhat, and each
time it rose above 101° F. towels with iced water were applied.
They invariably reduced the temperature to about 99°. On the
23rd of April iced towels were used 9 times; on the 24th,

ANEURISM OF ANTERIOR CEREBRAL ARTERY 455

9 times; on the 25th, 26th, and 27th, 7 times; and on the 28th,

5 times, and in every instance the application was followed by a
fall of temperature. On several occasions the patient so far
recovered as to seemingly recognise his friends, but he never
spoke, although he frequently appeared to be on the point of
saying something. When anyone approached his bed, he looked
at the visitor and quite consciously followed his or her movements
round the bed, the movements of the eyeballs being well carried
out At other times he was less conscious, and lay on the bed
taking absolutely no notice of anything or anybody.

By a second lumbar puncture, made on the 27 th, 15 c.c. of
fluid was obtained. It flowed freely and appeared essentially
similar in character to that previously obtained, and microscopical
and bacteriological examinations gave similar results.

Examination of the blood showed that the red blood corpuscles
were between 4,300,000 and 4,500,000. Haemoglobin remained
steady at 80 per cent. White blood corpuscles were: on the
23rd, 14,000; on the 24th, 17,000 ; on the 26th, 19,000 ; on
the 28th, 27,000. The differential count showed about: poly¬
morphs, 70 per cent.; lymphocytes, 19 per cent.; mononuclears,

10 per cent.; eosinophiles, 1 per cent. The average blood
pressure by Gaertner’s tonometer remained at 95°.

On the 29th the condition became more grave; the limbs
became quite flaccid; the eyelids remained incompletely closed,
the divergent strabismus being present, but the eyes tended to
show asynchronous movements. The pupils were moderately
dilated, the right being larger than the left. They did not react
to light. The conjunctivse were insensitive to touch. The upper
and lower limbs were flaccid ; there were no reflexes to pinching.
Rhonchi and crepitations were again heard all over the chest.
The coma deepened, and the patient died quietly at 6 p.m. on the
29 th, having lived twelve days after the initial onset of the
symptoms.

Autopsy .—The autopsy revealed evidence of incompetence of
the mitral and tricuspid valves of the heart. There were on the
cusps of the mitral valve several laTge nodules of old endocarditis
on the opposed surfaces. The lungs indicated a degree of con¬
gestion in the lower lobes, and the kidneys showed evidence of
slight sub-acute nephritis.

Spinal Cord .—The dura mater was somewhat tense. Under

456

BRUCE, PIRIE, and MACDONALD

the arachnoid a thin layer of blood-stained fluid covered the cord
throughout its whole length. A few small calcareous plates
were found in the arachnoid in the lumbo-sacral region. When
the layer of blood under the arachnoid was removed, the meninges
had a rusty-red tinge. There was great tortuosity of the veins
of the posterior surface of the cord. The consistence of the
cord was slightly reduced in the dorsal and cervical regions; in
the lumbar region it was fairly firm. On section of the cord, in
the lumbar region, the anterior cornua were found to be some¬
what congested. There were no haemorrhages visible to the
naked eye. On dividing the upper extremity of the cord from
the medulla, as soon as the arachnoid was incised a large quantity
of blood welled out from underneath this membrane through the
foramen magnum.

Brain .—On opening the skull, and dividing the dura mater,
the remains of the blood which had escaped from the foramen
magnum was found in the sub-arachnoid space, the sulci,
especially on the right side, containing a large quantity of blood¬
stained fluid, and the summits of the convolutions in the lower
frontal, temporal and opercular regions being separated from the
arachnoid by a thin layer of blood. Over the whole of the
vertex minute, bubbles of gas were found in the sub-arachnoid
space. The arteries at the base of the brain were all normal,
and the veins of the vertex were greatly engorged.

On making a longitudinal transverse section through the
brain below the level of the corpus callosum, it was found that
the two septa lucida, the fornix and almost the whole length of
the corpus callosum had been ploughed through by a haemorrhage
which had evidently arisen from between the lower part of the
two frontal lobes and had passed upwards and backwards,
its progress above being arrested merely by the pia arachnoid
covering the corpus callosum between the two hemispheres.
Some of the blood had also entered the lateral ventricles, and
had coagulated there without, however, either tearing up or even
seriously compressing the basal ganglia. The blood did not
appear to have passed backwards through the aqueduct of
Sylvius into the fourth ventricle. The main mass of the extra-
vasated blood had evidently found its way directly into the
sub-arachnoid space, and had spread freely through this space
along the lines of least resistance, filling up the sulci, the sub-

ANEURISM OF ANTERIOR CEREBRAL ARTERY 457

arachnoid cisterns, and raising the membrane from the convolu¬
tions, passing backwards, and, to some extent, seeking an
entrance into the fourth ventricle from the foramen of Majendie,
and also passing along the spinal cord under the arachnoid.

On making transverse sections through the basal half of the
cerebrum, after the brain had been carefully hardened in a
7 per cent, solution of formalin, a firm clot of blood was found
between the two frontal lobes. This had evidently been the
starting-point of the great extravasation just described, for when
a part of the clot was carefully washed away by a gentle stream
of water, an aneurism on the left anterior cerebral artery was
exposed (PI. 22, Fig. 2). This aneurism was almost spherical
in shape, and about the size of a small pea—5-6 mm. in
diameter. It was carefully removed along with an adjacent
portion of the brain cortex, and after some further fixation it
was embedded in paraffin and cut into serial microscopical
-sections. From these it was ascertained that the aneurism was
situated in the fork produced by the Y-shaped division of the
anterior cerebral artery into two branches. It had formed on
one of these branches just at the point of division (PI. 23,
Fig. 3). Beyond the limits of the aneurism, the main artery
and its branches were almost completely normal in their structure,
except at two points, which will be immediately referred to.
There was no trace of any thickening or degeneration of any of
the coats of the arteries, and, as already stated, the arteries at
the base of the brain were almost normal.

The aneurism was seen to be composed of two parts: (1) a
small primary sac ( b c, PI. 23, Figs. 3, 4, 5) formed by a
local dilatation of the wall of the artery from which it arose; and
(2) a somewhat larger secondary sac, or false aneurism (d in
Figs. 4, 5, and 6), which had arisen by rupture from the
preceding sac. Its walls were formed merely by the condensed
tissue of the pia arachnoid, and its cavity was almost completely
filled by mixed blood clot. On one side of this there was a
further coagulum formed by blood which had escaped into the
general mesh-work of the pia arachnoid (Figs. 5 and 6).

Microscopical examination of the wall of the aneurism
indicated that the initial weakening of the vessel which led to its
formation was due to a localised defect in the muscular coat.
This was most clearly evident at a part of the wall at which

458

BRUCE, PIRIE, and MACDONALD

dilatation was just commencing, and where other changes had
not been produced to complicate the picture, and the same
condition was also observed in one or two small aneurismal
dilatations of the other branch of the anterior cerebral artery at
a little distance from the main division. The nature of the
defect of the middle coat is shown in Fig. 3, and also in Figs. 7
and 8. At c in Fig. 3, and in Fig. 7, which is a more highly
magnified view of the same part of the wall of the sac, it is seen
that the middle coat is simply absent, and that the adventitia
and the intima are in direct apposition. There is no indica¬
tion of any pathological change in either the adventitia or the
intima of such a nature as to have been capable of causing
the disappearance of the media, and it is seen that at the margin
of the sac the middle coat has become somewhat rapidly thinned
or tapered off Over the sac it is entirely absent until the
opposite margin is reached, when it again begins to appear, and
to increase in thickness in the same manner as at the opposite
side. The adventitia in no way differs from the normal. The
intima is slightly thickened by the proliferation of its endothelium,
and by the splitting up of the elastic lamina into a series of
layers which, on cross section, appear as tortuous fibrils (see

Kg. 8>

Where the bulging of the sac has reached a higher degree,
further changes in the intima have developed, which obscure the
nature and meaning of the changes in the middle coat. The
intima here (Fig. 3, b ) has undergone an exceedingly high degree
of thickening by proliferation of its endothelium. Its boundary
from the remnants of the media, can be best determined in sections
which have been stained for elastic tissue by Weigert’s fuschin-
resorcin method. It appears from these that at the two margins
of the sac (5), the elastic lamina, split and tortuous, as already
described, comes for a short distance into immediate contact with
the adventitia, and then dips down between the thickened intima
and the remaining laminae of the muscular fibres of the middle
coat. Even here the remaining portion of the middle coat is
distinctly defective.

The wall of the more fully formed part of the primary sac
showed a great and irregular thickening of the endothelium of
the inner coat, with here and there small remnants of the elastio
lamina and slight thickening of the adventitia, but practically

ANEURISM OF ANTERIOR CEREBRAL ARTERY 459

no indication of the presence of non-striped muscular tissue. At
one part of the wall of the sac a small rupture had taken place
and the blood had escaped into the pia arachnoid tissue, which
it had driven before it and condensed into a firm layer sufficient
to resist, in the first instance at all events, the further progress of
the extravasated blood, which had to a large extent become
coagulated within its sac. A small channel had, however, been
left through which the blood had escaped into the loose-meshed
sub-arachnoid tissue. A small part of this had coagulated, and
i3 shown at e, Figs. 4 and 5.

It was found that on the branch a! of the anterior cerebral
artery there were one or two points at which similar defects of
the middle coat were associated with slight aneurismal dilata¬
tions. One of these is seen at i, Fig. 6. This, as in the previous
case, was situated near a point of division of a\

With regard to the aetiology of the condition, previous
observers, such as Oppenheim (2), Beadles (3), etc., have drawn
attention to the frequency with which aneurisms of the larger
cerebral arteries arise from their points of division and from certain
other sites of predilection, and to the relative frequency of the
occurrence of such aneurisms in young individuals in whom there
is no other evidence of arterial disease. The fact that in this
case there was complete absence of anything to indicate a
reason for the local disappearance of the middle coat, seems
entirely to favour the view that the predisposing cause of the
aneurism was a congenital defect of this coat.

From the clinical aspect, the case was of unusual interest in
several respects: (1) The occurrence of a transitory attack of
giddiness, with headache a week previous to the commencement
of the fatal illness; (2) the sudden onset with unconsciousness
associated with convulsive seizures of a special character with¬
out, in the first instance, any definite paralysis on either side of
the body, but with a later temporary flaccidity of the muscles;
(3) the large amount of blood-stained cerebro-spinal fluid obtained
by lumbar puncture on two occasions; (4) the duration of life
for twelve days after the first onset; and (5) the apparent partial
recovery during the illness.

With regard to the first transitory attack of giddiness, it
appears not improbable that this may have been associated with
either the first development of the secondary sac or with a slight

460

BRUCE, PIRIE, and MACDONALD

rupture of this sac and the escape of a limited quantity of blood
into the pia arachnoid. If so the quantity that had escaped
must have been comparatively small, for it did not impair the
patient’s faculties in any way.

The clinical history seems to indicate that there must have
been at least three other occasions on which haemorrhages had
occurred, namely, on the date of admission, on the following day,
and on the day preceding death, on all of which there was a
marked aggravation of the symptoms, with signs of increased
intracranial pressure.

The convulsive seizures so exactly simulated those observed
by one of us (A. B.), and recorded in this Review ( loc . cit.), as to
suggest a similar cause. The patient’s condition after the sudden
onset seemed to indicate the probable existence of a haemorrhage
into the third and lateral ventricles, but a haemorrhage which
did not destroy the internal capsule on either side, as there was
neither hemiplegia nor diplegia at first. In this case, therefore,
it could not have been due to the rupture of any of the vessels in
the basal ganglia.

The amount of blood removed by lumbar puncture was so
much greater than that met with in ordinary cases of haemor¬
rhage into the ventricles as to suggest that the blood had
descended into the spinal canal either under the dura or under
the arachnoid. The presence of this large quantity of blood¬
stained fluid on lumbar puncture and the nature of the con¬
vulsions, as well as the initial absence of hemiplegia or diplegia,
or of any of the symptoms of cerebral haemorrhage, suggested
during life the possibility of a rupture of an intercranial aneurism.

The duration of life after the onset was very remarkable, as
in haemorrhage into the ventricles such a duration is recorded
only in a very small number of cases. Sanders (4), in his
valuable work on ventricular haemorrhage, has found that in
about 65'7 per cent, of the recorded cases death has occurred
within twenty-four hours, and in the great majority of these in
less than twelve hours, rapid death being the rule and delayed
death the exception. He refers to three cases in which death
was deferred until the twelfth day, one in which it did not
occur until the eighteenth day, and one in which life was pro¬
longed for a month. In none of these cases was there any
association with aneurism.

Plate 22.

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ANEURISM OF ANTERIOR CEREBRAL ARTERY 461

Sanders is inclined to explain the apparent improvement
which appears to be by no means infrequent in cases of haemor¬
rhage into the ventricles, by the fact that the brain has become
accustomed to the pressure, and that its function has thus
become partially or completely restored. The improvement
varies from a very slight degree to perfect restoration of con¬
sciousness. As a rule it is merely transitory and is followed by
a relapse; it may be from a second haemorrhage. In one case
there was in all probability a succession of slighter or more
severe haemorrhages from the aneurism, to the pressure of some
of which the brain had become partially accustomed by the dis¬
placement of cerebro-spinal fluid.

The microscopical investigation of this case was made in the
Laboratory of the Royal College of Physicians.

Description of Figures.

Plate 22.

Fig. 1.—To show attitude of wrists and hands immediately after a fit.
Photograph of case recorded by Bruce and Drummond (Rev. Neurol,
and Psychiat., VoL ii., p. 737), and reproduced to show the similar
attitude in present case.

Fig. 2.—Frontal section through anterior part of brain of A. R., showing
the basal halves of both hemispheres separated by blood-clot (black), in
the anterior part of which, and to the right side, is seen the aneurism as
a paler globular mass.

Plate 23.

o' and a", branches of anterior cerebral artery ; b and c, opposite sides of
aneurism ; d, secondary (so-called false) aneurism followed by rupture
of the primary aneurism b, c; «, haemorrhage into tissue of pia arachnoid
from secondary sac; i, f, intima of wall of vessel; m, media.

Fig. 3.—Shows the aneurism b, e, formed on one branch (o') of the anterior
cerebral artery at the point of division into two branches, a' and a".

At b, the intima has undergone great thickening, while the media has
become thinned.

At c, the middle coat has entirely disappeared (see Fig. 7).

Figs. 4 and 5.—Show the aneurism b, c, lying between the now completely
separated branches a', a" of the anterior cerebral artery. By the rupture
of the wall of b, c at its power part, a second sac has been formed. It is
filled with partly-organised thrombus, and its walls are formed by con¬
densed tissue of pia arachnoid.

At e, blood has escaped from the secondary sac.

Fig. 6.— d, The secondary aneurism, with thin walls, formed merely of con¬
densed pia arachnoid tissue.

462 ANEURISM OF ANTERIOR CEREBRAL ARTERY

e , Haemorrhage from the secondary sac into the pia arachnoid.
a! and a", Branches of anterior cerebral artery,
a'", A small aneurism, with absence of middle coat.

Fig. 7.—(H. P. Zeiss Planar.) Part of wall of aneurism (c in Fig. 3), showing
how the media, m, m, becomes rapidly thinned, and at * has completely
disappeared, leaving merely the slightly thickened intima t.

Fig. 8.—(H. P. Zeiss Planar.) Section stained with Weigert’s (resorcin
fuchsin) stain for elastic tissue.

m, Media, terminated suddenly at the bend in the wall of the vessel
at t, where the intima is alone present.

t', Intima thickened, and, when examined with hand lens, seen to
contain numerous tortuous fibrillse of elastic tissue.

Literature.

1. Bruce and Drummond. Rev. Neurol, and Psychiat ., Vol. ii., p. 737.

2. Oppenheim. “ Lehrb. der Nervenkrankh.,” 4th ed., 1905, VoL ii., p. 925.

3. Beadles. “ Aneurisms of the Larger Cerebral Arteries,” Brain, Part 3,
1907, p. 285 (with Bibliography).

4. Sanders. Amer. Joum. Med. Sc., 1881.

6. Gowers. “ Diseases of the Nervous System,” 2nd ed., Vol. ii., p. 529.

6. Stolpe. “Ueber Aneurysmata der Arteria fossae Sylvii.” Inaug.
Diss. Kiel.

7. Rindfleich. Deutsche Arch./, klin. Med., Bd. 86, p. 183.

8. Flatau, Jacobsohn, and Minor. “Handbuch der pathol. An at des
Nervensystems,” 1903, 1 Abt., p. 215.

9. Kretz. "Tod durch Hydrocephalus nach intermeningealer Blutung
aus einem Aneurysma der Arteria carotis interna,” Wien. klin. Wchnschr., No.
33, 1895.

A CASE OF ARTERIO-VENOUS ANEURISM OF THE
INTERNAL CAROTID ARTERY AND CAVERNOUS
SINUS.

By ALEXANDER BRUCE, M.D., etc.

(With Plate 24.)

Cases of this condition in which a full clinical history is avail¬
able do not appear to be very numerous, and therefore the notes
of a case which has been under the writer’s observation may be
of interest.

The patient was a woman of 74 years of age. She had
just recovered from tin attack of influenza, complicated with
pleurisy of ten weeks’ duration, but previous to that time she
had been a thoroughly healthy woman. One morning in the

A CASE OF ARTERIO-VENOUS ANEURISM 463

end of May 1907 she was suddenly wakened about four o’clock
by a loud cracking noise in her head. Much alarmed, she
sprang out of bed and rushed into the next room, where she
wakened her daughter. She was able to walk quite well, but
complained of severe occipital headache and of noises inside her
head like those of a steam-engine panting. Her daughter gave
her some powder to allay the headache and to make her sleep,
but without success; she was too excited to sleep any more
that night. She remained in bed during the whole of the day
after the attack and part of the following day, suffering from
pains in the head and from the noises which she described as
like the noise of a steam-engine. These noises never ceased
except during her sleep since they first began to trouble her.

Shortly after the onset her walking became somewhat im¬
paired. She lost power in her legs, which gave way under her
when she tried to stand, and she could not move about without
help.

About two weeks after the onset the eyes became painful,
especially when she attempted to read. About a week later the
right eye became congested and swollen, and a few days after¬
wards the left eye was similarly affected. Then in another
month—that is about two months after the onset—the left eye
gradually became more prominent, the conjunctiva? being very
red. About the same time the right eyelid began to droop, and
by the end of June the palpebral aperture was completely
occluded. About the time of the beginning of the protusion of
the left eye there seems to have been a certain amount of
lividity of the face round about the eye.

Patient was admitted to Ward 40 in the Royal Infirmary,
under the care of Dr George Mackay, on the recommendation of
Dr Stewart. Ever since the onset she had been sleeping ex¬
ceedingly badly, and shortly before admission she seems to have
shown symptoms of a mild maniacal type.

After admission to Hospital the pain in the head became
gradually worse, so that she could scarcely keep her head on the
pillow because of the aching. The noises continued as before,
the prominence of the eye-ball diminished slightly, but the
ptosis persisted. The walking gradually improved, and the
patient was able to walk without support. All the mental
symptoms seemed to have disappeared, but the sleeplessness was

464

ALEXANDER BRUCE

very persistent, owing to the continuance of the pain and the
noises in the head.

The personal and family histories were perfectly satisfactory,
and do not throw any light on the causation of the condition.
They need not, therefore, be detailed here.

The patient was seen by me in consultation with Dr Mackay,
and we discussed the question of the diagnosis, and of the
possibility of treatment by ligature of the carotid artery. On
further consultation with Mr Cotterill this plan had to be
reluctantly abandoned owing to the patient’s advanced age, and
the extremely atheromatous state in which the carotid artery
was found to be. The patient was subsequently placed under
my immediate care by Dr Mackay, and the following notes are
extracted from the ward journal.

The patient was spare and grey-haired, with slightly livid
lips and complete left-sided ptosis. The left eye was enlarged
and protruding (PI. 24). There was congestion and oedema of
the eyelids and conjunctiva. The pupil was moderate in size and
the iris normal in appearance, but it did not react to light or to
accommodation. The eye itself was absolutely immobile. The
conjunctive were quite sensitive to touch. Vision was not
materially impaired, the patient being able to see quite well
when the eyelids were kept open. The veins of both retinae
were congested, but there was no optic neuritis.

With regard to the right eye, there was nothing abnormal
beyond the fact that the outward movement was somewhat
impaired.

The patient complained of some degree of deafness, not of
recent origin, in both ears. She suffered from constant and
extreme pain all over the head, of a beating character, the beats
corresponding to the noises heard in the head. The pain was
generally worst at the back of the head, or on the part of the
head which, for the time being, was most dependent. The pain
was aggravated by external noises. There was tenderness to
touch, especially over the supra-orbital and auricular nerves on
the left side. The noises of which she complained were com¬
pared by her to the puffing of a steam engine. They were
constantly present, but were aggravated by external noises, and
by anyone speaking to her for any length of time.

On auscultation of the head a marked blowing musical

Plate 24.

A CASE OF ARTERIO-VENOUS ANEURISM 465

sound was heard more or less continuously, but with a strong
reinforcement which was systolic in time. This murmur could
be made out all over the vertex, sides and back of the head, but
was most pronounced in the region of the temporal muscle
(maximum at the pterion) on both sides —-louder on the left side,,
if anything. This sound was conducted forwards with diminish¬
ing intensity to the external angular process of the orbit. It
diminished also on going backwards, and could be heard only
faintly above and behind the ears. It was conducted downwards
along the line of the internal carotid artery, and was well heard
right down the cheek as far as the lower jaw, with an increase
in loudness over the malar bones. A pulsation was visible in
front of and below the ears.

The patients sleep was greatly disturbed by the noises and
pain in the head.

Further examination of the nervous system did not reveal
anything of importance. There was no paralysis or sensory
disturbance. The deep reflexes in the lower extremities were
not very active. They seemed to be more so in the upper
extremities. The plantar reflexes were of the flexor type.

Examination of the circulatory system showed a slight
degree of hypertrophy of the heart, with considerable hardening
of the arteries, the carotids, as already mentioned, appearing like
hard cords on each side of the neck.

While the patient remained in hospital she was treated with
bromide and iodide of potassium, with rest in bed, and with the
further addition of butyl chloral for the pain in the head. There
was a considerable diminution of the pain, of the lividity of the
left eyelid, of the chemosis of the conjunctiva, and of the pro¬
trusion of the eye-ball, but the murmur heard over the head
and the noises in the ear continued unchanged up to the time
of the patient’s discharge from hospital on the 7 th of December
1907.

It was subsequently learned that she died a few weeks
afterwards, but unfortunately no opportunity was obtained for an
examination.

In spite of the absence of an autopsy, there can be little
doubt that the symptoms were due to the sudden development
of a communication between the internal carotid artery and the
cavernous sinus on the left side. Such communications may

2 L

466

ALEXANDER BRUCE

arise either from the rupture of an aneurism or of a carotid
artery whose walls have undergone a greater or less degree of
atheromatous degeneration, but without dilatation, or they may be
caused by an injury of the artery. It is almost impossible to
account for the sudden crashing sensation in the head in this
case, with the subsequent subjective noises and the auscultatory
phenomena, in any other way than by a sudden rupture and sub¬
sequent communication of the two vessels. It may be presumed
that the sudden noise in the head was coincident with the
rupture into the cavernous sinus. Rivington, in his valuable
paper on “ Pulsating Tumour of the Left Orbit,” in the
Medico-Chirurgical Society’s Transactions, vol. lviii., p. 184,
shows that in the majority of the idiopathic cases there was a
sudden onset with a crashing noise in the head, associated with
sudden and severe headache. In two instances the patients were
roused from sleep by the pain and noise. Rivington gives it as
his opinion that a continuous murmur with associated systolic
reinforcement, heard over the anterior part of the head, indicates
the presence of an arterio-venous aneurism of the carotid and
cavernous sinus. His statement ( loc . cit., p. 242) that a dis¬
tinctly intermittent bruit would point to true aneurism must, in view
of the work of Beadles, in Brain, 1907, be accepted with caution.

The murmur heard on auscultation was continuous, with a
somewhat musical character and a definite systolic reinforcement
—that is, it was distinctly louder during the systole. It was
widely distributed, and it was interesting to note that the part
of the temple at which it was loudest corresponded to the
pterion, or to the great wing of the sphenoid. Dr Kelman
Macdonald, who studied the distribution of the murmur with
great care, suggested that the sphenoid was probably the most
direct means of conducting the murmur to the surface.

Wildbrand and Saenger state that the protrusion of one or
both eyes may be absent, or may be immediate, or may not
appear for several days, weeks or months after the rupture. It
was noteworthy that in this case it did not appear until three
weeks after the onset, and that the congestion and swelling
appeared on the right eye a week before the left eye was
similarly affected. 1 The variation of the date of the appearance

1 There was some reason—namely, the paresis of the right external rectus—to
think that the right carotid artery might also have been somewhat dilated,
but no evidence that it was in an aneurismal condition.

A CASE OF ARTERIO-VENOUS ANEURISM 467

of this protrusion and congestion must depend upon several
factors—the size of the orifice in the wall of the artery or of the
aneurism, and the conditions regulating the possibility of the
free escape of blood from the cavernous sinus in the proper
direction. It will be obvious that should the opening in the
arterial wall dilate beyond a certain limit, the various outlets of
the cavernous sinus might thereby become insufficient to drain
away the additional amount of blood forced into it, and thus an
exophthalmos with chemosis and perhaps pulsation would be
produced. On the other hand, it is possible that the size of the
orifice might remain unaltered, but there might form in the
cavernous sinus such a degree of thrombosis as to limit the free
escape of blood from it, and in this way backward venous
pressure upon the eye-ball, etc., with its various consequences,
might be brought about.

It is to be noted that the fifth nerve alone of those that
pass along the wall of the cavernous sinus escaped paralysis,
the conjunctiva remaining perfectly sensitive. To this may
be attributed the absence of any neuroparalytic keratitis, which
■appears to occur in a very high proportion (according to
Wildbrand and Sanger in about 37 per cent.) of the cases.

A short note of some of the more important accessible
literature is appended.

Literature.

Frost. Tram. Ophthal. Soc., 1883, p. 9.

Rivington. Med.-Chir, Trans ., Vol. lviii., p. 184.

Wildbrand und Saenger. “ Die Neurologie des Auges,” Wiesbaden, 1900
(with Bibliography).

Karplus. “ Zur Kenutnis der Aneurysmen an den basalen Hirnarterien,”
Arb. a. Prof. Oberdeiner’s Lab., H. 8, 1900.

Maclaren. “ Intracranial Aneurism Treated by Ligature of the Common
Carotid,” Brit. Med. Joum., 1907, p. 10.

Williams. “A Case of Arterio-venous Communication in the Orbit,”
Tram. Ophthal. Soc., Vol. xL, p. 31.

Sattler. “ Graefe-Siimish.,” Bd. vi.

468

ABSTRACTS

Hbstcacts

ANATOMY.

“ DEB BAU DEB SPINALGANGLIEN DES MEN8CHEN UND DEB
(397) SAUGETIEBE.” Dr A. S. Dogiel, Professor of Histology in
the University of St Petersburg. Jena, 1908, Gustav Fischer.

In a monograph of 150 pages, accompanied by many beautiful
coloured plates, Professor Dogiel discusses the structure of the
mammalian spinal ganglion. The work is dedicated to “those
distinguished investigators of the nervous system—Ramon y Cajal,
Camillo Golgi, and Gustav Retzius,” and an introduction to it
gives a good review of the results which have accrued from the
researches of these and other workers in this subject. The
employment of the silver reduction method by Cajal confirmed
many of the previous observations of Dogiel, and added new
material to what was already known. Cajal found six distinct
types of cells among the spinal ganglia, and these types are briefly
criticised by Dogiel in the light of his own researches. The work
of Levi, Lenhossek and Nageotte is reviewed, and particular notice
is taken of the question of the regeneration of nerve fibres in the
posterior nerve roots from cells of the spinal ganglia.

In his investigations Dogiel made use of Cajal’s method in
addition to that of staining living material by weak methylene
blue, but found that he got better results by the latter method.
A description is given of his technique, the difficulties of which
would require much patience and practice to overcome. Hand-
cut sections of the fresh ganglia are incubated at body temperature
in weak methylene blue for a suitable time, fixed in 7 per cent,
solution of ammonium molybdate for eighteen hours, then dehy¬
drated, cleared and mounted in balsam or damar. The picture of
the ganglion cells obtained by this method, as illustrated in the
plates, is certainly very fine, and the process in the hands of a
competent worker would seem to give a better general impression
of the cell and its branches than can be obtained by the silver
method. The latter is of more use in revealing the fibrillar nature
of the cell-body itself.

Dogiel finds that the spinal ganglion is a much more complex
structure than has previously been supposed. It contains at least
eleven distinct types of cells, and between these types no direct
relationship exists. The types are designated by Roman numerals,
and in some of them there are sub-varieties. The cells are
unipolar, bipolar and multipolar. To type I. belong the commonly
described typical cells of the spinal ganglion. The cells of type

ABSTRACTS

469

II. are characterised by the giving off of collaterals from the axis
•cylinder after it emerges from the connective tissue capsule of its
cell, the collateral fibres ending in a form of end-plate which lies
in the sheath of the cell or in the connective tissue of the ganglion.
Many of the other types give off branches which end in different
forms of swellings or end-plates in the ganglion. Type VI. contains
four sub-varieties, and its cells are remarkable on account of the
number of branches which arise from the cell; these constitute a
thick network of fibres which branch and anastomose with one
another,and finally unite to form an axis cylinder process which even¬
tually divides into a peripheral and central branch. The cells of type
VIII. are unipolar, but the peripheral branch of the axis-cylinder
breaks up into numerous fibres which end in the neighbourhood of
the ganglion or in the posterior nerve roots. Type IX. consists of
bipolar cells which have preserved their embryonic character; the
peripheral process is usually thicker than the one which runs
centrally. Types X. and XI. are made up of true multipolar cells.
In type X. the dendrites do not emerge from the connective tissue
capsule of the cell. The cells of this group agree in many respects
with the multipolar cell described by Cajal. Perhaps the most
interesting are the cells of type XI., which have peculiarities dis¬
tinguishing them from all nerve cells hitherto known. They are
large or medium-sized, occurring in groups, or singly in the nerve
trunk or connective tissue near the ganglion. One process is an
.axon which runs directly into the spinal cord without branching;
the other processes become medullated fibres or remain non-
medullated, branch after leaving the cell capsule, and end in the
•connective tissue framework of the ganglion or in some part of the
posterior nerve roots. Dogiel believes that these processes re¬
present the peripheral branch of the other ganglion cells, and
whereas the branches of the latter end in sensory nerve-endings in
different parts of the body, the processes of the cells of type XI.
•end in nerve-endings in the ganglion or adjacent nerve trunk.
The nerve-endings are modified Vater-Pacinian bodies, end-plates,
and different forms of end-bulbs. The presence of multipolar cells
•of this variety in the normal ganglion is of importance in revealing
possible sources of error in work like that of Nageotte, who
^described similar cells in transplanted ganglia which he believed to
be an attempt on the part of the normal cells to regenerate.

A'chapter is devoted to the description of other nerve fibres which
•enter the spinal ganglia and end in them. Sympathetic nerves
«nd in the pericellular network of all types of ganglion cells.
Other fibres, medullated and non-medullated, and probably of
■cerebro-spinal origin, enter the ganglia and end in relation to the
ganglion cells or their processes.

The different types of cells are considered by Dogiel to

470

ABSTRACTS

indicate differences in function, but what physiological role each
type subserves is not determined. The work marks a large
advance in our knowledge of the anatomy of the ganglion cells, and
will stimulate fresh interest in the subject. A wide field for re¬
search is opened up, and new ground is afforded for the investigation
of the different paths of afferent impulses to the central nervous-
system.

A special word of praise must be given to the plates illustrating
the book; they are numerous, admirably executed, and are works-
of art in themselves. Percy T. Herring.

RESEMBLANCES BETWEEN THE HUMAN SPINAL CORD AND 1
(398) THAT OF ANIMALS. (Zur TiertUmlichkeit im menschlichen
Riickenmarke.) Paul Biach, Neurol. CentraXbl., Juni 1, 1908,
p. 507.

The writer describes abnormal appearances which he has met
with in human spinal cords which resemble the structure of the
cord in animals. In some cords the substantia gelatinosa which
normally encloses the posterior horn somewhat like a gothic arch
shows two well-marked convolutions and merely lies on the top
of the grey matter without surrounding it. Again, the grey matter
is unusually rich in fibres; indeed, so numerous are these fibres,
coming from the substantia reticularis or posterior columns, as in
the horse and pig, and so far forward are they situated, that the
posterior horn is sometimes completely cut off from the grey matter
of the anterior horn. These changes are limited to the cervical
region. An abnormality of the posterior roots almost always co¬
exists, the glia in the posterior horn extending out into the posterior
root for some little distance. Bauer has shown that this is the nor¬
mal condition in a large series of mammals, and he has also described
it in cervical tabes in man. Levi, on the other hand, has shown
that in the human subject the transition between glia and the
connective tissue of the root takes place normally within the cord
in the cervical region.

Among 27 pathological cords examined by the author, in
which one or other of these abnormalities was present, in 16 both
of the appearances above described were met with. It is argued
that this coincidence must be more than mere chance. The
author examined in all 50 pathological and 14 normal cords. In
27 of the pathological cords, one or both of the abnormalities were
present, while in only 1 of the normal cords was this so.
Among 17 cases of tabes, in only 4 were these abnormal
features absent. The author concludes finally that a cord, which
in its features resembles that of lower animals, is especially pre¬
disposed to tabes. Edwin Bramwkll.

ABSTRACTS

471

ON THE RELATIONS BETWEEN THE ARCUATE NUCLEI AND

(399) THE EXTERNAL ANTERIOR ARdFORM FIBRES OF
THE MEDULLA OBLONGATA (Bui rapporti tra i nuclei
arcuati e le fibre arciformi esterne anteriori della midolla
allnngata.) Volpi-Ghirardini, Riv. Hal. di Neuropatol., Psich.
ed Eletiroter., June 1908, p. 266.

The author finds that the arciform nuclei are peculiar to man,
although there are occasionally rudimentary traces of them to be
found in the chimpanzee, and he associates this development of
the nuclei with the function of the maintenance of equilibrium.
He thinks that the external arcuate fibres enter into connection
with the arciform nuclei—the occasional concomitant variation in
the numbers of the fibres and of the nuclei substantiating this—
and that the more ventral of the arcuate fibres are specially
associated with the arciform nuclear cells. It is certain, however,
that not all the arciform fibres are derived from the arcuate nuclei,
as these fibres may be developed although such nuclei are absent.

Alexander Bruce.

ON THE STRUCTURE OF NERVE CELLS OF THE ELECTRIC

(400) LOBE AND OF THE NERVE ENDINGS IN THE ELECTRIC
ORGAN OF TORPEDO OOELLATA. (Sur la structure des
cellules nerveuses du lobe llectrique, et des terminaisons
nerveuses dans l’organe 41ectrique du Torpedo ocellata.) G.
Pighini, Anai. Anz., xxxii. Band, No. 19-20, 1908.

Pighini has used Cajal’s reduced silver method in his studies.
The nerve cells show numerous dendrites, each of them composed
of a small bundle of fibrils which, on arriving at the periphery of
the cell, spread out fan-wise, the different fibrils passing in all
directions. Two kinds of fibrils are seen—stout and fine. The
stoutest fibrils stretch out quite to the periphery, where they inter¬
lace with other stout fibrils from neighbouring dendrites. From
these are given off the finest fibrils, which pass obliquely towards
the centre of the cell, interlacing with each other and forming
small polygonal spaces, the whole of which has the appearance
of a network. This network is distributed all over the cell body,
and becomes denser in the interior. Arriving at the oval central
space which contains the nucleus, the fibrillar meshwork becomes
much thicker, and inserts itself, or is continued into a network
of much stouter fibrils which envelop the nucleus. This peri¬
nuclear network is composed of fibrils similar to the peripheral
fibrils; they assemble together and unite into a bundle directed
towards the periphery at precisely the place where the axis-cylinder

472

ABSTKACTS

arises, with which it is continuous. He only observed one axis-
cylinder to each cell (Cantani states that there are several), which,
at a short distance from its origin, narrows down abruptly and is
directed towards that pole of the lobe where all the fibres reunite
in the nerve which passes to the electrical muscles.

The dendrites, according to him, only contract relations of
continuity between different cells; he has never seen free termina¬
tions of fibres or fibrils. He describes this method of junction as
follows:—a dendrite from one cell arrives at the surface of a
neighbouring cell, generally in a different plane, and divides into
several fibrillar bands, which in turn break up into their component
fibres and contribute to the formation of the peripheral reticular
layer of stout fibrils previously mentioned. In some cases he
observed two cells in the same plane and very near one another,
exchanging between them many fine dendrites.

With regard to the manner of the termination of the nerves in
the muscles of the electrical organ, he finds, as Betzius previously
found, that they ramify dichotomously and terminate freely, and
do not form a network. John Turner.

PHYSIOLOGY.

THE FATIQUABUJTY OF NERVES. (Tiber die Ermiidbarkeit des
(401) Nerven.) A. Beck, PflugePs Arch., Bd. cxxii., H. 12, 1908,
p. 585.

This investigator studied the effect of prolonged stimulation of the
cervical sympathetic upon the iris of the eye of the cat. The ex¬
periments continued for several hours, seventeen in one case, with
short intervals every hour or so of less than two minutes, the con¬
tinuous stimulation by rapid induction shocks being of rather greater
strength than was sufficient to give a maximal dilatation of the
pupil. No effects were observed which might be attributed to
fatigue of the nerve, and the author agrees with the older con¬
clusions of Bernstein and others. T. Graham Brown.

THE LOSS OF CONDUCTIVITY OF MOTOR AND SENSORY
(402) NERVES IN THE FROG AT INCREASED TEMPERA¬
TURES. (Erlischt Leitungsvermogen motorischer und sensl-
bler Froschnerven bei derselben TemperaturerhShung 7) Max
Hafemann, PHiiger’s Arch., Bd. cxxii., H. 10 and 11, 1908,
p. 484.

The author of this paper investigated the effect of heat on the
conductivity of motor and sensory fibres in the sciatic nerve of

ABSTRACTS

473

the frog. He severed one leg, in the decapitated frog, above the
knee, leaving only the sciatic nerve in continuity with the body,
and he applied heat to this part of the nerve, and stimulated it
Above and below the heated portion. The contraction of the
muscles of the severed leg served to give an index for the conduc¬
tivity of the motor fibres when the nerve was stimulated above
the heated part, while the contraction of the muscles of the
opposite leg served as an index of the conductivity of the sensory
fibres when the nerve was stimulated below this point. It was
found that, if the nerve was heated by means of hot Ringer’s
solution, to a temperature of 50° C., the conductivity of both
motor and sensory fibres disappeared in a few seconds; on the
•other hand, the temperature of 42° C. did not disturb the con¬
ductivity within twenty minutes. Within these two limits of tem¬
perature the conductivity remained for a shorter or a longer time
before it disappeared. The sensory fibres were always the first
to be paralysed. T. Graham Brown.

CONTRACTION OF FROG’S MUSCLE IN STRYCHNINE POISON
-(403) ING. (Beitr&ge zur Kenntnis der willkttrlichen Bewegung.
L Die Kontraktion des Froschmuskels bei Strychninver-
giftung.) Adolf Baslrr, Pfliigefs Arch., Bd. cxii, H. 8 and
9,1908, p. 380.

The forms of the contraction curves of the frog’s gastrocuemius
muscle were studied in animals treated with 01 to 0*5 mgrm. of
strychnine, the contractions being sometimes obtained by stimula¬
tion of the sciatic nerve electrically, sometimes caused only by
the spasm of the animal The forms of these two kinds of curve
were very similar, but in the latter case were rather higher and
longer than in the former. This stretching of the curve is to be
ascribed to a change in the condition of the muscle. In the later
stages of the poisoning the muscles did not react to voluntary
stimuli, while they would do so to direct stimulation, a result of
the curari-like effect of strychnine. The electrical excitability of
the nerve disappears much sooner than the excitability to volun¬
tary impulses. The electrical current of action was also investi¬
gated, and it was found that in the strychnine single spasms the
negative variation had a course slower by l second than in the
case of muscle contractions obtained artificially; it was also
.higher. T. Graham Brown.

474

ABSTRACTS

AN EXPERIMENTAL INQUIRY INTO THE ACTION OF
(404) ADRENALIN ON THE CENTRAL NERVOUS SYSTEM
OF THE RABBIT. (Experimentelle untersuchungen fiber
die Wirkung des Adrenalin anf das Zentralnervenaystem des
Kaninchens.) R. Shima, Arb. a. d. Neur. Inst, an der Wien -
Univ. Obersteiner, Bd. 14, 1908.

In continuation of the work of W. Erb and others, the author has
investigated the action of adrenalin on the central nervous system,
especially with a view to determining what effects are produced
by acute and chronic adrenalin poisoning, and whether these
effects are indirect and due to lesion of the vessels, or directly due
to toxic action. Rabbits of different ages were used, and adrenalin
injections in varying doses were made into the marginal vein of
the ear. The animals lived from 1 to 132 days.

The author finds that adrenalin produces effects on the central
nervous system, which he groups as (1) localised, due to degenera¬
tion of the vessels, and consisting of infiltration and hyperaemia of
the pia mater, and of small areas of softening and haemorrhage in
the brain; (2) diffuse, characterised among others by changes in
the “ ganglion ” cells of the whole cortex, which show shrinking,
vacuolation of the cell body, and corkscrew appearance of the
dendrites, by increase in the glial tissue, and by proliferation of
the ependyma cells.

The diffuse changes are seen especially in chronic adrenalin
poisoning, and the author believes, in opposition to prevailing
views, that adrenalin has a direct toxic action on the central
nervous system, apart from its effects on the blood vessels.

He points out that in many respects these morbid appearances
produced by adrenalin resemble those seen in progressive paralysis;
and, further, that they may be of importance in regard to the
observations of Schur and Wiesel, who have suggested that the
existence of adrenalin in the blood is the cause of the rise of blood
pressure in nephritis, for the symptoms of uraemia may be due to
chronic adrenalin poisoning.

He concludes that, of poisons formed in the body itself,,
adrenalin plays a more important part in reference to the central
nervous system than has hitherto been supposed.

J. A. Gunn.

ABSTRACTS

475

PSYCHOLOGY.

COLOURED THINKING. David Fraser Harris (St Andrews),
(405) Joum. Abnorm. Psychol., June-July 1908, p. 97.

Coloured thinking is to be distinguished psychologically from
coloured sensation. Coloured sensations are coupled sensations
(synaesthesiae) as when heard sounds arouse colours, thus certain
persons have coloured hearing (audition color^e). To some people
a high note has, e.g., a blue or green colour, a low note a deep red
or violet.

Monsieur Peillaube {Rev. Phil., Paris, 1904) has examined
the coloured hearing of four persons with a view to discovering
the bond between the sensation of one kind—the tone, and the
sensation of another kind—the colour. Locke’s blind man, to
whom scarlet was “ like the sound of a trumpet,” is an early case
of this sort of thing.

Chromatic conception is somewhat different. Here it is the
thought, the idea, that is possessed of colour. There are certain
persons who habitually think of “ things," words, etc., as coloured;
to them the hours of the day, the days of the week, the months of
the year, etc., have each a distinct colour. The coloured concept
may be called a psychochrome (Galton).

People differ considerably in their power of visualising (ex¬
teriorising); Mr Francis Galton has classified them (1883) into
strong visuals and poor visuals; only the former are likely to be
capable of coloured thinking. The characteristics of coloured
thinking may be thus summarised:—

1. The associations between the concept and the colour have
been formed at a very early age. In all Mr Galton’s cases and in
all I have examined this is so. Mr E. S. Holden {Nature, 1891,
Vol. xliv.) reports on the psychochromes of his daughter at the age
of seven. “Ever since childhood I have always seen,” “as far
back as I can remember,” are the phrases used.

2. In the next place we may note the total lack of agreement
between the colours attached to the same concepts in the minds
of seers. 1 To take a definite case, the thought of the vowel “ u ”
is to one seer grey, to another yellow, to four others black, brown,
blue, and green respectively.

3. The third characteristic of psychochromes is their extreme
definiteness in the minds of seers. Contrary to what might be
expected, the precise colours attached to concepts are by no means
vague or beyond accurate description. Indeed, a seer is most
fastidious in his choice of terms to give adequate expression to his
chromatic imagery. One is not content with speaking of Sep-

1 Mr Galton’a term for coloured thinkers.

476

ABSTRACTS

tember as grey, he calls it “ steel-grey ”; another speaks of a dull
white, a silvery white, etc. The degree of chromatic precision
which can be given by seers to the description of their visualisings
is as surprising as anything else in this curious subject.

4. Though so distinct, psychochromes never attain to halluci¬
nations ; they have all the definiteness of a thought without the
verisimilitude of a “subjective” sensation. Psychologically this
is intelligible, since the psychochrome is not a sensation but a
concept.

5. The next distinguishing feature is that this mental faculty
is hereditary, “ very hereditary ” Mr Galton puts it. The tendency
to coloured thinking is congenital, not environmentally produced;
it is due to “ Nature not nurture ” (Galton). The same is true of
coloured hearing. In one case, “ Un cas hereditaire d’audition
color^e ” (Lauret et Duchassoy, Abst. in Centralbl. f. Physiol .,
Leipzig and Wien, 1888), a father and son each associated both
sounds and thoughts with colours. With vowels (sounds or
thoughts) they associated “gay” colours, with the consonants
shades of grey.

These cases were typical in that the father and the son did
not associate the same colour with a particular vowel heard or
thought of.

6. Perhaps the most marked characteristic of coloured con¬
cepts is their unchangeableness throughout life. Middle-aged
persons will tell you there has been no modification of them since
early childhood. Mr Galton remarked of them, “ they are very
little altered by the accidents of education.” Just as their origi¬
nation is not due to the influence of the environment, so the
environment exercises no modifying influence on them as life
proceeds.

The precise colours associated are those in the spectrum as
well as white, black, grey, and a very large number of tints and
shades.

The colours differ greatly in the relative frequency of their
occurrence: of 100 psychochromes, white constituted 24, brown
24, black 17, yellow 11, green 7, blue 5, red 4, pink 3, cream 3,
orange 1, purple 1 per cent.

The kind of people who are coloured thinkers are, according
to Mr Galton, above rather than below the intellectual average.
Coloured thinking occurs both in men and in women; as an
example of the latter we may take Ellen Thomycroft Fowler,
some of whose psychochromes are described in her novel, “In
Subjection” (Hutchison & Co., 1906).

Can we arrive at any explanation of synaesthesia and of
■coloured thinking ? As to coupled sensations, Monsieur Peillaube
has attempted an analysis of its origin. He examined the case of

ABSTRACTS

477

a Monsieur Ch-, to whom low notes (heard) called up violet,

thus - —

To this person low notes were “ douces et profondes,”
the colour violet was “ douce et profonde,”
therefore low notes were violet.

The link “ douce et profonde ” was arrived at only after a great
deal of introspection. The sequence was x — l — y, where l was the
emotional link which had long ago dropped out of consciousness,
so that ever after x and y seemed instantaneously and indissolubly
bound together.

It is quite possible that the concept and the colour in a psycho¬
chrome might in some cases have a similar origin. To take one
example, where the concept “February” is always white, it is
arrived at thus—

Snow is white,

the earliest February remembered was snowy,
therefore February is white.

While some psychochromes may be so explained, it seems hopeless
on similar lines to explain such curious and arbitrary associations
as October with black, Monday with yellow, Thursday with white,
9 p.m. with yellow, 11 P.M. with green, and finally the vowel “u”
with white, yellow, black, brown, blue, green in the minds of six
different persons respectively. My experience is that of Mr
Galton: those questioned say, “ I cannot account for their origin
in any way.”

There seems no light to be thrown on coloured thinking by
considering it in connection with any of the theories of colour
vision. We have seen that psychochromes are remarkably stable
throughout life. Those who are coloured thinkers are somewhat
above the general intellectual average. Coloured thinking may
thus be regarded as in a category allied to genius; genius is noto¬
riously not conferred by training or education; if not inherited it
cannot be acquired. These things show us that it is not in the
ordinary type of mind, but in the recesses of the slightly aberrant,
that the more recondite problems of mental physiology present
themselves for solution. Author’s Abstract.

AN EXPERIMENTAL STUDY OF SLEEP. (Part II.) Boris Sidis,
(406) Joum. of Abnorm. Psychol., June-July 1908, p. 63.

In continuation of the account of his study of sleep, Dr Sidis here
describes his experiments on cats, dogs, and children.

The kittens and puppies which were used in preference to older
animals were usually wrapped in a cloth in such a way as to
prevent movement, and conduce to the monotony required. Their
eyes were then closed, and sleep quickly set in even in the case of

478

ABSTRACTS

puppies which at first violently resisted the endeavour to restrict
their activities. Slight catalepsy was frequently observed in the
paws at the beginning and towards the end of the sleep-state, this
being one of the signs of the presence of the hypnoidal or sub¬
waking state. This condition was more noticeable in the puppies
than in the kittens, and in older than in younger animals. An
interesting feature of the experiments was the habituation of the
animals to the oncoming of the sleep state. With some of them it
became sufficient to lay them on their sides and merely touch the
eyelids.

In the case of the children the subjects ranged from infants a
few days old to children twelve and thirteen years of age. In
young babies, as Dr Sidis points out, consciousness is concerned
not with external but with internal sensations. Hence if a baby
is hungry, the monotony necessary for the induction of the sleep
state cannot be produced merely by shutting the eyes and
restraining the activity. Babies a few weeks old are easily put to
sleep by enforcing monotony of sensation. Cataleptic conditions
are frequently observed. In older children the hypnoidal states
become more marked, and hypnosis, and even somnambulistic
states sometimes appear. Thus “ in infants and children, as in the
lower animals, sleep, hypnosis, and hypnoidal states are intimately
related, sleep presenting complex manifestations of sub-conscious
states which become fully developed in the adult.”

Margaret Drummond.

EXPERIMENTS IN PSYCHOGALVANIC REACTIONS FROM 00-
<407) CONSCIOUS (SUB CONSCIOUS) IDEAS IN A CASE OF
MULTIPLE PERSONALITY. Morton Prince and Frederick
Peterson, Journ. of Abnorm. Psychol ., June-July 1908, p. 11.

This paper describes experiments devised to obtain further
evidence regarding the existence under certain conditions of
conscious processes of the presence of which the subject is
unaware. It has been shown by Tarchanoff, Veraguth, Jung, and
others, that when a weak electric current is passed through the
body, the current is increased whenever emotion is aroused. This
fact was made use of in testing for the co-conscious processes. Dr
Prince had a very complex case of multiple personality, in which
one of the personalities claimed to be co-conscious all the time
that another was in the ascendancy. Eight sets of experiments
arranged with a view to testing this claim are described. The
guiding principle of these may be thus indicated. A series of
words was selected in which some occurred which roused vivid
emotions in the subordinate personality, but which had no special

ABSTRACTS

479

association for the personality dominant at the time. If the sub¬
ordinate personality were really present and active, then it was
thought that the galvanometer should indicate the rise of emotion
when the test words were pronounced. For example the word
“ Smith ” recalled an episode in the life of personality B of which
personality A had no knowledge; of this episode B was now
ashamed. The word “ Smith ” was introduced into a series of
indifferent words and the current passed through A. A marked
rise took place at the test word. This rise Dr Prince attributes to
the co-conscious influence of B. Tracings are given representing
various tests of like nature, in all of which the emotions of the co-
conscious subordinate personality seem to be able to produce an
effect on the galvanometer. Margaret Drummond.

PATHOLOGY.

SOME LESIONS OF THE SPINAL OORD PRODUCED BY EX-
<408) PERIMENTAL CAISSON DISEASE. A. E. Boycott and
G. C. C. Damant, Jmm Path, and Pact., Yol. xii., 1908,
p. 507.

As the result of the examination of a series of goats dying of
caisson disease, or killed after exposure to compressed air, the
authors show that the distribution of the lesions found in the
spinal cord follows theoretical considerations. (1) Bubbles are
uot uncommon outside the vessels in the substance of the cord,
their frequency here being doubtless due to the fatty nature of the
myelin. They are, however, about five times more abundant in the
white than in the grey matter; the fatty content of the two parts
being about the same, this distribution must be due to the differ¬
ence in blood supply, the dissolved gas being carried away by the
blood much more easily from the grey than from the white matter.
In the same way, the bubbles are more frequent in those parts of
the cord which have an abundant (lumbar and cervical enlarge¬
ments) than in those which have an indifferent (lower dorsal)
blood supply. (2) The paralysis which often follows exposure to
compressed air is nearly always a paraplegia due to softening of
the white matter in the dorsal cord. In the authors’ experience
the lesion, due to air embolism, is strictly confined to the white
matter, and is either restricted to, or much more marked, in the
dorsal cord than elsewhere. This distribution is explicable on the
basis of the varying activity of the circulation in different parts
of the cord. In the central nervous system above the cord, neither
extra-vascular bubbles nor softening was found in any case.

Author’s Abstract.

480

ABSTRACTS

ON THE POWER OF OHOLBSTERIN AND NERVOUS SUB-
(409) STANCE TO NEUTRALISE THE HJ3MOLTTIO ACTION
OF LECITHIN AND SPECIFIC SERUMS, G. Pighini,
Riv. Sper. di Fren., Vol. xxxiv., fasc. I.-II., 1908.

Pighini by a series of experiments shows that cholesterin and
nervous tissue of brain or cord (ox, dog) exert a neutralising
effect on the alleged haemolytic power of lecithin and specific
serums. This action seems to be in proportion to the quantity of
the substance used in the reaction, since one can see that increased
quantities of lecithin or serum require increased doses respectively
of cholesterin or nervous tissue emulsion to prevent haemolysis.

He believes that the neutralising substance in both cases is
cholesterin, which occurs free in the central nervous system. In
discussing its mode of action he refers to the views of Neuberg,
Reicher and Rosenberg, according to which many haemolytic pro¬
cesses are included among the lipolytic, and which attribute to
the fatty material of the red corpuscles the essential part in the
production of specific haemolysms. If these views are confirmed
he believes that it will be possible to trace a connection between
the lipolytic action and the antagonistic action of cholesterin.

He refers to the experiments of Wassermann and Bruck on the
prevention of the haemolysis ordinarily produced by an incubated
haemolytic serum and its complement, when there is added an
extract of a syphilitic organ (liver), and a certain quantity of
cerebro-spinal fluid containing the anti-bodies sought for, and which
they have interpreted as a “deviation of the complement,” i.e. the
complement, instead of effecting haemolysis, helps the reaction
between the specific toxin and the supposititious anti-toxin.

Wassermann, in consequence of the repeated positive results he
and others have obtained, regards the syphilitic nature of tabes
and general paralysis as proved. But the experiments of Levaditi
and Jamanouchi throw grave doubts on the accuracy of Wasser-
mann’s conclusion. They showed that the active principle of ex¬
tract of syphilitic liver is contained in the alcoholic extract, and is
composed of a mixture of fats and bile acids, and also that the
active principle of the serum of syphilitics and the cerebro-spinal
fluid of general paralytics is equally extracted by alcohol and con¬
sists of fats and salts ; and this alcoholic extract hinders haemolysis
in the presence of a watery or alcoholic extract of liver, and even in
the absence of liver extract, provided only that the dose is stronger.
They find that if one compares the anti-complementary strength
of extracts of serums or pathological fluids with extracts from
normal persons, there is only a small quantitative difference
between the two. According to them it is not correct to speak of

ABSTRACTS

481

deviations of complements brought about by true antigens and
antibodies. It is a question rather of substances soluble in
alcohol and ether, which are found in larger quantities in patho¬
logical tissues and fluids.

In view of Pighini’s results it will be necessary to ascertain if
the alcoholic extracts obtained by Levaditi and Jamanouchi con¬
tain cholesterin, which occurs free in bile and nervous tissues. An
alcoholic extract of liver may contain cholesterin, and if this body
is not usually a component of cerebro-spiual fluid, it may escape
into it from the surrounding nerve substance in pathological
conditions. JOHN TURNER.

CLINICAL NEUROLOGY.

AMYOTONIA CONGENITA. James Collier and S. A. K. Wilson,
(410) Brain, 1908, p. 1.

In this paper the authors have collected all the hitherto recorded
cases of this condition, amounting to twenty-one. In addition,
they report four new cases, making a total of twenty-five cases
described and commented on. The material is sufficient to make
a clinical description reliable, although pathological information
is at present limited to the somewhat contradictory results
obtained in two cases.

Amyotonia congenita (which is preferable to myatonia con¬
genita) may briefly be defined as a condition of extreme flaccidity
of the muscles associated with an entire loss of the deep reflexes,
most marked at the time of birth, and always showing a tendency
to slow and progressive amelioration. There is great weakness,
but no absolute paralysis of any muscle. The limbs are most
affected, the face is almost always exempt. The muscles are small
and soft, but there is no local muscular wasting. Contractures
are prone to occur in the course of time. The faradic excitability
in the muscles is lowered, and strong faradic stimuli are borne
without complaint. No other symptoms indicative of lesions of
the nervous system occur.

In nearly all cases the paralysis has been obvious at the time
of birth, or it has been noticed so few hours after birth as to make
it certain that the condition has been pre-natal. In four out of the
twenty-one, however, it seems clear that the weakness either
supervened or became much worse some months after birth.

The affection is always strictly symmetrical upon the two sides;
it may be universal in distribution, but the muscles of mastication
and deglutition seem always to have escaped. When the affection
is general the several parts of the body are never equally affected;
the lower extremities are most often and most deeply involved,
2 M

482

ABSTRACTS

n<*xt the upper extremities, then the trunk, and lastly the face.
The distribution of the affection is not in terms of the long axis of
the body.

In the limbs the amyotonia may be distributed equally upon
both proximal and distal parts, but this is unusual. It has been
stated by most of the previous writers upon this subject that the
proximal muscles are always more severely affected, but it seems
to us certain that this conclusion has been arrived at from the
obvious disadvantage at which the proximal muscles act upon the
limbs against gravity as long levers. There is no local muscular
atrophy comparable to the local atrophy which is characteristic of
all cases belonging to the group of the myopathies. Contractures
have only been met with in the lower extremities, and they do not
correspond either in position or in degree with the severity of the
amyotonia.

This tonelessness of the affected muscles is the most striking
feature in the condition. However complete the apparent
paralysis may be, yet every muscle when put into a favourable
position as regards work involved, contracts voluntarily. The
relaxation of muscles and ligaments allows of the most remarkable
over-extension of the joints, and leads to a highly characteristic
flail-like condition of the joints when shaken.

Amyotonia congenita must be distinguished from acute in¬
fantile spinal muscular atrophy of familial type, a condition of
complete atrophic palsy of the muscles with complete loss of
faradic excitability, and of sensibility to all forms of stimulation
in the region affected.

Whether amyotonia is a variety of myopathy, or whether it is
a clinical and pathological entity entirely separate from the
myopathies, is a matter of importance and difficulty. So far as
the pathological evidence derived from the two cases which have
been examined goes, it is quite compatible with a condition of
myopathy, though the results in the two cases are widely at
variance one with another. The following points are those on
which the opinion is based, that amyotonia is, clinically at least, a
distinct condition:—

1. The myopathies are conspicuously familial diseases, whereas

no familial tendency has been recorded in amyotonia.

2. The several types of myopathy often show familial re¬

lationship one with another, whereas no case of amyotonia
has been reported in a myopathic family.

3. A large majority of the cases of amyotonia are congenital,

the condition being obvious at birth. In none of its
several types is myopathy apparent at birth.

4. The characteristic muscular flaccidity of amyotonia is not

present in myopathy.

ABSTKACTS

483

5. The local muscular wasting that is a marked feature of
myopathy is not present in amyotonia.

■6. The course of myopathy is one of progressive increase of the
muscular weakness, that of amyotonia is one of progressive
amelioration of the symptoms.

7. Ketum of the deep reflexes after their persistent absence
for months or years has been recorded several times in
amyotonia, and has occurred in two of our cases under our
observation. Such a return of an absent deep reflex has
never been recorded in myopathy.

Authors’ Abstract.

ARE THERE "FORMES FRUSTES” OR RUDIMENTARY FORMS
<411) OF MUSCULAR DYSTROPHY (ERB), AND ARE THEY
CURABLE ? (Oibt es Formes frustes Oder rudiment&re
Formen des muskulftren Dystrophia (Erb), und ist deren Heilung
mSglich? Marina, Deutsche med. Wochensch ., 1908, p. 1087.

In this lecture, delivered by Marina at the Italian Congress of
Pediatry at Padua in October 1907, the question of the existence
of rudimentary forms of muscular dystrophy is discussed.

Under the general heading of muscular dystrophy Erb in¬
cluded an infantile or pseudo-hypertrophic type, with or without
implication of the face (Landouzy and Dejerine), a juvenile scapulo¬
humeral type, and a hereditary type. Such a disease, affecting
the muscles in different degrees, and advancing often with great
slowness, readily lends itself to classification into sub-varieties. It
is well known that the pseudo-hypertrophy and the atrophy are
often irregular and atypical, and that fibrillary tremors may even
be observed in some cases, so as to give rise to uncertainty in the
diagnosis; moreover, the course of the malady may be so slow as
to cause little or no interference with muscular activity.

Marina gives an account of a mild case of juvenile muscular
dystrophy in a young man aged 31, of feeble character and
physique, who had a degree of atrophy (not enlargement) of the
xupra- and infra-spinati and of the serrati, more marked in the left
side. The calf muscles were somewhat enlarged, and the patient
climbed up his legs from the recumbent posture in a typical
manner. Marina also recalls the occurrence of so-called “ abortive ”
forms of muscular dystrophy (Oppenlieim), in which the disease
remains confined to the shoulder-girdle and does not tend to
spread.

An account is given of another case, which he regards as a
rudimentary type or “forme fruste” differing in certain parti¬
culars from the foregoing “abortive” type. The patient was a

484

ABSTRACTS

girl, who originally came under observation at the age of 8J for
commencing scoliosis. The right shoulder was higher than the
left, the scapulae were winged at their lower angles. The supra-
spinaii were slightly atrophied, the infra-spinati slightly enlarged.
The pectoral and deltoids and certain other scapular muscles were
moderately wasted, whilst the right facial muscles were distinctly
enlarged. The lower limb appeared normal, but the faradic excit¬
ability of the muscles was diminished. All the deep reflexes of the
upper limbs were absent; those of the lower limbs were normal.
The patient was muscularly feeble and easily tired. The patient
was re-examined at the age of 14. By this time she had improved
considerably in general muscular strength. A mild scoliosis was
still present, but the general musculature appeared normal save
for slight hypertrophy of the lower halves of the infra-spinati and
diminished development of the muscles of the right upper arm.
The right half of the face was still hypertrophied. Electrical excit¬
ability of the muscles was still below normal, and in the right
hand-muscles no motion was obtained. In this case, therefore, the
malady had apparently come to a standstill, and had even im¬
proved. Marina admits, however, that this apparent “ cure ” may
prove to be but a period of remission or standstill in a disease
which may later reassert its progressive nature.

Purves Stewart.

THE DIFFERENCE BETWEEN CENTRAL AND PERIPHERAL
(412) FACIAL PARALYSIS. (Die Unterschiede centraler nnd
peripherer Facialis-l&hmungen und die anatomische Orundlage
derselben.) C. Hudovernig, Neurolog. Centralbl, 1908, p. 577.

The essential clinical differences between facial paralysis of central
and of peripheral type are commonly stated to be three in number.
Firstly, in central facial paralysis the upper facial muscles are
completely, or almost completely, spared, whereas in peripheral
cases all the muscles, upper and lower, are affected. Secondly,
electrical reactions of degeneration are absent in central and
present in all moderately severe peripheral cases. Thirdly, it is
stated that certain reflexes which are lost in peripheral cases are
preserved in central paralysis.

With regard to the escape of the upper facial muscles in most
of the central cases, the classic explanation of Charcot was that
there exists in each hemisphere a common centre for the bilateral
innervation of the upper facial muscles, so that when one centre
is paralysed the other maintains its function. Hudovernig, how¬
ever, holds that the true explanation is to be found in the fact
that the upper facial muscles have a separate cortical centre from

ABSTRACTS

485

the lower, and that the central path of the upper facial muscles is
separate from the lower facial path in the internal capsule, hence
it escapes in the usual central lesion. He also maintains that in
the bulbar facial nucleus itself there is a dorsal portion corre¬
sponding to the upper facial muscles and a ventral corresponding
to the lower muscles. Once the infra-nuclear course of the facial
path is interrupted, these two divisions are implicated simultane¬
ously, and no difference is possible between the degree of paralysis
of upper and of lower muscles.

The remarks on electrical reactions contain nothing new.
With regard to the third point—the alleged loss of the “supra¬
orbital reflex ” in peripheral lesions, as compared with its preser¬
vation in central lesions—Hudovemig maintains that the supra¬
orbital phenomenon is not a true reflex, but simply a diffusion of
mechanical excitability by direct stimulation of muscles and
fasciae. Moreover, the supra-orbital phenomenon can still be
elicited after division of the trigeminal nerve or extirpation of the
Gasserian ganglion, i.e. when the sensory limb of the supposed
reflex arc is absent. It is, therefore, of no value in distinguishing
central from peripheral lesions. Pubves Stewabt.

OPTIC AND OCULOMOTOR NEURITIS FOLLOWING OONOR-
{413) RHCEA. (Nevrite ottica e nevrite dell’ oculomotore comune
da intossicazione gonococcica.) F. Barile, Giomale di mtd.
militare, 1908, p. 275.

A soldier contracted gonorrhoea in December 1905. In January
1906 bilateral gonorrhoeal conjunctivitis developed, with predomin¬
ance of the lesions on the conjunctival surface of the left upper
lid. The conjunctivitis cleared up under treatment, but in the
course of the year frequent relapses occurred. Ptosis, convergent
strabismus and amblyopia developed in the left eye, and the
reaction to light and accommodation in the left pupil was lost.
The patient finally recovered a certain degree of vision in the left
eye, but when last seen he had still some ptosis, strabismus and
mydriasis. J. D. Rolleston.

A CASE OF POLIOMYELITIS POSTERIOR OF THE GENIOU-
(414) LATE GANGLION. (Bin Fall Ton Poliomyelitis posterior
des Ganglion genicnli; anschliessend Betrachtungen fiber
den dabei festgestellten Symptomenkomplex.) J. Ramsay
Hunt, Neurol. CenbraXbl., Juni 1, 1908, p. 514.

The symptoms of an herpetic inflammation of the geniculate
ganglion are pain in the ear, an herpetic eruption on the concha

486

ABSTRACTS

the external auditory meatus, and the tympanic membrane.
Facial paralysis, deafness, and the Meni&re symptom-complex
occur when there is an extension to the neighbouring nerve
elements. When the inflammatory process is limited to the
geniculate, the herpetic vesicles may be distributed on the drum,
the external auditory meatus, the concha, the tragus, the anti¬
tragus, and its immediate neighbourhood. The author describes
four types.

1. Herpes oticus characterised by pain in the ear, with an
herpetic eruption in the distribution above mentioned.

2. Herpes oticus, herpes facialis, or herpes occipito-cervicalis,
together with facial paralysis. In the latter case the herpes is
distributed in the areas supplied by the 1st, 2nd, and 3rd cervical
roots.

3. Herpes zoster involving one or more zones of the head,
facial paralysis and diminution of hearing.

4. Herpes zoster of the head with facial paralysis and the
Meniere symptom-complex.

The Gasserian ganglion, the geniculate ganglion, and the
upper cervical ganglia are liable to be affected together, as is the
case with the spinal ganglia. Dr Hunt has collected 61 cases of
herpes of the head with facial paralysis. In 20 there were dis¬
tinct signs of involvement of hearing, six showing a mere diminu¬
tion of hearing, while 11 exhibited in addition the Meni&re
symptom-complex. Edwin Bramwell.

CHRONIC NEURITIS OF THE ULNAR NERVE DUE TO
(415) DEFORMITY IN THE REGION OF THE ELBOW JOINT.

Sherren, Edin. Med. Joum., June 1908, p. 500.

Attention is drawn in this paper to a condition which has often
led to errors in diagnosis. The twenty-one previously recorded
cases are tabulated and reviewed, and two upon which the writer
operated fully recorded.

In most of the cases the deformity was a cubitus valgus, due
usually to injury in early life, a fracture or epiphyseal separation
at the lower end of the humerus. The interval between the
injury and the onset of symptoms was found to have varied from
six to thirty-six years. In all in whom a note on the condition of
the nerve was made, it was found enlarged in a spindle-shaped
manner.

The writer concluded that the neuritis was due to pressure upon
or irritation of the nerve in movements of the elbow owing to its
altered bony relationships.

The symptoms and treatment are shortly discussed.

Author’s Abstract.

ABSTRACTS

487

ON A CASE OF AMYOTROPHIC POLYNEURITIS. (A propos

(416) d’un cas de polyn^vrite amyotrophique.) G. Cato la, Nouv.

Icon, de la Salpitribre, 1908, p. 129.

The patient whose case is here recorded was a young girl of
18 years, suffering from dementia prsecox. During the course
of a pulmonary and intestinal tuberculosis the patient developed
a progressive amyotrophic paralysis, beginning in the upper limbs.
Both paralysis and muscular atrophy were localised at the start to
the muscles supplied by the musculo-spiral nerves, and in the
lower limbs to the tendons of the external popliteal nerves; later
the affection spread to the other muscles of the limbs and to the
thoracic muscles. The muscular wasting was accompanied by
loss of reflexes and R.D. No notable changes were detected in
sensation. The cranial nerves and sphincters were intact.

The chief diagnostic difficulty in this case was its diagnosis
from acute anterior poliomyelitis: the initial asymmetry of the
disease and the practical absence of sensory phenomena would
have been compatible with a poliomyelitis, but the strictly peri¬
pheral distribution of the muscular wasting and paralysis were in
favour of a polyneuritis, so also were the picking-out of certain
nerve-territories, and the tenderness on pressure of the nerve-
trunks. The slow development of the disease, taking several weeks
to attain its maximum, was also against a diagnosis of poliomyelitis.

Histological examination showed that the anterior and posterior
roots of the spinal nerves were normal. The spinal cord, however,
showed, by the Marchi method, well-marked diffuse discoloration
of all the white matter — not the black globules characteristic
of degeneration: evidently the myelin had undergone some
chemical change. The peripheral nerves, on the other hand,
showed degeneration of the axis cylinders and medullary sheaths,
closely resembling the changes of Wallerian degeneration. This
fact would tend to indicate that there is no fundamental difference
between so-called “ degenerative ” and “ secondary ” neuritis.
The integrity of the spinal nerve-roots is an interesting point to
which special attention is called. The peripheral nerve fibres,
therefore, were specially picked out by the tuberculous toxin,
which spared the central nervous system. Pukves Stewart.

THE VALUE OF THE UNILATERAL LOSS OF THE KNEE JERK

(417) IN THE DIAGNOSIS OF TABES. (La valour de la perte

unilat&ale du r^flexe rotulien dans le diagnostic du tabes.)

R. Burnand, Rev. mid. de la Suisse Romande, April 20, 1908,

p. 282.

A shoemaker, aged 57 years, was admitted to hospital on August
13,1907, for attacks of vomiting and abdominal pain, which on

488

ABSTRACTS

examination proved to be of the nature of gastric crises. The
right knee jerk was completely absent, while the left knee jerk
and both the tendo Achillis jerks were normal. The pupils
were equal, and reacted to light. There was no Romberg’s sign,
ataxia, nor any anomaly of gait. Precipitate micturition and
occasional delay in starting the act were also present. Syphilis
was at first denied, but later the patient admitted that he had had
a chancre on the penis at the age of 22 years. Lumbar puncture
showed an abundant lymphocytosis, and was followed by headache
and inequality of the pupils, the pupillary reflexes remaining
normal. No further gastric crises occurred. Shortly before leav¬
ing hospital he suffered from lightning pains.

After a review of the literature the author concludes that
unilateral abolition of the reflexes is not very exceptional in tabes,
and attributes it to asymmetry of the lesions. Absence of the
knee jerks coinciding with persistence of the Achillis jerks is more
rare. Cases of the kind have been reported by Babinski, Camus
and S^zary, Kollarits and Berger.

The unilateral loss of the knee jerk in this case is attributed
to local traumatism. For the last twenty years the patient had
been in the habit of mending boots on his right knee. That
trauma of this kind in the absence of tabes does not affect the knee
jerk was proved by the fact that subsequent examination of about
twenty shoemakers who had been using the same knee for the last
fifty years showed a perfect equality of the knee jerks on both
sides. J. D. Rolleston.

ON A CASE OF SYPHILITIC SPINAL PARALYSIS. (tJber
(418) einen Fall von syphilitisches Spin&lpar&lyse.) Renner,
DeutscK Zeitseh . /. Nervenheilk., 1908, p. 451.

The case here recorded was that of a man aged 36, the date of
whose syphilitic infection was uncertain. For nine years before
his terminal illness he complained of pains in the legs and
cramps in the calves; four months before his death definite spastic
phenomena developed, together with unsteadiness of gait. A
course of mercurial inunction was without effect, the gait became
much more unsteady, and seven weeks before death bladder
trouble developed. On admission to hospital he had definite
evidences of cystitis. There was loss of pupillary light reflex,
optic atrophy, ataxy of the upper limbs, a zone of slight diminu¬
tion of tactile sensibility around the upper part of the abdomen
—phenomena suggestive of tabes; but, on the other hand, the
spastic paresis of the lower limbs, the brisk deep reflexes and
the presence of extensor plantar reflexes showed that the pyra-

ABSTRACTS

489

midal tracts were also implicated. Towards the end psychical
symptoms appeared, apparently the result of toxic absorption from
the bladder infection.

Autopsy confirmed the diagnosis of syphilitic combined
system degeneration. The changes in the cervical cord cor¬
responded with those in an incipient tabes superior. They
implicated mainly the postero-external columns, and were most
marked in the upper thoracic and cervical regions, increasing in
intensity as they were traced upward. In addition, there was
well-marked pyramidal degeneration, increasing in intensity on
tracing downward. There was no thickening of the pia, nor any
local meningitis or compression. There is a good plate showing
the degeneration in the cord. Purvbs Stewart.

OBSERVATIONS ON CEREBRO SPINAL MENINOITIS. Stuart
■(419) M‘Donald, Joum. Pathol, and Bacteriol., Vol. xii., No. 4, April
1908, p. 442.

This paper deals with (1) observations on the staining reactions
of the meningococcus, (2) the presence of leptothrix forms in the
cerebro-spinal fluid in cases of acute meningitis, (3) some experi¬
mental results in meningococcal infection.

I. Staining Reactions of the Meningococcus .—The author is of
opinion that at certain times certain stains of undoubted meningo¬
cocci show a variable reaction towards Gram’s stains. In over
fifty cases of epidemic meningitis personally studied, meningo¬
cocci were demonstrated forty-three times in the cerebro¬
spinal fluid during life or in the meninges at the post-mortem
examination.

In thirty-five of these cases a culture of the meningococcus
was obtained, but only in three of the strains was the Gram
variable reaction observed. In none of the cases was a Gram
positive reaction on the part of the organism demonstrated in the
cerebro-spinal fluid or in the tissues, but on several occasions
meningococci were seen which, after staining with Gram’s gentian
violet solution, and the application of the iodine solution, resisted
decolorisation with absolute alcohol for one minute. The three
strains referred to were cultivated from the cerebro-spinal fluid
during life in typical acute cases. In all of the three strains Gram
positive forms appeared on cultures or sub-cultures; in no case
did the organism grow on gelatine at room temperature; in two of
the strains at least the author considers that the possibility of two
■organisms being present was absolutely excluded. In the case of
the third strain, from a very acute fatal case, the organism was
typically Gram negative in the cerebro-spinal fluid; but in the first

490

ABSTRACTS

sub-culture some Gram positive cocci appeared. In the case of
some of the diplococci one element was Gram positive, the other
Gram negative. An intraperitoneal injection in a mouse of five
minims of an emulsion of a twenty-four hours’ culture of
the organism on serum agar proved fatal in less than twenty
hours. The organisms found in the peritoneal exudate were
morphologically identical with meningococci. The organism was
recovered in fine culture from the peritoneum, and films from
this culture showed the organism to be still Gram negative.

II. The Presence of Leptothrix Forms in Cerebrospinal Fluid in
Acute Cases of Meningitis. —In five cases of acute meningitis Gram
negative bacilli have been observed in the cerebro-spinal fluid
during life, in two cases no other organisms could be demonstrated,
in other two cases Gram positive diplococci were present together
with the bacilli; in the fifth case an organism resembling a true
meningococcus was present. The bacilli varied much in length,
being sometimes seen in a short diplo-bacillary form; at other
times long thread-like forms were present, staining faintly and
irregularly. The author believes the organism to have been the
same in all the cases. In one case a pure culture of the bacillus
was obtained and proved to be a leptothrix form, long sinuous
filaments appearing on blood agar. No proof of pathogenic property
on the part of the organism was obtained. The significance of this
leptothrix invasion is not quite clear; it may be a secondary
infection, but on the other hand, in the two cases in which a post¬
mortem examination was obtained, the organism appeared to have
at least modified the infection, as the distribution of the exudate
in the meninges was vertical rather than basal, and the exudate
itself was more fibrinous than is usually seen in meningococcal
meningitis.

III. Some Experimental Results in Meningococcal Infection .—
The animals employed were mice, guinea-pigs, monkeys, and a
goat. Of the smaller animals mice were found most suitable for
experimental work. Intraperitoneal maculation of cultures of the
meningococcus or of cerebro-spinal fluid containing the organism
gave fairly constant results, the animals usually dying in from twelve
to thirty hours. Guinea-pigs, even when young, did not prove
suitable subjects, showing apparently a greater resistance to the
meningococcus. A goat, given an intra-dural (spinal) injection
of thirty minims of cerebro-spinal fluid from an acute case, con¬
taining numerous meningococci, suffered no inconvenience what¬
ever. The author confirms Flexner’s experimental observationa
on monkeys, and by using cerebro-spinal fluid, containing meningo¬
cocci, rather than cultures, has obtained positive results with,
much smaller doses of meningococci than Flexner employed.
Some experiments have been performed with the object of throw-

ABSTRACTS

491

ing light on the natural paths of infection by the meningococcus.
One monkey was inoculated intravenously with fifteen minims of
cerebro-spinal fluid from an acute epidemic case. The animal died
on the fourth day with symptoms of acute toxaemia; there were
no meningitic symptoms. Post-mortem, no meningitis was
found, but there were evidences of an acute general toxaemia. In
another experiment fifteen minims of an emulsion of a twenty-
four hours’ culture of a meningococcus were injected into the
sheath of the sciatic nerve, the object of the experiment being to
determine the possibility of infection of the cord by way of the
perineural lymphatics. The animal showed no symptoms for
between three and four weeks, but died rather unexpectedly just
over four weeks from the time of injection. Post-mortem, no
apparent cause for death was found. There was no meningitis.
No meningococci could be demonstrated in the tissues, or re¬
covered by culture. Locally at the point of inoculation there waa
chronic inflammatory change in the sciatic itself and in its sheath.
In order to determine the possibility of a primary intestinal route
of infection, cerebro-spinal fluid from an acute meningococcal case
was injected into the jejunum of a monkey after abdominal section.
The animal almost at once showed symptoms of general toxaemia ;
there was slight diarrhoea, but no indications of meningitis; death
occurred on the fourth day. Post-mortem, there was found no
peritonitis and no meningitis, but there was evidence of a general
acute toxaemia. The mesenteric glands near the jejunum were
enlarged and acutely inflamed, and Gram negative diplococci mor¬
phologically identical with meningococci were demonstrated in
them ; the organisms, however, could not be recovered in cultures.

The author believes that further experiments on similar linea
may be expected to yield definite information as to the natural
routes of infection, which cannot be regarded as satisfactorily
established so far. Author’s Abstract.

TYPHOID BACILLI IN THE CEREBRO-SPINAL FLUID IN
(420) TYPHOID FEVER. (Ueber den Nachweis von Typhus-
b&zillen in der Zerebrospinalfliissigkeit bei Typhus abdomin-
alis.) Nieter, Munch. Med. JFoch., 1908, No. 19, p. 1009.

Thk diagnostic value of lumbar puncture in typhoid fever is well
illustrated by the following case. A man, aged 20 years, died
after a week’s illness with symptoms of meningitis. The diagnosis
lay between typhoid fever and epidemic cerebro-spinal meningitis.
A complete autopsy was not performed, but cultures were taken
from the nasal mucus, cerebro-spinal fluid, faeces and spleen. No
meningococci were found in the nasal mucus, but typhoid bacilli

492

ABSTRACTS

were present not only in cultures from the spleen and faeces, but
also in that from the cerebro-spinal fluid, in removal of which
special care had been taken to prevent contamination. Nieter
alludes to other cases in which the diagnosis of typhoid fever was
made during life by examination of the cerebro-spinal fluid.

J. D. Rolleston.

A CASE OF ACUTE POLIO-ENCEPHALOMYELITIS IN A BOY
(421) OF THREE. (Cas de Polio-encdphalomydlite aigue chez un
Gar$on de trois ans.) M. AcuSa, Arch, de mid. des Enf.,
Juin 1908, p. 405.

This boy had some slight fever, diarrhoea, and an impetiginous
eruption of the skin for twelve days, then his legs became para¬
lysed ; the paralysis rapidly ascended till in a few days there was
complete paralysis of the limbs, trunk, neck, and palate. Death
with bulbar symptoms twenty days from the onset. The patho¬
logical changes in the central nervous system were mainly seen in
the blood vessels. These were much distended, some thrombosed,
but most in evidence was the peri-vascular infiltration of small
round cells. This reaction was not confined to the anterior cornua,
the posterior cornual vessels being also considerably affected, and
also those of the nerve roots and pia-arachnoid. Similar more
scattered areas were also found in the medulla, pons and basal
ganglia. The dorsal cord was most affected. The nerve cells
showed only slight chromatolysis. The author attributes the
disease to some virus carried by the blood-stream. No organisms
were found in the cord. J. H. Harvey Pirie.

ABSCESS OF FRONTAL LOBE OF TRAUMATIC ORIGIN. F. L.

<422) Taylor, N.Y. Med. Journ., May 1908.

The clinical report of the case of a man who was struck with
a brick above the right eye in May 1906. The man was not
rendered unconscious by the blow, and returned to his work on
the next day.

A month later an abscess developed round the wound. It was
opened, some spicules of bone were removed, and the wound
healed.

Thereafter, however, his intellect became sluggish. He could
not sleep, and in addition severe occipital headache and frequent
vomiting developed. When seen in September 1906 he was
emaciated, yawned every few minutes, was apathetic, and had

ABSTRACTS

493

a bilateral optic neuritis. He had no Bakinski, but there was
incontinence of urine and faces, and persistent vomiting.

An incision was made in the line of the old cicatrix, the dura
was opened, a large hypodermic needle was pushed into the frontal
lobe, and two ounces of pus were evacuated. As a result of the
operation the man regained his intelligence, could control his urine
and faeces, and stopped vomiting.

He remained well until October 1907, when the severe head¬
ache returned, and in addition he had convulsions which came on
three days before, and occurred at ten-minute intervals for twenty-
four hours before his death. The writer thinks that the return of
these symptoms was due to the formation of a secondary abscess,
and points out the importance of carefully watching cases that
have been operated on with apparent success.

D. K. Henderson.

PALATO-LARYNGEAL HEMIPLEGIA. Rose and LemaItre, Ann.
(423) de mal. de V oreille, du larynx, du nez et du pharynx, November,
1907, p. 467.

In this paper the varieties, anatomical and pathological, of palato-
laryngeal hemiplegia are discussed in a systematic and lucid
manner. The actual anatomical innervation of the palate and
larynx is still sub judice : the authors uphold Willis’ contention
that the bulbar roots of the spinal accessory should be considered
as belonging to the vagus: in this sense the view that the palate
and larynx receive practically all their nerve supply from the
vagus is widely supported. The sensory supply of the palate is
from the fifth: the laryngeal and pharyngeal afferent fibres belong
to the tenth.

1. Palato-laryngeal hemiplegia of peripheral origin. — Such
cases are rare. For a space of about two centimetres, immediately
below the jugular foramen, a lesion of the vagospinal nerve will
produce the form of paralysis under discussion: lower down, the
pharyngeal branch leaves the vagus. Several instances are on
record where the syndrome has resulted from disease in the
neighbourhood, notably tuberculous glands and new growths.

2. Of radicular origin .—Basal lesions such as tumours or
syphilitic pachymeniugitis may occasion a palato-laryngeal hemi¬
plegia. It is rare to find that there is a concomitant sensory
paralysis.

3. Of intrabulbar origin .—Cases of palato-laryngeal hemiplegia
of bulbar origin are not infrequently associated with a crossed
anaesthesia, but no motor affection of face or limbs. It is supposed
that a vascular lesion of the postero-inferior cerebellar artery, or

494

ABSTRACTS

of the vertebral artery beyond the origin of the former, produces
the syndrome. The association of 'the clinical phenomena with
definite parts of the vagal nuclei is still a matter of difficulty. In
most cases both nuclei and vagal fibres are involved. Paralysis of
the palate certainly seems to depend on a lesion of the anterior
part of the nucleus ambiguus. The occasional occurrence of
certain (cervical) sympathetic symptoms in this syndrome is a
point of considerable interest. In tabes, syringomyelia, and acute
inferior polioencephalitis, palato-laryngeal hemiplegia may be
encountered, as also in certain tumours of the area under con¬
sideration.

4. Of supranuclear origin .—A few rare cases have been de¬
scribed, notably those of Garel and of D&j^rine. Paralysis of
palate and vocal cord is known as the syndrome of Avellis;
paralysis of palate, cord, stemomastoid and trapezius, the syndrome
of Schmidt; paralysis of palate, cord, and tongue, the syndrome of
Hughlings Jackson (incomplete); and of palate, cord, stemomastoid,
trapezius, and tongue, the syndrome of Hughlings Jackson
(complete). S. A. K. Wilson.

TTF.MTP T.mTA WITH UNILATERAL OPTIO ATROPHY. (Clinical

(424) Lecture.) R. T. Williamson, Brit. Med. Joum., June 6, 1908.

In this lecture four cases are described, in which there was atrophy
of the right optic disc (causing loss of vision in the right eye) with
hemiplegia of the left side.

These cases are examples of a peculiar combination of symptoms
—optic atrophy on one side, with hemiplegia on the opposite side.
The explanation suggested is that the symptoms were produced
by obstruction (thrombosis) of the internal carotid and middle
cerebral arteries on one side, with occlusion of the central artery
of the retina (on the same side) by thrombosis (or embolism)
spreading from the thrombus in the internal carotid. The patho¬
logical examination in two of the cases, and the ophthalmoscopic
changes in one case, were in favour of this view. (A diagram
illustrates the situation of the lesion.) Author’s Abstract.

DIAGNOSIS OF TUMOURS AND OTHER LESIONS IN THE

(425) OEREBELLO-PONTILE ANGLE. T. H. Weisenburg (Phila¬
delphia), Jmm. Amer. Med. Assoc., April 18, 1908.

The paper is concerned with the value of the different symptoms
found in lesions of the cerebello-pontile angle, and five cases are
reported, three with necropsy.

Two cases in which a tumour grew from the dura and covered

ABSTRACTS

495

the petrous portion of the temporal and occipital bones gave
symptoms of a lesion of the cerebello-pontile angle sufficient in
one case to cause an operation to be done.

In the third patient there was almost entire absence of head¬
ache, nausea, vomiting, vertigo and choked disc, yet a cerebello-
pontile angle lesion was diagnosed, and operation done and
recovery followed.

The fourth patient after middle ear disease developed rigidity
of the back and neck, increased reflexes, sluggish pupils, choked
disc, cerebellar gait, inco-ordination of upper and lower limbs, and
involvement of the left 6th, 7th and 8th nerves. Autopsy showed
an abscess of the pia in the left cerebello-pontile angle.

The fifth patient showed occipital and temporal headache,
gradual to almost complete loss of vision, double choked disc, par¬
alysis of the entire 7th nerve, unsteadiness of gait and station,
marked tremor, especially in the right upper limb, all the reflexes
were increased, legs spastic; the autopsy showed a tumour filling
the fourth ventricle and the posterior part of the aqueduct of
Sylvius, a part growing outward into the left cerebello-pontile
angle.

The paper furnishes much useful information concerning the
interpretation of the clinical manifestations of cerebello-pontile
lesions from carefully selected and well-studied cases.

C. H. Holmes.

SYMPTOMS OF PONTINE TUMOURS. PARALYSIS OF ASSOOI-
<426) ATED EYE MOVEMENTS, AND LOSS OF CORNEAL
REFLEXES. (Sur quelques symptomes des tumours do la
protuberance. Los paralysies des mouvements associds des
yeux et la perte des reflexes coradens.) Raymond and Claude,
L’Enc4phale, March 1908, p. 264.

The symptoms of this case pointed to a tumour of the right half
of the pons, with a crossed motor and sensory paresis. The
patient was, in addition, unable to look either to right or left, and
presented bilateral corneal amesthesia, with loss of the corneal
reflexes. The authors appear struck with the rarity of comeal
anaesthesia when the rest of the trigeminal area is normal (yet
this condition is not so very rare), and think it possible that
certain trigeminal fibres run in the posterior longitudinal bundles
which may be considered a path of motor and sensory fibres
concerned in associated reflex movements of the eyelids and eye¬
balls. They remark, however: “H&tons-nous de dire qu’il »e
s’agit ici que d’une hypoth&se qui ne s’appuie sur aucun fait
physiologique ou anatomo-clinique.” S. A. K. Wilson.

496

ABSTRACTS

CEREBELLAR TUMOUR WITH PROPTOBIS. Parkinson and
(427) Hosford, Ophthal. Rev., May 1908, p. 133.

The patient during life presented somewhat anomalous symptoms,
including great proptosis of each eye, equal on the two sides.
There were unmistakable indications of intracranial neoplasm,
and post-mortem a fibro-psammoma about the size of a pigeon’s
egg was found on the under surface of the right lobe of the cere¬
bellum, pressing on the pons and medulla. The ventricles were
much dilated, “ and the cerebral cortex flattened and thinned, and
tunics of nerve sheath distended." S. A. K. Wilson.

PAPILLOMA OF THE OHOROID PLEXUS, Etc. (Papillome des

(428) plexus choroides du IVe ventricule, etc.) Viqouroux, Rev.
neur., April 15, 1908, p. 281.

The patient suffered for some years from an incessant escape of
cerebrospinal fluid by the nose. He developed epileptiform
seizures later, of a general nature, followed by mental con¬
fusion for some days. It was observed that the cerebrospinal
discharge disappeared before the onset of fits, and re¬
appeared thereafter. During the fits considerable bilateral
exophthalmos was noted. At the autopsy the cavity of
the fourth ventricle was found to be filled with a tumour resem¬
bling hypertrophied choroid plexus. The sella turcica and the
pituitary fossa were abnormally large, and occupied by a cystic
formation of the meninges, and in addition there were several
apertures in the cribriform plate of the ethmoid, communicating
with which were funnel-shaped prolongations of the dura,
perforated at the distal ends. This was probably due to extreme
intracranial tension, and not, as has been supposed, the result
of a congenital malformation of the cribriform plate, with
encephalocele. S. A. K. Wilson.

LARGE ANEURISM OF THE SYLVIAN ARTERY (Andvrysme

(429) volumineux de l’artdre cdrdbrale on sylvienne.) A. Souques,
Nouv. Icon, de la Salpetrihre, mars-avril 1908, p. 108.

The symptoms first appeared when the patient, a man of 65, was
10 years old, in the shape of paroxysmal headaches, lasting a
quarter of an hour or so, and vomiting. When 29 the headaches
became more severe, localised to right side, and he had an attack
of aphasia and left-sided hemiplegia. At 30 he became blind, the

ABSTRACTS

497

hemiplegia gradually improved. When 63 years of age there was
almost no trace of the hemiplegia, no objective sensory disturb-
ances, reflexes normal save fan sign on left foot and a positive
Oppenheim’s sign. He was still having vertiginous attacks with
headache and vomiting about once a fortnight, as he had had nearly
all his life. There was optic atrophy following neuritis in both
eyes, and no vision. Delusions of persecution now began to appear,
and at 65 he committed suicide. Post-mortem there was found
an aneurism of a branch of the right sylvian artery the size of a
hen’s egg. The other cerebral arteries showed a considerable
degree of atheroma. J. H. Harvey Pirie.

ON THE MECHANISM OF GLIOSIS IN ACQUIBED EPILEPSY.

(430) E. E. Southard, Amer. Joum. Insan., No. 4, 1908.

The writer terms his theory a micro-physical one, in that it seeks
a logical basis for the epileptic discharge in certain intimate
alterations of pressure in the central nervous tissues. He is in¬
clined to thiuk that by combining the consideration of gliosis on
the one hand and of certain stratigraphic changes on the other, a
structural basis can be laid for the understanding of the inhibitory
mechanism which underlies epilepsy.

The theory expounded lays claim to originality in two
directions—(1) In .setting forth the properties of a typical epi¬
leptogenic focus in the cortex; (2) the nature of that change in
cortical tissue which favours epileptic discharges.

The characteristic features of a typical prime focus are described
as the separation of a normal cell group from its normal control
by other cell groups, and the impact upon the receptive surfaces
of these normal cells of a steady, intimate, abnormal pressure—
both segregation and pressure effected by neuroglia overgrowth.

That feature of cortical tissue which favours the spread of
epileptic discharges is described as due to a simplification of cell
arrangements, arising in the destruction of controlling elements
with maintenance of motor elements.

The peculiar features of the epileptic discharge depend upon
the inertia of currents travelling in simplified areas, and upon the
lack of energy-absorbents en route. The cerebral areas normally
escape automatism through a multitude of synaptic connections;
under epileptic conditions the cerebral mechanism approaches in
fatality the spinal mechanism.

Under this conception, epilepsy and phenomena like clonus are
readily perceived to belong to a single logical group.

The paper is illustrated by some very good photo-micrographs
of the brain-cortex, showing the distribution of the glial changes

2 N

498

ABSTRACTS

affecting chiefly the small cells of the second layer and the cells of
the stratum granulosum. John Turner.

EPILEPSY—THE SO-CALLED IDIOPATHIC FORM. Tucker,
(431) N.Y. Med. Joum., June 6, 1908.

This paper contains merely an account of the clinical forms,
diagnosis, pathology, and treatment of epilepsy, largely based on
the views of W. Aldren Turner. The author expresses himself as
in the main in agreement with the views concerning the pathology
of the disease as expressed in Turner’s book on epilepsy.

John Turner.

A REPORT OF TWENTY-SEVEN OASES OF CHRONIC PRO-
(432) ORESSIVE CHOREA A S. Hamilton, Am. Joum. of Inaan .,
VoL lxiv., No. 3, Jan. 1908.

The writer gives full clinical reports of these twenty-seven cases,
seventeen of which he examined personally, and ten of which are
taken from the records of the institution at Independence, Iowa.
He maintains that there is no essential difference between
hereditary chorea and senile chorea, as seventeen of these cases
which were originally diagnosed as senile chorea were found later,
on a more thorough investigation being made, to have a well-
marked hereditary predisposition. In the writer’s cases there is
a history of the condition in the immediate relations in twenty-four
instances. In the remaining three the history is lacking, and it
is pointed out that the ordinary nervous and mental diseases are
conspicuous by their absence in these patients. Rheumatism was
present in but five cases, and certainly plays no such important
r61e here as in the chorea of childhood.

Manifestations of ordinary physical disorders were not more
frequent in most parts of the body than would be expected in
a group of people, many of whom were well advanced in life.
It is noteworthy that in some of the patients in whom the
movements were violent and continued, not only during the
day, but also through a considerable portion of the night, there
was no complaint of fatigue. The part of the body first affected
varied considerably; sometimes the movements were first noticed
in the hands, sometimes in the lower extremities, and sometimes
in the face. Ultimately, however, the whole body is involved in
most instances, though the movements may be more severe in
some parts than in others. Speech defect appeared in most of
the cases, though at times only when the disease was far advanced.

ABSTRACTS

499

In all the writer’s cases the movements were absent during sound
sleep, but not always during light slumber.

A well-marked increase in muscular tonicity was present in
nearly all of the well-developed cases, and in several it was a very
striking phenomenon.

In all the cases recorded here there was mental impairment,
the condition being a gradually increasing dementia, marked
irritability, and often distinct delusions of persecution.

D. K. Henderson.

SOME OF THE MOTOE PHENOMENA OF CHOREA CLINI-
^433) PALLY CONSIDERED. F. R. Fry, Joum. Amer. Med. Assoc.,
Yol. i., No. 18, May 1908.

The writer distinguishes between tic and choreic movements. Tic
is held to be an affair of a higher cerebral level and closely related
to psychic functions. The choreic movement, on the other hand,
is due to some defect in the motor inhibitory apparatus. Tic is
-evidence of a more pronounced neuropathic predisposition.

Many of the subjects of chorea are very silent, and the difficulty
in these cases is mostly one of motility, but in other cases it is due
to a sluggish general mentality. D. K. Henderson.

DISTURBANCES OF SENSATION OF CEREBRAL ORIGIN AND
<434) SPINAL TYPE. (Zur Frage der zerebralen Sensibilit&ts-
stdrrmgen von spinalem Typus.) Straussler, Monatsschr. f.
Psych, u. Neurol., May 1908, p. 381.

In a case of Jacksonian epilepsy affecting the right arm and face
followed by paresis in the same distribution, the author found
-certain disturbances of sensation approximating to a spinal type.
Thus with a slight subjective numbness of the whole of the right
half of the body was coupled an objective loss to pain, touch, and
temperature stimuli in an area corresponding more or less exactly
to parts of the fourth, fifth, and eighth cervical segments, and of
the first to the fourth dorsal segments. Passive movements of the
fingers (and toes) on the right side were not recognised at all.
Stimuli were incorrectly localised in the forearm, hand and
fingers. The right hand was astereognostic. At a later stage
improvement took place. The patient was frequently wrong in
his localisation in his fingers, although he recognised the nature of
the stimulus: it was almost constantly referred to the middle
finger. Passive movements were usually recognised, but referred

500

ABSTRACTS

to the wrong finger. The error of atopognosis was chiefly a
proximal one.

In a case such as this, of considerable scientific value, it is to be
regretted that the examination was not more thorough. There is
no reference to the exact nature of the stimuli used for testing
topognosis, nor to the degree of the proximal or other errors that
were noted. There is no record of the nature of the passive
movements employed, and whether any distinction was appreciated
by the patient between flexor and extensor movements. The
desirability of a careful discrimination between the protopathic
and epicritic types of sensation does not appear to haVe been
realised, as there is no reference whatever to their diagnostic value
as regards the localisation of the lesion. The term “motor
atopognosis ” for errors in the recognition of passive movements is
ambiguous. It would have been interesting to know whether the
patient exhibited astereognosis in the exact sense of the word, as
the description suggests his condition may really have been one of
tactile agnosia. S. A. K. Wilson.

TOTAL ANAESTHESIA. (Totalanaesthesie.) L. E. Bregman,
(435) Neurol. Centralbl., Juni 1, 1908, p. 498.

Total anaesthesia is one of the rare sensory symptoms of hysteria.
The symptom is of great interest in connection with (1) the
influence of sensory impressions upon the accomplishment of
movements, and (2) the importance of sensory impressions for
consciousness. Strumpell has recorded a case in which there waa
complete loss of sensation, excepting that sight in one eye and
hearing in the opposite ear were retained. This patient went
off into a deep sleep whenever the eye and ear were covered.
Strumpell deduced from this case that afferent impressions are
necessary to maintain the waking state. This explanation does
not, however, account for the periodicity of sleep, or for the fact
that we go to sleep in spite of the external impressions which are
constantly reaching our cerebra. Striimpell’s observation has
been confirmed by Heyne and others. Pronier has recorded a
negative observation, and the case here reported is also negative.

The patient, a girl aged 26, had suffered for twelve years from
attacks in which she stated that she lost all feeling in the limbs
and body as well as taste and smell. She felt, she said, like a
piece of wood in these attacks. Upon examination, there was
found to be some general weakness, although she was able to walk
and run quite well. There was total anaesthesia for touch, pain,
and temperature over the whole body. The muscle sense, sense
of position, sense of movement, and pressure sense were all lost, as
was the perception of electrical currents. Taste and smell were

ABSTRACTS

501

lost. There was full vision in both eyes, although the fields were
somewhat contracted. Hearing was also preserved. The patient
was able to stand and walk quite well when the eyes were closed.
All movements were carried out quite well without a trace of
Ataxia. When the eyes were bandaged and the ears stopped the
patient lay for two hours without manifesting any tendency to
go to sleep. The sleep described by Stnimpell is thus no neces¬
sary accompaniment of total anaesthesia. Stnimpell, who inter¬
preted his experiment with all reserve, admitted later that the
sleep induced iu his patient resembled that of hypnosis. An
attempt to hypnotise Bregman’s patient failed.

Edwin Bramwell.

INTEGRITY OF STEREOGNOSTIO FUNCTION AND ALL FORMS
<436) OF SENSATION IN A CASE WITH A LESION OF THE
LEFT PARIETAL LOBE. A. Gordon (Philadelphia), Med.
Bee., April 18, 1908.

A man of 58 shot himself in the right temple, and the bullet lodged
in the left parietal region; he had no recollection of the shooting
and remembered little for several months afterward. His reflexes,
motor power and sensations were normal and equal on both sides;
he could understand written or spoken words and he could write;
the eye examination was practically negative.

After the location of the bullet by X-ray examination, and both
before and after operation, the author made numerous examinations
for Bensation, and invariably the sense of touch, pain, temperature
and stereognostic sense were found to be normal and equal.

The operation was performed on the left parietal lobe, the
bullet found and removed about one half inch from the cortex.
The patient recovered, and there were no more epileptiform
seizures. C. H. Holmes.

BONE BENSATION. (La sensibility osseuse.) Egoer, Rev. neur.,
<437) April 30, 1908, p. 345.

In this communication Egger restates his views on the sensation
of vibration, and criticises the arguments that have been variously
advanced against his theory. It cannot be said that his criticism
invariably carries conviction. S. A. K. Wilson,

502

ABSTRACTS

STEREOGNOSIS AND SYMBOLY IN THE LOWEE EXTREMITIES.

(438) (La Sensibility styryognostique et la symbolie anx membrea
in/yrieors.) Marb£, Rev. neur., April 30, 1908, p. 351.

It is highly desirable to preface any communication on “ stereo-
gnosis” and “symboly” with a precise definition of these controversial
expressions, as understood by the author. In the present instance
this has not been done; one is accordingly at a loss to know what
he intends by them; the impression conveyed is that they are
either identical or interchangeable, since in one passage the author
says, “ l’astyrdognosie coincide avec l’ataxie,” and immediately
below he repeats, “ cette coexistence de l’asymbolie et de l’ataxie,”
etc. No good purpose can be served by such confusion. All of
the cases examined (the objects were applied to the patients’ feet
and toes) had some or other defect of cutaneous or deep sensation
—rendering the interpretation of the author’s results very"
ambiguous. S. A. K. Wilson.

ON THE MECHANISM OF BABINSKI S SION, OR THE PHENO-

(439) MENON OF THE TOES. (Sur le mychanisme du signe de
Babinski, ou le phynomtoe des orteils.) Noica, Joum. de
Neurol ., March 1908.

The relation of the toe phenomenon to a lesion in the pyramidal
system of fibres has been established, but its precise nature and
mechanism have given rise to considerable discussion. Babinski
regarded it as a transformation of the normal plantar reflex, while
Yan Gehuchten saw in it two distinct phenomena—abolition of
the normal plantar reflex and the production of a new reflex
(extension of great toe).

These views have been disproved, for it is a clinical fact
(Crocq, Marinesco, Noica) that in some spastic paraplegiacs both
reflexes exist: on exciting the external border of the foot,
Babinski’s phenomenon is produced; on exciting the internal
border, the plantar reflex (flexion) results. Marinesco has shown
that if the external and internal borders of the foot are simul¬
taneously excited, it is the flexion-reflex that prevails, or else
there is a sort of hesitating action of the great toe, which takes up
a position midway between flexion and extension. Sometimes it
is the extension-reflex which predominates. Both Crocq and
Marinesco hold that in this case there is a struggle between the
flexor and extensor muscles for the production of the reflex, and
the victory most often falls to the flexors. Even in those cases
where only the extension reflex is obtained, it does not follow

ABSTBACTS

603

that the flexor-reflex is abolished, but simply that the contraction
of the extensors prevails over that of the flexors.

Dr Noica admits the facts, but rejects the explanation above
given. He contends that in spastic conditions the flexor muscles
are the stronger, and if the character of the reflex depended upon
a contest between the two sets of muscles, then the flexion-reflex
should be constant in spasmodic states. He reminds us that a
condition of muscular repose is essential for the production of
a reflex, and argues that in strongly spasmodic states we may fail
to obtain a plantar reflex, not because it is abolished, nor yet
because it is inhibited from manifesting itself owing to the pre¬
sence of Babinski’s reflex, but for the simple reason that the
degree of contracture prevents it showing itself. The less the
contracture, the more likely are we to obtain both reflexes, and
it is in these cases that simultaneous excitation of both borders of
the foot may be followed by a struggle between flexors and ex¬
tensors resulting in a flexor-reflex. If the contracture becomes
still less marked, we may get a well-marked plantar reflex and
only the outline of the Babinski reflex. If the hemiplegia is cured,
the plantar reflex is exaggerated, and excitation of either the in¬
ternal or external borders of the foot will always be followed by
the plantar flexor-reflex.

The toe phenomenon is not, strictly speaking, an abnormal re¬
flex. It is normal in the newly born, and in young infants for a
variable length of time.

The flexor plantar reflex only makes its appearance, says Dr
Noica, with the development of the function of walking, and
thereafter supersedes the extensor reflex, which diminishes and
finally disappears.

In the young infant the flexor muscles of the limb are the
stronger. As a rule, the foot is bent dorsally on the leg, the
leg flexed on the thigh, and the latter on the pelvis. When
walking is required, the extensor muscles of the foot become
more developed, and so the normal man has more power to
lower the point of the foot and to flex the toes downwards than
to bend the foot and toes dorsally on the leg. In the adult, ex¬
citation of the sole of the foot, especially the internal border, is
consequently followed by a downward flexion of the toes (classic
plantar reflex), for the motor centres of the muscles concerned are
now much more active than the centres co-ordinating the opposing
group of muscles (dorsal flexion of toes or extension reflex).

Noica brings forward strong evidence in support of his argu¬
ment, and concludes “that with the development of walking,
which is in direct relation with the development of the pyramidal
tract, the reflex of Babinski disappears or is reduced to a shadow,
and that if the function of the pyramidal tract is interfered with.

504

ABSTRACTS

this reflex re appears, and, further, persists with the character
described by Babinski, so long as the function of the pyramidal
bundle is not re-established.” J. H. MacDonald.

THE SIONIFIOANOE OF THE TENDO AGHILL1S JERK. (Ueber
(440) die Bedeutung des Achillessehnenreflexes .) Conzen, Munch.

Med. JVoch., 1908, No. 19, p. 1014.

Conzen investigated the tendo Achillis jerk in 3290 cases in
F. H. Hoffmann’s clinique at Leipzig. He found that normally it
was always present, and that it was only absent or diminished in
pathological conditions of the nervous or muscular systems.
Babinski’s method of examination was adopted, which consists in
making the patient kneel on a chair with the feet hanging free.
In some cases of varicose veins the ankle jerks were diminished or
absent, an occurrence which Conzen attributes to slowly developing
neuritic changes. In one of two cases of alcoholic neuritis in
which the knee jerks were present, both ankle jerks were com¬
pletely absent, and in the other the right ankle jerk was absent,
while the left was very feeble. In cases of sciatic neuritis diminu¬
tion or abolition was sometimes preceded by a slight exaggeration
of the knee jerk. (A similar observation was made by the abstrac¬
tor in examination of the tendo Achillis jerk in diphtheria.
V. Brain, 1905, p. 71.) In a case of progressive muscular atrophy
both ankle jerks were absent, while the knee jerk was present on
the left. In tabes Conzen found that the ankle jerk was lost much
earlier than the knee jerk.

These observations show that examination of the tendo
Achillis jerk should never be neglected, since it is as constant in
health and as liable to be affected in nervous disease as the knee
jerk, while even unilateral abolition is pathological.

J. D. Rolleston.

HYSTERICAL MUTISM. (Ein Beitrag zur Geschichte des hyster-
(441) ischen Mutism.) Franz Jahnel, Neurol. Centralbl., Juni 1,
1908, p. 512.

In an old book entitled “ Magazin des Ausserordentlichen in der
Natur, der Kunst und im Menschenleben,” published in 1815, the
author has met with an account of an interesting case of hysterical
mutism occurring in a man who lived so long ago as 1653. The
patient when ten years of age was nearly drowned, and soon after
lost his speech for gradually increasing periods each day. Until
his death nearly fifty years later he only spoke between the hours

ABSTRACTS

605

of twelve and one each day. Even when no clock was near he
knew to a minute the hours of twelve and one. Only on two
occasions did he break this rule during his life, and on each of
these occasions he was suffering from fever. For two or three
days before his death, however, he was able to speak quite well.
Mendel has recorded a case in which the patient for a year was
only able to speak between the hours of six and nine.

Edwin Bramwell.

ON ALLEGED WORD-DEAFNESS IN MOTOR APHASIA (Uber
(442) die angebliche Worttaubheit der Motorisch-Aphasischen.)

Liepmann, Neurol. Centralbl., April 1, 1908, p. 290.

Pierre Marie has maintained that all cases of Broca’s aphasia
exhibit a greater or less degree of imperfection in understanding
speech. A motor aphasic is thus a sensory aphasic with anar-
thria. The fact that a motor aphasic is frequently unable to per¬
form the somewhat complicated tests which that author employs
is far from convincing, however, inasmuch as they do not really
test his ability to understand written or spoken language, but
rather his capacity for retaining recent impressions.

Apart from this, it is undoubtedly the case that with motor
aphasia a degree of word-deafness may occur; but the conclusion
that this word-deafness is part of the clinical picture of motor
aphasia is unwarrantable, for the following reasons :—

1. Many patients who have been diagnosed intra vitam as cases
of motor aphasia are found subsequently to have had lesions which
are far from being limited to Broca’s area (understanding by that
term the posterior end of the third left frontal convolution, the
operculum, and the anterior part of the insula). That such cases
are called motor aphasics is due to the frequently overlooked fact
that their word-deafness is so often transitory. As long ago as
1874 Wernicke emphasised the transitory nature of word-deafness
in many left hemisphere lesions. Either the right temporal lobe,
or the rest of the left temporal lobe, assumes the function that has
been for a time lost. It is a common experience in cases of sen¬
sory aphasia to find the word-deafness diminishing, while the
paraphasia and reading and writing defects remain. In discussing
the question of motor aphasia those cases only must be considered
where the lesion is strictly limited to Broca’s area.

2. A diagnosis of motor aphasia is frequently made erroneously:
as when a patient understands fairly well, but is of very limited
speech because of paraphasia. When a lesion in the temporal
lobe is subsequently discovered, the physician is astonished at the
insufficiency of the classical theory instead of at his own ignorance.

506

ABSTRACTS

Sensory aphasia and complete word-deafness are not identical, nor
are motor aphasia and difficulty in the expression of speech. The
motor aphasic is entirely, or almost entirely, word-dumb. The
difference between the motor and the sensory aphasic is not
that the former cannot speak properly, while the latter cannot
understand properly. The usual lesion in a case of imperfect
(however slight the imperfection) comprehension with consider¬
able defect of expression is in the temporo-sphenoidal lobe.

3. Not all word-dumb patients are cases of motor aphasia, pace
Pierre Marie. It is years since the question was first discussed
whether patients with complete sensory aphasia may not therefore
be speechless. Bastian and others have laboured to make it clear
that in the majority of mankind speech depends on the revival of
the sounds of words, and that the functional activity of Broca’s
centre depends on the functional integrity of Wernicke’s. Com¬
plete speechlessness is one of the elements of sensory aphasia. It
is true that this loss of speech is rarely if ever found in unilateral
(left-sided) lesions of the temporal lobe. In bilateral lesions, how¬
ever, the patient becomes absolutely word-dumb (Mott, Liepmann,
etc.), although he is not suffering from Broca’s aphasia. Trans¬
cortical motor aphasia of this kind is as different from Broca’s
aphasia as is hysterical mutism or bulbar anarthria. In motor
aphasia of frontal origin there is never word-deafness. A case of
word-deafness and word-dumbness of bilateral temporal origin
can be distinguished from a case of Wernicke’s plus Broca’s
aphasia by the circumstance that in the latter the power of
understanding speech may return to some extent, as well as often
by the clinical history of the case.

4. Many motor aphasics are dyspraxic, and thus are not un¬
commonly supposed to be suffering from word-deafness.

While it may be admitted that some cases of motor aphasia
reveal a “ defect of intelligence,” this defect is always of the nature
of a failure to understand the meaning of words, whereas the
typical cortical sensory aphasic’s failure is in understanding the
sound of words. In the motor aphasic’s case this “defect of
intelligence,” if present, indicates that he cannot associate quickly
enough the words of a sentence with their corresponding inner
meaning. If the two are not associated at once, the patient may
appear not to understand. Such a condition may readily arise in
any normal individual, without his ever being considered word-
deaf. It may very well be that such impairment is the result of
a general cerebral change (of an arterio-sclerotic, atrophic, or
chemical kind) apart from the actual local lesion.

S. A. K. Wilson.

ABSTRACTS

507

THE CONDUCTION APHASIAS. Mingazzini, L’Endphale, Jan.
(443) 1908, p. 1.

According to Wernicke and Lichtheim, a lesion situated so as to
interrupt the fibres which pass from the auditory speech (word)
centre to Broca’s area, via the insula, will produce an aphasia of
conduction, and this conduction aphasia is characterised by one
special symptom, viz., paraphasia. This paraphasia must not be
confused with that which accompanies word-deafness or word-
blindness, still less with that which accompanies motor aphasia.
In conduction aphasia the auditory word-image, as a result of the
interruption of the conduction path, cannot exercise its influence
on the choice of motor word-images. The patient thus afflicted
understands his paraphasias and seeks in vain to remedy them. In
addition, he always reveals some defect both in reading and in
writing.

Proof of this theory, however, is still to seek. Various para-
phasic cases have been found, it is true, to present a lesion of the
insula, but there has always been an additional involvement of
regions outside the insula itself. If the posterior part of the
insula be destroyed, one finds clinically an incomplete auditory
aphasia, as well as paraphasia. If the anterior portion of the
insula be destroyed, we have a motor aphasia (Bastian, D&j&ine)
identical with what is known as Broca’s aphasia. Yet this state¬
ment, too, requires reconsideration. The author adduces patho¬
logical evidence to show that the auditory and motor word-centres
have a wider extent than is usually supposed, and that it may be
impossible to define their limits precisely. He gives the details of
a case of partial lesion of Broca’s convolution on both sides, when
the patient was unable to put in order the syllables forming the
words which he wished to pronounce, the result being a paraphasia
strictly comparable to what is found with a lesion of Wernicke’s
area. Broca’s lobule registers glosso-kinsesthetic memory images
of syllables, not of words, and it arranges them in proper order on
stimuli from the auditory word-centre; thus while clinically a
paraphasia from a Broca lesion and a paraphasia from a Wernicke
lesion are identical, the mechanism of their production is different
in the two cases: in the latter the stimulus is awanting, the glosso-
kinsesthetic images of letters and syllables remaining intact; in
the former the stimulating element is present, but it no longer
finds the motor-images which it should co-ordinate.

There are cases of lesion of Wernicke’s zone and the left
lenticular nucleus in which, in spite of the preservation of the
third left frontal convolution, the patient suffers not merely from
auditory aphasia but also from almost complete motor aphasia.

508

ABSTRACTS

and on these cases Pierre Marie has laid stress in his revision of
the question of aphasia. The explanation is that the fibres which
descend from Broca’s lobule carrying the impulses from that area
pass by the antero-lateral part of the putamen. If the posterior
part of the putamen be injured, dysarthria results, according to
MingazzinL The question of the distinction between dysarthria
or anarthria and aphasia is difficult. The author believes that
lesions of the fibres from Broca’s centre below the level of the
putamen produce dysarthria, above that level aphasia. He sup¬
poses that a new order of fibres convey from the putamen and the
pontine nuclei motor influences corresponding to the word or
syllable images transmitted from Broca’s convolution. This
bundle of fibres is intimately associated with the ordinary cortico-
bulbar path for the innervation of facial and other musculatures
and the pontine nuclei; hence the frequent association of their
paresis with dysarthria. S. A. K. Wilson.

A CONTRIBUTION TO THE STUDY OF APRAXIA. S. A K.

<444) Wilson, Brain, 1908, p. 164.

This paper contains a historical retrospect over the field of
agnosia, asymboly, and apraxia, and in view of the ready con¬
fusion which an inaccurate use of these terms occasions, their
meaning is carefully determined. Due recognition is made of
the contributions of Dr Hughlings Jackson to the subject, now
more than forty years ago, contributions of which all previous
writers on apraxia have apparently been unaware. Numerous
original clinical observations of apraxia are reported. Attention
is drawn to the occurrence of apraxia in chorea.

Apraxia may briefly be defined as “ inability to perform certain
subjectively purposive movements or movement-complexes, with
conservation of motility, of sensation, and of co-ordination.” There
are various kinds of impairment of cerebral function, producing
defect of movement: the position occupied by apraxia may be
thus indicated:—

1. Cortical blindness, caiiical deafness , cortical sensory paralysis:

loss of visual, auditory, and cutaneous ingoing sensory
impressions.

2. Cerebral ataxia: loss of afferent kinaesthetic impressions,

resulting in erroneous estimation of range, power, etc.,
of movement.

3. Mind-palsy (Seelenldhmung): incapacity for movement from

loss of kinaesthetic images and memories for complex
movements.

4. Agnosia, mind blindness, mind deafness, etc.: conservation

ABSTRACTS

509

of sensation, but failure of recognition; loss of sensory
memory pictures.

5. Ideational agnosia: loss of the Bpatial associations and

inter-connections that build up the idea of an object
from its component ideas.

6. Ideational apraxia: defective synthesis of the ideational

components of a movement-complex: defective psychical
“sketch” of movements or acts.

7. Motor apraxia: intactness of the cortico-muscular apparatus,

but inability to translate a normally produced idea of a
movement into the corresponding movement-form.

8. Motor paresis or paralysis.

It is advisable to restrict the term apraxia to motor apraxia.
Sensory apraxia is misleading: the proposal is made to describe
apraxic phenomena due to agnosia as “agnostic apraxia,” or
apraxia secondary to agnosia. That apraxia is often thus deter¬
mined is of course obvious. Various instances are recorded and
analysed. Apraxia may be caused by perseveration. Inattention,
incapacity for retaining recent impressions, and absence of initia¬
tive are also factors in the production of apraxia.

The relation of apraxia to aphasia is alluded to, but it forms
too important a subject to be handled in the limits of one paper.
The pathological anatomy of apraxia is vastly interesting and
instructive. Cases are quoted to show the importance of lesions
of the corpus callosum, of the left frontal lobe, and of the left
Benso-motorium in the determination of apraxia. The article
finishes with a scheme for the examination of apraxic patients.
The subject of the paper does not admit of a satisfactory rdsum^.

Author’s Abstract.

A CASE OF WORD-BLINDNESS WITH AGRAPHIA, IN A LEFT-
(445) HANDED HEMIPLEGIC. (Su d’un caso di cecitk verbale con
agrafe in una mancina ’emiplegica.) G. d’Abundo, Riv. Ital ,
di Neuropat., Psichiat., ed Elettroter., 1908, p. 257.

It has recently been argued that, inasmuch as speech is a purely
human function, nothing is to be learnt about it from experimental
pathology. In view of this argument we shall need to consider
a fresh series of clinical observations. Marie’s revolutionary
views on this subject also necessitate renewed research into the
problem of the localisation of the neuropsychical factors of speech.

The case described is that of a woman, 31 years of age. She
was left-handed as a girl, though she could, if need be, both write
and sew with her right hand. Her school education was very

510

ABSTRACTS

scanty. At the age of 15, two days after receiving a great fright,
she became unconscious, and, on coming to herself, was found to
be completely paralysed on the left side, as well as being word-
blind ; subsequently agraphia also developed.

A year later, having to some extent recovered the use of her
limbs, she was seized, while carrying a heavy weight, with a left¬
sided convulsive attack; from that time onwards any attempt at
voluntary movement of the left arm threw it into a spasmodic
choreiform condition. The alexia and agraphia remained per¬
manent.

On examination, some years later, patient’s general health was
found to be good. Besides the features already described, there
was diminution of tactile sensibility in the limbs of the left side,
and marked left homonymous hemianopsia in both eyes. She was
also frequently the subject of left-sided convulsive seizures, some
of which consisted merely of flashes of light on the hemiopic side,
others involving the left facial nerve, and others being typical
Jacksonian attacks. She was not only unable to read a word, but
could not even recognise the letters of the alphabet. Agraphia
accompanied the word-blindness. Her intelligence and memory
were good.

The leading symptoms of this case—hemiplegia, with hemi-
hypaesthesia, hemiopia, and word-blindness—point to a lesion of
the inferior and ascending parietal convolutions on the right side;
patient being left-handed, the word-blindness would depend on
involvement of the right angular gyrus.

The centre for the memory of movements necessary in writing
would in this case be naturally developed by education in the left
hemisphere. The noteworthy point is that the word-blindness
caused by a lesion of the right parietal cortex had associated with
it agraphia, a disturbance of the left hemisphere; for this there
must be a psychical explanation.

This lesion involving the centre for visual word-memories was
entirely unconnected with any intellectual deficiency ; thus the
case tends to maintain the distinction between mind-blindness
and word-blindness.

Attempts at the re-education of this patient were much impeded
by the hemiopia. Arthur J. Brock.

ON CONGENITAL WORD-BLINDNESS. (Ueber kongenitale
(446) Wortblindheit.) Peters, Muench. Med. Wchnschr., May 26,
1908.

The writer gives a brief r4sum£ of various publications on this
subject since the pioneer observations of Kerr and Morgan in
1896, and states that no thoroughly typical case has yet been

ABSTRACTS

511

recorded in Germany; he then quotes two cases which have come
under his own observation. The first was that of a boy of twelve,
in whom the power of recognising written or printed words was
badly developed, although in other respects he was quite normal.
The second case was also in a boy, in whom, however, mental
deficiency was superadded, the investigation of the case being
thereby much complicated.

It is very noteworthy that almost all cases of congenital word-
blindness have so far been published either by English or by
English-speaking investigators; this is probably because “ the
words of the English language, owing to their peculiar pronuncia¬
tion (eigenartige Aussprache), are more difficult to read than words
from other languages, which can be more easily learnt phoneti¬
cally.” Stephenson reports a case in which Latin words were
read more easily than English.

In London the school medical officers estimate the occurrence
of this disturbance as 1 case in every 2000 school children. The
condition is far more frequent in boys than in girls.

As regards its pathology, the writer agrees with Morgan that
it is due, not to degeneration, but to faulty development—to a
congenital aplasia of the cortex in the region of the angular gyrus.

In regard to treatment, much may be done outside the schools
by systematic training, and the writer considers this a profitable
field for charitably-disposed ladies. Arthur J. Brock.

DYSPRAXIA WITH LEFT-SIDED HEMIPLEGIA (Dyspraxia bei
(447) linksseitiger Hemiplegie.) Hildebrandt, Neur. Centralbl.,
June 16, 1908, p. 576.

This is a record of a case in which there was pronounced hemi¬
plegia of the left side, with decided dyspraxia of the right hand.
When young the patient had been left-handed, but on account of
her being teased by her brother for this she had endeavoured to
get over it and use her right hand. She had largely succeeded in
correcting her early habit, but not entirely. Cases of left-handed
dyspraxia, with right-sided hemiplegia, are not unknown, but so
far as the author has ascertained few of the contrary have been
recorded. Hence his communication of the above case.

Jas. Middlemass.

PSYCHIATRY.

ALCOHOL AS AH ETIOLOGICAL FACTOR IN MENTAL DISEASE.

(448) Henry Cotton, Amer. Journ. Jnsan., April 1908.

That “alcohol accounts for an alarming number of commitments
in the insane hospitals to-day, directly, indirectly, and through

512

ABSTRACTS

inherited influence, and that the percentage is slowly but steadily
increasing,” is the conclusion the author of this paper draws from
a statistical study of the question. An examination of the statistics
of modern mental hospitals easily convinces one that alcohol is the
direct cause of a large percentage of the cases of insanity treated
in them. But that is not all. There are a vast number of habitual
drinkers who, though not legally insane, are a danger to the
community. Various illustrations are given of the evil effects
of alcohol. Kraepelin’s observations are of special interest, and
tend to refute the idea that alcohol (in the form of beer-drinking)
does not affect the German nation.

The indirect results of alcohol are equally important. The
percentage of cases of mental and other nervous diseases in the
production of which alcoholism may be considered as acting as
a contributing cause is remarkable, e.g. in 46'6 per cent, of general
paralytics alcoholic excesses were present Kraepelin believes
that one-third of the cases of general paralysis would be avoided
if syphilitic subjects abstained from alcohol It must further be
borne in mind that three-fourths of the injections of syphilis occur
during intoxication.

As to the inherited effects of alcohol, apart from the vexed
question of the inheritance of acquired characters, there is not a
little to support the view that alcoholism in the parents, especially
at the time of conception, can exert a toxic influence on germ plasm.
The percentage occurrence of miscarriage and abortion is greater
in alcoholic than in non-alcoholic families. The effect of alcoholic
parentage in idiots and epileptics some observers give as high as
85 per cent. A. Hill Buchan.

ON A GLASS OF CHRONIC NON-MORAL ALCOHOLICS. (IFune
(449) classe d’alcooliques chroniques amoraux. Envisages au point
de vue de la responsibility ldgale.) Soutzo fils and P.
Dimitresco, Ann. Mtd.-Psychol., May-June 1908.

In this article the authors deal with a class of chronic alcoholics
whose moral and intellectual faculties have been impaired by their
habits. The symptoms are described and cases given in illustra¬
tion. The relation of such persons to criminal law—whether they
can be considered responsible for their actions or ought rather to
be regarded as subjects of a special mental disease req uiring other
than ordinary prison treatment—is discussed.

A. Hill Buchan.

ABSTRACTS

513

EPILEPSY AND OHBONIO DELUSIONAL INSANITY—OONTRI-
(450) BUTTON TO THE STUDY OF COMBINED PSYCHOSES.
(Epilepsie et D41ire Ohronique—Contribution k l’Etude des
Psychoses Combines.) Fr. Meens, Ann. Mid. Psych., May-
June 1908, p. 353.

This paper is concerned with the possibility of the co-existence
in the same individual of two distinct psychoses, a question already
discussed by many eminent alienists, but about which unanimity
of opinion does not yet prevail. Dr Meens records two cases
which, in his view, conclusively prove that such a co-existence is
possible. Theoretically speaking there appears to be no insuper¬
able argument against its occurrence. In the case of most other
organs it is quite well recognised that two quite different diseases
may co-exist, each showing the main features which distinguish it
when existing alone. There is, therefore, no a priori reason why
the same condition may not be exhibited in the diseases of the
brain which give rise to psychoses.

The first of the two cases recorded is that of a woman, who, at
the age of eight, developed epilepsy, at the age of forty-one began
to show symptoms of paranoia, and at the time of writing was
aged sixty-six. For twenty-five years the two conditions co¬
existed, developing each along the lines usually followed by it,
and not apparently influencing each other’s progress to any
marked degree.

The second case is that of a man aged fifty-six, who, since he
was thirty-five, has manifested the symptoms of both epilepsy and
chronic delusional insanity. It could not be ascertained whether
the epilepsy was the first to make its appearance or not, and, if so,
how long before. In his case also the two diseases have run their
course side by side.

In discussing the question of combined psychoses the author
rightly insists that care must be taken not to confound a distinct
psychosis with accidental and frequently transient symptoms,
such as depression, elevation, or confusion. These are symptoms
common to many psychoses, and do not therefore by themselves
indicate the existence of a second disease. By those who uphold
the existence of combined psychoses various explanations of their
contention are given. It is supposed that one is transmitted from
the father, the other from the mother (Magnan). In the first case
described by Dr Meens this was certainly not so. In the other
the history was defective. By some it is suggested that the
paranoiac delusions are the outcome of incorrect deductions made
during the confusional state associated with the epileptic fit
(Ziehen). But here again the author’s observation is against this
suggestion. Others, again, hold the view that epilepsy, by weaken-
2 o

514

ABSTRACTS

ing the mental faculties, lays the affected individual open to
attack by delusional ideas, which in a healthy mind would be
resisted (Buchholz). This view is also set aside by the author
as not warranted by the facts of his cases, as well as on other
grounds. He considers the co-existence of two psychoses in one
individual to be only an accidental coincidence which, in the
absence of definite pathological knowledge, cannot yet be satis¬
factorily explained. Jas. Middlemass.

THE DEVELOPMENT OF THE MODEEN OAKE AND TEEAT-
(451) MENT OF THE INSANE, AS ILLUSTRATED BT THE
STATE HOSPITAL SYSTEM OF NEW YOEK. Carlos F.
Macdonald, Amer. Joum. Intan., Vol. lxiv., No. 4, p. 647.

The author records what has been done in recent years to improve
the unhappy lot of the insane in the State of New York.

As a result of a reform agitation by some philanthropic people,
there was appointed in 1889 a State Commission in Lunacy, in
which was vested plenary power in respect to the insane and the
management of institutions for the insane, both public and private.

As an outcome of the investigations and recommendations of
the Commission, the State Care Act was passed in 1890. By this
means the dependent insane were looked after as wards of the
State, and were treated and cared for in a humane way. Asylums,
or State Hospitals as they are called, were built. Old institutions
were put into a thoroughly sanitary condition, and overcrowding
of patients was abolished. It was made compulsory for all im¬
provements and reconstructions of a hospital and for all expendi¬
ture to be approved by the Commission. At the same time there
was established a Pathological Institute, which was to be main¬
tained for the benefit of all hospitals, and where scientific research
would be carried out in the endeavour to elucidate the etiology
and pathology of mental diseases.

Prior to the passing of the Act it was customary to transfer
unrecovered patients, often at the end of a year, from asylums to
poorhouses, where existed a deplorable state of affairs as regards
management and treatment. This is now illegal.

The author points out many other important improvements
which have accrued to the institutions for the insane, and some of
the benefits derived by the patients as a result of this legislation.

The interests of the patients are safeguarded in a manner very
similar to that in this country, and proper medical treatment is
now administered.

Certification of an insane person, in order to commit him to a
hospital, can be done only by a qualified examiner, whose qualifi¬
cations must be certified to by a Judge of a Court of Record, and

ABSTRACTS

515

the certificate must be filed in the office of the Lunacy Com¬
mission. Resident officers in State Hospitals are required to pass
a competitive civil service examination.

A most praiseworthy step has been taken in the formation of
the State Charities’ Aid Association, the object of which is to
render temporary assistance and friendly aid and counsel to needy
persons after their discharge from the hospital. It was believed
that timely help and encouragement to such persons would serve to
prevent relapse in many cases, and the results thus far reported
justify the opinion that the belief was well founded.

While the mentally afflicted have benefited in every way under
the ‘‘Insanity Law,” a great saving in the maintenance of the
hospitals has been effected. R. Dods Brown.

TREATMENT.

THE USE OF SILK LIGAMENTS IN THE TREATMENT OF
(452) INFANTILE PARALYSIS. Robert Soutter, Boston Med.
and Surg. Joum ., June 4, 1908.

Dr Soutter here contributes an interesting article on the above
method, first suggested by Lange of Munich. Short notes of a
number of cases successfully operated on by the author are also
given. As recommended by Robert Jones, Soutter strongly insists
on no operation being undertaken until massage, electricity, and
careful muscle training have been carried out for several years, in
order to give the apparently paralysed muscles a chance of
recovering their function. The use of silk ligaments is indicated
in a number of different cases. Thus it may be done (1) in
addition to transplantation of non-paralysed tendons when the
deformity is great or where the transplanted muscle cannot
reasonably be expected to correct the deformity, although it may
take up the new motion; (2) in cases where transplantation cannot
be done owing to the distribution of the paralysis. Here the
unparalysed muscles are thrown out of commission; by the use of
silk ligaments the distortion is corrected, and in this way from half
to all of the function of the unparalysed muscles may be utilised j
(3) in a few cases of total paralysis; most of such cases, however,
are best treated by arthrodesis; (4) the method may also be tried
before proceeding to tendon transplantation in order to give the
apparently paralysed muscles a further chance of recovery.

The silk causes the formation of tough fibrous tissue around it
which not only reinforces the silk, but is eventually strong enough
to take its place. Such ligaments stiffen the joint (ankle)
sufficiently to prevent lateral motion, but allow dorsal flexion, which

516

REVIEWS

is so necessary in walking. Soutter uses No. 14,16, or 20 silk for
the ankle. Above, the silk ligament is attached to the periosteum
of the tibia, below to the particular tarsal bone indicated—cuboid,
scaphoid, etc. To do this, the periosteum of the tibia is split
vertically, the edges everted, and the silk introduced by a needle,
in and out, on either side. In this way a firm hold above is
obtained by the loop of the strand of silk. Below a hole is drilled
in the tarsal bone, one of the free ends of the loop passed through
it, and then knitted with the other free end. The superficial wound
having been closed, the foot is put up in plaster for eight or ten
weeks. After this a brace is worn during the day for four months
to limit extremes of motion. This is succeeded by a light brace
inside the shoe (for long walks only).

A A. Scot-Skikving.

■Reviews

VORLE8UNGEN UEBER DEN BAU DEB NERVOSBN ZENTRAL
O&OANE DES MENSOHEN UND DEB TIEBE. Professor
L. Edinger. Zweiter Band, Siebente Auflage, 1908, S. 334, mit
283 Abbildungen. Price M. 15.

Professor Edinger’s well-known text-book on the anatomy of the
central nervous system ran through six editions in its original one-
volume form, but during the first nineteen years of its existence
the subject to which it is devoted had grown so much that when
the time came to prepare the seventh edition the author was forced
to extend his text to so many pages that two volumes became
necessary. The first of these, which appeared four years ago, dealt
only with the anatomy of the nervous system of the mammalia;
the second volume, which is at present under review, is devoted to
the comparative anatomy of the nervous system of the lower
vertebrates.

Much that is contained in this volume is entirely new, but
knowledge from all available sources has been carefully sorted and
incorporated. It is scarcely possible to praise this volume suffi¬
ciently or to over-estimate its value, as in it we now possess for the
first time a complete account of structure and phylogenesis of the
vertebrate nervous system.

The subject is so immense that the author, despite his excep¬
tional experience, found it advisable to avail himself of the aid of
authorities on special subjects. Thus the first three chapters,
which are devoted to the structure, development, and functions of
the peripheral nerves, were entrusted to Professor Froriep; and

REVIEWS

517

Wallenberg is largely responsible for those on the spinal cord and
medulla oblongata. Nothing could be more admirable than the
manner in which Edinger has fused these pages into his own so as
to present to his readers a harmonious whole.

The book is written in the form of lectures; this form allows
the author more freedom in expression and description. Its first
three chapters deal with the development, classification and con¬
nections of the spinal and cranial nerves, and the following two
with the spinal cord ; the next five are devoted to the anatomy of
the medulla oblongata in the aquatic and air-breathing verte¬
brates ; the description of the cerebellum and mid-brain occupies
three lectures, the thalamencephalon two, and the last three chap¬
ters are devoted entirely to the forebrain.

It is scarcely possible to single out any of the matter of the
volume for detailed reference in a short review, but the importance
of comparative anatomy in indicating or at least suggesting the
nature or function of special parts is well represented by the
manner in which the nerves of taste are dealt with. Taste-buds,
which in air-breathing vertebrates exist only in the mucous mem¬
brane of the mouth and pharynx, extend to the surface of the head
and even to the trunk in fishes. In this class these organs, or at
least structures with a chemo-receptive function, are supplied by
a special group of viscero-sensory fibres which owing to their
relatively large bulk can be easily traced; they run in the sensory
facial and in the glossopharyngeal and vagus nerves, and are con¬
nected with the Kiemenspaltenorgane (Froriep), and terminate in
a specialised centre of the medulla, the lobus visceralis. In the
amniota the ganglion geniculatum, the ganglion petrosum, and
ganglion nodosum are the only remnants of the Kiemenspalten-
OTgane, and it is consequently in the nerves connected with them
that the path of taste should be sought. The primary taste centre,
on the same line of argument, probably lies in or near the fasci¬
culus solitarius, which is the homologue of the lobus visceralis.

The eighty pages devoted to the structure and evolution of the
forebrain will be of general interest; the lucid description and the
numerous illustrations, many of them diagrammatic, combined with
the author’s unique authority, should make this section extremely
welcome to all who are interested in the origin and the mode of
evolution of “ the organ of intellectual life.”

The majority of the illustrations are new and original; the
greater number of them are reproduced from drawings or recon¬
structed models, but there are many diagrams.

The volume concludes with a bibliography which includes
Almost all the important contributions to the development and the
comparative anatomy of the nervous system.

Gordon Holmes.

518

REVIEWS

THE ANATOMY OF THE BRAIN AND SPINAL OORD, WITH

SPECIAL REFERENCE TO MECHANISM AND FUNCTION.

Harris E. Santee. Fourth edition, revised and enlarged.

Pp. 453, with 128 illustrations. London: Appleton, 1908.

The aims of this volume may be expressed in a paragraph from
the author’s preface: “ The special objects held in view throughout
the book are the location of functional centres and the tracing of
their afferent, associative, and efferent connections. Particular
emphasis is laid upon the origin, course, termination, and functiou
of conduction paths. . . . Function is everywhere correlated with
structure; and so far as present knowledge permits, the function
of each group of neurones is given in connection with its ana¬
tomical description.” The author adheres to this programme
throughout the greater part of his volume.

Nothing would be more welcome than an anatomical text-book
constructed on these lines, in which a sufficiently full and accurate
account of the structure of the nervous system would be combined
with an intelligent appreciation of the functions of the different
parts described; such a book would be an invaluable basis for
clinical study.

But anatomy as a science must deal with concrete facts alone,
and when such an attempt is made special care must be taken to
avoid the danger of constructing anatomical diagrams to explain
the mechanism of functions. Into this error, it appears to us, the
author has here and there fallen. It is, for instance, repeatedly
stated that the trunks of the facial nerves receive fibres from the
oculomotor nuclei for the supply of the upper facial muscles, and
others from the hypoglossal nuclei for the orbicularis oris. This hypo¬
thesis, it is true, was at one time put forward to explain certain clini¬
cal observations; but what anatomical evidence lias ever been pro¬
duced of such connections ? And what evidence, either clinical or
experimental, is there that “a destructive lesion in the nucleus of the
seventh nerve causes inferior paralysis of the face, the frontalis, cor-
rugator, orbicularis oculi, and orbicularis oris not being affected ” ?

The attempt to correlate structure with function has not pro¬
duced a happy result in the sections that deal with the “ sensory
or afferent paths.” In addition to a direct route—the median
fillet and the spino-thalamic tracts—there is also, according to
Santee, an indirect route for sensation, formed by the spino¬
cerebellar tracts and the external arcuate fibres from the dorsal
column nuclei to the corpora restiformia, through which sensory
impulses run to the cerebellar cortex ; thence they are transmitted
through the superior cerebellar peduncle to the red nuclei and
optic thalami, from which they are conducted by the cortical fillet
to the cortex. This view is put forward regardless of the fact that
all recent experimental and clinical observations on the function*

REVIEWS

519

of the cerebellum emphatically negative the theory that this organ
is in any way concerned with conscious sensation. The author
does not adduce any evidence that the spino-cerebellar tracts
convey impulses of any form of sensation, though he attributes to
the dorsal the conduction of the “muscular and tactile senses,
chiefly from the viscera,” and regards the ventral as a “ path con¬
veying pain, temperature, and tactile impressions.” It is regrettable
that there is no discussion on such controversial points, and that
the facts or the authority on which such important statements and
conclusions are based are not quoted.

Despite these and other points against which adverse criticism
might be directed, the author may be congratulated on the volume
he has produced; it is eminently practical, and should prove of
considerable service to the student of clinical neurology. It con¬
tains 128 illustrations, many of which are printed in colours; the
majority have been judiciously selected from other text-books;
but unhappily the author cannot be congratulated on the success
of his artist in the execution of many of the original figures from
microscopical sections. Gordon Holmes.

MODERN CLINICAL MEDICINE—DISEASES OF THE NERVOUS
SYSTEM Sidney Appleton, London, 1908. Price 28s.

This work is an authorised translation of the articles on nervous
diseases which have appeared at various times since the opening
of the century in Die Deutsche Klinik. The names of the original
contributors are sufficient guarantee of the quality of the work,
although in a few instances some of the very latest views may not
be referred to. The actual translator’s names are not given; we
need only say that the translation appears to be well done. One
word of warning, however, must be given to those who might seek
this volume as a reference text-book for nervous diseases. It can
scarcely claim to be a complete text-book of nervous diseases, for,
to mention only some of the more outstanding, we find no special
consideration of such conditions as meningitis, poliomyelitis, brain
tumours, chorea, paralysis of III., IV., and VI. nervea They may
be referred to, incidentally, it iB true, under such headings as
pathological histology and general diagnosis, but in a general text¬
book more than that is expected. J. H. Harvey Pirie.

VEREDnOUNO FUR GERIOHTLIOHE PSYOHOLOOIE UND
PSYCHIATRIC IN GROSSHERZOGTUM HESSEN.
Viertes Heft. (Der Alcoholismus. Seine strafrechtlichen
and sozialen Bestohungen. Seine Bek&mpfong.) Balser,
Aull, and Waldschmidt. Halle: Marhold, 1908. M. 2.

This work consists of three parts. The first, by Medizinalrat
Kreisarzt Dr Balser of Mainz, is entitled Zur forensischen Bedeut -

520

KEVIEWS

ung des Alkololismus, and deals with those forms of alcoholic
poisoning most frequently met with in medical jurisprudence.
Among the subjects treated (with illustrative examples) are
atypical forms of alcoholism, dipsomania, epileptic conditions and
their relation to alcoholism, delirium tremens, acute alcoholic
hallucinatory insanity, the bearing of alcoholism on divorce, and
certain statutes in the law of Germany.

The second article, entitled Alcohol und Verhrechen, by Assessor
Aull, Offenbach a Main, discusses the direct and indirect bearings
of alcoholism on crime. Numerous interesting tables are given,
showing comparative statistics of the consumption of alcohol in
Germany for different years, with the number of criminal convic¬
tions for corresponding periods. Days of the week, months of the
year, and various districts in the German Empire are treated in
the same manner, and a striking correspondence is brought out
between increase in drinking habits, special facilities of drinking,
etc., and the amount of crime. The effects of alcoholism on
heredity and family life are emphasised.

Die Behandlung der Alcoholisten, by Dr med. Waldschmidt,
Charlottenburg, forms the third and last paper. Many aspects of
the question of treatment are discussed. The complete withdrawal
of alcohol—while it is a sine qua non of treatment—is not alone
sufficient. There is a deceptive stage of apparent recovery, and
the patient must be carried beyond this before he can be con¬
sidered cured. The risk is that the patient leaves the institution
where he is being treated too soon. A long period of treatment is
essential. Voluntary entrance into a Home should be encouraged.

A. Hell Buchan.

BOOKS AND PAMPHLETS RECEIVED.

Spitzka. “ A Study of the Brains of Six Eminent Scientists and Scholars
belonging to the American Anthropometric Society, together with a Descrip¬
tion of the Skull of Professor E. D. Cope.” Amer. Philos. Soc., Philadelphia,

1907.

Bresler. “ Die Willensfreiheit in moderner theologischer, peychiatrischer,
und juristischer Beleuchtung.” Marhold, Halle, 1908, M. —-80.

Liepmann. “Drei Aufsatze aus dem Apraxiegebiet.” Karger, Berlin,

1908, M. 1.50.

Kurt Mendel. “ Der Unfall in der Atiologie der Nerv enkrnnkhgiten n
Karger, Berlin, 1908, M. 5.

Anton. “Vier Vortrage iiber Entwicklungsstorungen beim Kinde.”
Karger, Berlin, 1908, M. 1.80.

Ludwig Bach. “ Pupillenlehre. Anatomie, Physiologie, und Pathologie,
Methodik der Untersuchung.” Karger, Berlin, 1908, M. 12.

■Review

IReui'ologi? anb flb8£cbiatn>

©dglnal articles

OASES ILLUSTRATING THE COURSE AND PROGRESS
IN DISSEMINATE SCLEROSIS.

By W. B. WARRINGTON, M.D., F.R.C.P. Lond.,

Physician to the Northern Hospital and Eye and Ear Infirmary, Liverpool;
Lecturer in Clinical Medicine and Neuropathology in the University.

Op the four cases I here record, the first three will, I think, be
admitted to be ordinary disseminate sclerosis. May W., as far
as could be ascertained, had previously shown no signs of the
disease until the rapid development of extensive palsy occurred.
The presence of old optic atrophy in Mrs X. brings her case into
line with those recently described by Dr Williamson (1). Her
illness commenced with a very rapid onset of palsy of consider¬
able extent, followed by an apparent complete recovery.

Such cases are no doubt not very common, but are well
recognised, though hardly perhaps yet sufficiently appreciated in
general by the profession.

The history of the third patient, D. R, is instructive as
showing at how late a period of the disease marked though tem¬
porary recovery may yet occur.

They certainly indicate how cautious one should be in giving
too unfavourable a prognosis when the diagnosis has been made.
Some time ago I saw, with Dr M'Cann of this city, a lady aged
about 45, who gave a history of recurrent attacks of paralysis
since she was 24 years of age ; they had all been followed by a
R. OF N. & P. VOL. VI. NO. 9—2 P

522

W. B. WARRINGTON

practically complete recovery, and had been considered to be
functional in nature. Such an extended duration afforded strong
presumptive evidence against there being any gross organic
disease, yet on each of the several occasions of my visits there
was a distinct bilateral extensor toe response with absence of
the abdominal and epigastric reflexes, and, moreover, this attack
evidently was of greater severity than its predecessors, and many
months elapsed before the lady was able to walk without some
support.

The last case, that of Mr Z., raises the question of diagnosis.
The course of the disease, the paralysis of the thoracic muscles,
the wasting of the muscles of one arm, and the disorder of
stereognostic sense are not features ordinarily seen in true dis¬
seminate sclerosis, yet in the interesting case recently recorded
by Karl Wegelin (2), where the profound disturbance of sensa¬
tion and atrophy of muscles might have led to the diagnosis of a
“ myelitis,” the post-mortem disclosed what Wegelin considers to
be patches of sclerosis which differed in no single respect from
the classical description of the patches in disseminate sclerosis.

Professor J. Hoffmann (3), in an address delivered in 1901,
gives a formidable list of twenty-four morbid conditions from
which a differential diagnosis is to be made, and amongst these
he places multiple myeloencephalitis acuta et subacuta, between
which and disseminate, he says, “ sind die Grenzen fliissig."

Oppenheim (4), in his valuable article on “ Encephalitis ” in
Nothnagel’s System, mentions disseminate sclerosis as one of
the events in which myeloencephalitis may terminate, and
Edward Mtiller considers that the anatomical feature of dis¬
seminate sclerosis may be the final stage of quite different
processes.

Pathological studies can alone decide these questions.
Clinically, however, cases resembling that of Mr Z. differ en¬
tirely from acute haemorrhagic disseminate myelitis, nor do they
much resemble those illnesses which follow fairly definitely the
infective diseases, and which were the subject of Sir Thomas
Barlow’s (5) Presidential Address to the Neurological Society.

The essential clinical point of distinction seems to be the
variability of the symptoms. The disease may begin in an acute
manner and its course be characterised by acute exacerbations.
In the myelitic and encephalitic processes the history rather is

CASES ILLUSTRATING DISSEMINATE SCLEROSIS 523

that of a steady process either to recovery or death, or to a per¬
manent and fixed residual defect.

Short Summary of Cases.

1. May W., set. 18.—Rapid development of paralysis within
three weeks, with nystagmus and diplopia and great mental dis¬
turbance. Gradual recovery in six weeks. Now can walk a
fair distance.

2. Mrs X., aet. 40.—Optic atrophy known to exist for two
years without other symptoms. Attack of sudden giddiness
followed by marked paralysis, obtaining a maximum in about
fourteen days. Apparent complete recovery. Can walk four
miles.

3. D. R., girl set. 22.—Total duration of illness known to
be about eight years, culminating towards the end of the seventh
year in spastic ataxic paralysis, with inability to stand. Marked
recovery for nearly a year, then rapid onset of bulbar symptoms,
ending in death within a week from their onset.

4. Mr Z., set. 25.—Appears to have had deficient vision
and attacks of giddiness two years before onset of present illness,
twelve months ago, and three months after an acute illness loss
of power rapidly developed in left-sided limbs. Nystagmus,
pallor of right disc. Intention tremor right arm; increase in
the palsy of all the limbs, paralysis of intercostal and abdominal
muscles, and loss of the knee jerks. Some disorder of sensation
later, improvement in the upper limbs, marked spastic paralysis
of lower limbs remains, yet able to stand. Duration of acute
symptoms threatening life about three weeks.

May W., set. 18, under the care of Dr Sclater of Liscard,
was first seen by me on August 30, 1907, a young lady who
until her present illness had been a thoroughly healthy girl

About three weeks previously she had noticed a numb
feeling in both hands, and occasionally her grasp became weak,
so that she dropped objects. The menses were due about this
time, and with their occurrence the patient felt unusually ill,
and in a few days had to go to bed feeling “ feverish ” and out
of sorts. She remained in bed a few days, and on getting up felt
weak in her lower limbs.

Ten days before my visit the legs suddenly “ gave way,” and

524

W. B. WARRINGTON

she had to be carried to bed. She then complained of double
vision, the memory became very impaired, so that she could not
recall events which had happened a few hours before.

Loss of power in the right upper limb now set in.

When seen by me, the general nutrition and appearance was
that of a healthy young woman, but the childish, excitable
manner Of speaking, and the marked deficiency in memory
arrested attention. The right upper limb was markedly
paralysed, lying ilaccidly by the side, slight flexion of the fingers
and some little movements of the shoulder girdle alone being
possible.

There was also slight deficiency to light touch over most of
the limb.

The left upper limb was also weak, and though it could be
moved, the patient was unable to feed herself, and distinct
tremor was present in attempting to touch any object. The
triceps, radial and ulnar jerks were equal and brisk.

Both lower limbs were markedly paretic; the heels could
just be raised off the bed; no loss of sensation was discernible.
Both knee jerks were brisk, the R > L. The ankle jerks
present, but no clonus. The right plantar reflex was distinctly of
the extensor type ; the left sometimes flexor, sometimes extensor.

The abdominal and epigastric reflexes were absent

There was no affection of bladder or rectum.

Distinct lateral nystagmus was present, but though the patient
complained of double vision there was no obvious impairment of
movement of the eyeballs. The optic discs were rather diffused ;
vision seemed good, and equal in both eyes.

I then lost sight of the patient, but am told that the mental
symptoms increased, she could not remember the doctor’s visit
for more than a few minutes, often there was marked depression
and emotional disturbance. She spoke of throwing herself
downstairs, or of killing herself with a knife, etc.

These marked symptoms and the paresis gradually cleared
away, so that in six weeks’ time she was able to get out of bed
and move about with help.

Diplopia, choking sensations, and apparent difficulty in
swallowing were troublesome symptoms.

The lady was last seeu by me on July 22nd of this year.
Judging from the private account of her previous state, I judged

CASES ILLUSTRATING DISSEMINATE SCLEROSIS 525

that a marked alteration had taken place in her disposition and
mental capacity. She behaved in a childish, frivolous manner,
making silly jokes, and had largely lost power of attention and
concentration. The depression had, however, vanished, and the
memory was considerably better.

She was able to walk about without help, though in a jerky
manner, advancing the legs in an abrupt ataxic manner. The
power was fairly good, and her parents told me she could walk
a mile or more without a rest. The upper limbs were fairly
strong, though slight “ intention tremor ” was present in both.

There was no loss of sensation. Ankle clonus and bilateral
extensor toe reflex were present. The abdominal and epigastric
reflexes remained absent.

Nystagmus was marked. The optic discs were normal, and
vision = f with both eyes. A hesitancy and difficulty in passing
water was not infrequent, once there had been retention for
thirty-six hours. Occasionally, when in bed, the urine had been
voided involuntarily.

Mrs X., aged 40, was first seen by me on June 1st, 1907.
The lady was the mother of several healthy children and had
enjoyed excellent general health. Two years before she had
suddenly lost sight in one eye, and had consulted an eminent
ophthalmic surgeon, who stated there was optic atrophy. Nothing
else was noticed, however; the vision was said to have improved,
and all went well until three weeks before I saw her, when on
getting out of a tramcar she experienced an acute giddiness and
staggering; she went home at once and these symptoms passed
away. About a fortnight later, difficulty in standing or walking
became apparent, and a numbness over both left limbs was com¬
plained of.

On examination I found the patient compelled to lie in bed
on account of weakness in the limbs. There was distinct flaccid
paresis of both lower limbs, more so in the left than the right, and
also of the left arm, and on movement slight but distinct inten¬
tion tremor. The plantar reflex was of the extensor type on
both sides. The eyes showed distinct though slight lateral and
vertical nystagmus. The left disc was markedly atrophied.

On June 14 the tremor had nearly disappeared, and power
had returned to a considerable extent in both left-sided limbs,
but the paresis of the right lower limb had increased and pain

526

W. B. WARRINGTON

about it had become a somewhat obtrusive fact, but these symp¬
toms gradually disappeared, and a month later she could walk
about with support, though diplopia waB present. I did not see
my patient again till January of this year, when I accidentally
met her in a public reception of medical men ; she appeared quite
well, and I venture to think that had I told many of my profes¬
sional colleagues that the lady suffered from disseminate sclerosis,
my diagnosis would have been received with some incredulity.
She told me she could walk four miles and over without trouble,
and 1 am glad to learn that this state of affairs still continues.

Miss D. R, set. 22, under the care of Dr Medwyn Hughes of
Ruthin, was first seen by me on 9th February 1904 on account
of difficulty in walking of five years’ duration. The gait was
peculiar, the limbs being advanced in an abrupt, uncertain and
somewhat ataxic manner. The patient was able to walk a fair
distance, and the power of the various groups of muscles was good.
Both knee jerks were brisk, ankle clonus on the right side, not
on the left. There was slight impairment of sensation in the
lower limbs extending upwards as far as the lowest dorsal zone.

She also complained of a numbness in the hands, and men¬
tioned that sometimes during the last four years there had been
a hesitancy and difficulty in passing urine.

The optic discs were normal, and vision good, there was no
nystagmus or diplopia and no tremors were present. The general
nutrition was good, but a distinctly enlarged thyroid gland was
found and there was some exophthalmos, but no other eye signs of
Graves’ disease. The pulse, however, was 100, and Dr Hughes
told me it was usually too fast.

Miss R. was next seen a year later ; the difficulty in walking
had increased, so that support was required, the extensors of the
feet being particularly paralysed. A typical extensor toe reflex
present on both sides. Lateral nystagmus had appeared, and the
temporal half of the right optic disc was pale. There was a
distinct “intention tremor” in both upper limbs.

Enlargement of the thyroid, prominence of the eyes, and a
pulse rate of 120 were still obvious features.

The patient was not seen again until February 1907. The
spasticity and loss of power in the lower limbs had markedly
increased, and she could only stand with support. Pallor of
the right disc, with V = A- Nystagmus, slight inco-ordinate

CASES ILLUSTRATING DISSEMINATE SCLEROSIS 527

intention tremor, absence of abdominal reflexes, and an
occasionally staccato speech, were obvious symptoms of
disseminate sclerosis.

The prominence of the eyeballs and enlargement of the
thyroid were still as before, but the pulse rate had dropped and
was rarely over 90. In addition to the inco-ordination of gross
movement in the upper limbs, there was also a fine, delicate
tremor noticeable in the hands, like that of Graves’ disease.

The patient was admitted into hospital, and remained there
until November 23, 1907. No improvement occurred, and the
patient was discharged barely able to move about, even when
helped by the nurses.

I have recently learned the history of the termination of her
illness. Some time after leaving the hospital she began to
improve, and gradually became so strong that she was able to
walk about without support, and could go upstairs alone, and do
“fancy” work. The exophthalmos and tremor disappeared.
The end came suddenly; in the beginning of April of this year,
pain in the back and inability to walk or stand rapidly set in.
The patient had to go to bed. She soon became delirious in a
quiet, rambling way, then there was absolute blindness for six
hours, followed by some return of vision. Two days before
death, difficulty in swallowing, paralysis of the tongue, and
complete paralysis of all four limbs were present. The duration
of these terminal events was about one week.

Mr K., set. 25, was brought to me by his brother, a medical
man, on September 9, 1907. A year ago, when in Canada, he
had a severe attack of “ gastro-enteritis,” accompanied with
sharp fever; he was in bed ten days, but appears to have quickly
convalesced, and returned home to England apparently quite
recovered. Last Christmas— i.e. about three months after the
acute illness—loss of power was observed in the left leg, so that
in April he was no longer able to work. After a time the
weakness disappeared to such an extent that he was able to
walk, and what caused him to seek advice was a rather sudden
weakness in the left arm, accompanied by tingling sensations in
both upper limbs and in the left leg.

He then told me that he had observed deficiency in vision
in the right eye for two years, and had been subject to attacks
of giddiness.

528

W. B. WARRINGTON

On examination he presented the symptoms of profound
disturbance of the nervous system. He was unable to stand
without support, the left lower limb was almost completely
paralysed, extension and flexion of the foot being just possible.
The power in the right leg was fairly good. Both knee jerks
were exaggerated, ankle clonus on the left side, and a typical
extensor toe on both. The abdominal and epigastric reflexes
were absent.

The left upper limb was also weak, with some wasting,
especially in the small muscles of the hand.

Slight “ intention-tremor ” could be elicited with the right
arm. There was marked lateral nystagmus; the right pupil
was > left, right vision = ts, left i, and there was distinct
pallor of the right disc on its temporal side. No diplopia or
paresis of external eye muscles.

The speech was perhaps a little slurring in character.

There had been no bladder trouble.

I am indebted to Dr EL for the remainder of the clinical
history:—

The patient was put to bed, and in two days the weakness
of the upper limbs had increased to such an extent that the
patient had to be fed by the nurse, and the abdominal muscles
appeared palsied. On September 27 th palsy of right leg was
noted, paralysis of the intercostals, flaccidity of the abdominal
muscles, and loss of the knee jerks. Two days later there was
alarming difficulty in breathing, with complete paralysis of
thoracic movements. On October 4th he was described as lying
in bed unable to change his position, the left arm atrophied, and
scarcely able to be voluntarily moved. The right arm had some
power, but little co-ordination in its movements. There was
also a distinct affection of sensation, so that he could not dis¬
tinguish between the blankets and sheets of his bed-clothes by
touch. Words were spoken in a slurring, indistinct fashion.
Owing to the lack of respiratory force he could only speak a few
words, not more than five, without a pause.

From time to time there was a paresis of the eye-muscles.

The abdominal reflexes and knee-jerks were absent.

On the 30th November, Dr K. informs me, the patient had
steadily improved. He could draw up and extend both legs.
The knee jerks had returned. The hand and shoulder could be

CASES ILLUSTRATING DISSEMINATE SCLEROSIS 529

moved with fair power. The inco-ordination had also disap¬
peared, but there was still some astereognosis; for example, the
patient could not recognise a sixpence, or distinguish it from a
collar-stud or thimble. On several occasions a transient right¬
sided facial palsy had been noticed. The thoracic and abdominal
muscles were still very weak. The general health and mental
power remained unimpaired.

On May 11th he had so far improved as to be able to sit
up in a chair. Every now and then marked inco-ordination in
the upper limbs was present, but this was not constant. Some¬
times the head and neck were seized with nodding, shaking
movements. The knee jerks just obtainable, double ankle clonus,
and extensor toe reflexes present. The speech was clear, and
nystagmus less marked.

The unfortunate gentleman about this time had a second
attack of appendicitis, and his medical attendant thought be was
going to die; however, he pulled through well enough, and now
can use his arms and hand with strength and efficiency, shooting
with a toy pistol straight enough to get “ bull’s eyes,” and can work
a typewriter, but cannot write, for a violent jerk carries his pen
off before three letters have been formed. The muscles of the
left shoulder and arm are somewhat wasted. Sensation and
stereognostic sense now normal. There is still the curious
tremor, nodding and jerking of the head and neck. The thoracic
expansion remains feeble, and seems to explain the slowness of
speech, which, however, has no scanning or staccato features.

There is a distinct pallor of the right disc, and less so of the
left, and some failure of vision. Nystagmus has disappeared.
Knee jerks just obtained; abdominal reflexes absent. Typical
double ankle clonus and extensor toe reflex.

He can now stand, but spasm of the muscles of the feet
tends to upset him. Individual movements of muscle groups
can be fairly well performed.

The action of both bowels and bladder are at times precipitate.

Mr Z.’s appetite, general health, and mental power are in no
way impaired.

References.

1. R. T. Williamson. Lancet , May 2, 1908.

2. Wegelin. Deutsche Zeit. fiir Nervenheilkunde, Bd. xxxi., Heft 3 and 4,

p. 313.

3. J. Hoffmann. Ibid., Bd. xxi., p. 16.

4. Oppenheim. Notlinagels Svstem.

5. Barlow. “Brain,” 1906.

530

J. D. ROLLESTON

THREE CASES OF HEMIPLEGIA FOLLOWING
SCARLET FEVER.

Bt J. D. ROLLESTON, M.A., M.D., Oxon.,

Assistant Medical Officer, Grove Fever Hospital, London.

The rarity of hemiplegia in scarlet fever is illustrated by the fact
that the present three cases are the only ones that have occurred
among 10,781 consecutive cases of scarlet fever admitted to
the Grove Hospital between August 1899 and December 31,
1907. A prolonged search through literature has enabled me
to add 63 more, thus making a total of 66 cases. It is
well known that hemiplegia may follow any infectious disease.
Forty-six cases have recently 1 been collected by Smithies in
typhoid fever, and 65 cases in diphtheria by myself. When
one considers the greater prevalence of scarlet fever compared
with diphtheria or typhoid fever, it is obvious that hemiplegia
is much less common in scarlet fever than in the other two
diseases.

It is well to insist on the rarity of hemiplegia in scarlet
fever, as the statements of some neurologists are somewhat mis¬
leading. More confidence should be given to paediatrists, who
see much of scarlet fever, than to those who are likely to be
consulted only for its nervous sequel®. It is instructive to com¬
pare the words of Sir W. Gowers: “ Sudden cerebral hemiplegia
(in scarlet fever) is not infrequent," with the following quota¬
tions : “ Nervous complications and sequelae are seen less frequently
after scarlet fever than with most of the infectious diseases of
such severity ” (Holt). " Le3 paralysies dans le cours de la
scarlatine sont excessivement rares ” (Moizard). “ Eine Betheili-
gung des Gehirns am Scharlachprocesse kam mir nur selten vor”
(Henoch). Similar testimony is given by Landouzy in his well-
known monograph, “ Des paralysies dans les maladies aigues,"
in opposition to Gubler, who regarded paralysis in scarlet fever
as fairly frequent. In this connection it may be said that some
authorities have a mistaken tendency to ascribe too large a
number of cases of cerebral palsy to infectious disease. Sachs
and Spiller have rightly protested against this view. In striking

1 Two additional cases have 9ince been recorded by Bari4 and Lian, and Laignel-
Lavastine (i\ abstract in Review of Neurology and Psychiatrg , 1908, p. 37).

HEMIPLEGIA FOLLOWING SCARLET FEVER 531

contrast to Marie and Jendrassik, who were of opinion that
infectious disease was the only cause of infantile hemiplegia,
Sachs states that the appearance of this palsy after infectious
disease could be affirmed with certainty in only 20 per cent, of
his 225 cases.

In discussing the aetiology of hemiplegia in scarlet fever, it
is interesting to note that the occurrence of this paralysis is by
no means confined to young children. This is clearly shown in
the following table :—

Table 1.—Ages and sexes of scarlet fever patients at the
onset of hemiplegia.

Ages.

0—1

1—2

2— 3

3— 4

4— 5

5— 6

6— 7

7— 8

8— 9

9— 10
11—12

12— 13

13— 14

14— 15

15— 16

16— 17
20—21
24—25

Male.

4
1
4
1
0
1
1
0
1
0
0
1
0

Female.

4
2
1
3
7

5
2
1
0
0
1
0
2
1
0
1

25 32

In 9 the ages and sexes were not recorded. Thus 20 cases
occurred in the first quinquennium, 28 in the second, 4 in the
third, and the remainder in older patients. Right hemiplegia
occurred in 43, left in 15. In Muls’s case there was crossed
hemiplegia (left facial palsy, with paralysis of the right upper
and lower limbs). In 7 no details were given. Hemiplegia took
place at the following dates :—In the first week of scarlet fever

532

J. D. ROLLESTON

5 cases, in the second 7, in the third 5, and in the fourth to
sixth week 12. In cases where no exact date is stated it is said
to have occurred in convalescence in 18 cases. In 19 no date
whatever was stated. Recovery took place in 49, but in only
17 cases was it complete. In the majority contractures and
atrophy supervened. Henoch’s case is remarkable in that the
contractures disappeared at the end of a year. Among other
sequelae athetosis is mentioned in the cases of Barlow, Dejerine,
Fisher, Fiirbringer, Montgomery, and Pastore; chorea in Fiir-
bringer’s, Kennedy’s, and one of Osier’s cases ; recurrent convul¬
sions in those of Barlow, Bernhardt, Dejerine, Heubner, Lewis
Smith, Montgomery, and Wallenberg; and failure of the memory
and intellect in the cases of Bernhardt, Bohn, Condie, Hughlings
Jackson, Osier, and Wallenberg.

Death occurred in 11, in 8 of which there was an autopsy.
In 3 of the latter, however, death took place many years after
the onset of hemiplegia, being due in one case to pneumonia
at fifty-four (Dejerine), and in others to phthisis at nineteen and
twenty-seven (Bernhardt and Taylor). In 6 the issue of the cases
was not recorded.

In 28 of the cases of right hemiplegia the paralysis was
associated with aphasia. It is of historical interest that the two
phenomena were combined in the earliest case recorded, that of
De Haen in 1760. 1 In 3 it is stated that there was no aphasia,
but one of these patients (Dr F. Taylor’s case) was left-handed.
In the great majority of cases in which details are given, i.e. in
22 out of 30, the initial scarlatinal attack was severe. In the
remainder, wherein may be included the three cases to be
described, it was mild. In some of the recorded cases another
infectious disease had recently preceded scarlet fever, e.g.
diphtheria in the cases of Heubner and of Fyshe and Hunter,
and whooping-cough in the cases of Walker and one of Osier’s
patients.

Since diphtheria and whooping-cough may each be followed
by cerebral palsy, it is impossible to exclude them from the
causation of the hemiplegia in these cases. In 28 cases, includ¬
ing Cases II. and III., hemiplegia was associated with scarlatinal

1 Paella 16 annorum febre scarlatina correpta mense Septembri anno 1760, dein
convulsione 7 Octobri latere dextro paralytica facta eat, et perfecte aphona.—Quoted
by Imbert-Goubeyre, loc. cit.

HEMIPLEGIA FOLLOWING SCARLET FEVER 533

nephritis. In the remaining 38 nephritis either did not occur
or was not recorded.

As already stated, autopsies were held in 8 cases. Cerebral
haemorrhage was found in 3 (Dejerine, Ftirbringer, Southard and
Sims), embolism in 1 (Taylor), thrombosis in 1 (Alexeff), sclerosis
in 1 (Neurath), and atrophy in 2 (Bernhardt and Taylor). Out
of the fatal cases on which no autopsy was held haemorrhage was
diagnosed in 1 (Sufrin), embolism in 1 (Case I.) and uraemia in 1
(Case III.). In the cases which recovered the diagnosis of
haemorrhage was made in 4 (Henoch, Luukonen, Montgomery,
and Sufrin), of thrombosis in 5 (Addy, Baginsky, Bazin, and
Ferrier), of embolism in 11 (Barlow, Cheripin, Freud, Fyshe and
Hunter, Hughlings Jackson, Kennedy, Osier, Rosenberg, and
Wallenberg), of acute encephalitis in 3 (Heubner, Muls, and
Pastore), and of uraemia in 1 (Case II.). One of Osier’s cases
was unique in that the hemiplegia was of surgical origin. A
cervical abscess following scarlet fever gave rise to ulceration of
the right carotid, necessitating ligature in a girl of six. Left
hemiplegia followed, and was still present at the age of twenty-four.

Table II. shows that apart from uraemia cerebral embolism
has been regarded as the commonest cause of hemiplegia in
scarlet fever. However, now that more attention has recently
been given to acute non-suppurative encephalitis as a cause of
cerebral palsy, more cases may be found due to this cause than
has hitherto been supposed. 1 In 18 cases no mention is made
of a cardiac lesion, but the occurrence of nephritis alone was
noted. With the exception of three cases recorded by Alexeff,
Bohn, and Semple respectively, in which complete recovery took
place, the paralysis was permanent. It is highly improbable,
therefore, that the hemiplegia, except in the three cases men¬
tioned, could have been due to uraemia, since almost invariably
uraemic paralysis is of transient duration. It is far more likely
that coexistent haemorrhage or embolism due to an undetected
cardiac lesion was the cause of the hemiplegia in the other cases.
If this supposition is correct, only three cases of uraemic hemi¬
plegia in scarlet fever have hitherto been recorded, to which
number Cases II. and III. may now be added.

1 Rhein has recently recorded a fatal case of scarlet fever in which acute en¬
cephalitis was found at the autopsy. Death had been preceded by convulsions,
but no paralysis had occurred.

534

J. D. ROLLESTON

In Walker’s case, in which the hemiplegia occurred on the
first day of disease, the paralysis was attributed to the direct
action of the scarlatinal virus on the cerebro-spinal system. In
Bassette’s case the condition was regarded as a neuritis, though
the existence of a mitral lesion and the disturbance of speech
make cerebral embolism more probable.

Table II.—Showing causes of hemiplegia in 66 cases :—

Cerebral embolism .

„ haemorrhage
„ thrombosis
Encephalitis
Cerebral atrophy .

„ sclerosis .
Nephritis. Uraemia
Neuritis

Ligature of carotid .
Toxaemia (Walker’s case)

13 cases
8 „

6 „

3 „

2 „

1 case
17 cases
1 case
1 „

1 ..

No cause was assigned in 13 cases.

Case I.

A woman, aged 24, a milliner by occupation, was admitted
to hospital on July 6th, 1904, on the sixth day of an attack
of scarlet fever. For the last few weeks she had been treated
for anaemia, but there was no history of heart disease. She
stated that she had already had scarlatina in 1888.

On admission there was a fading punctate erythema on the
trunk. On the limbs the rash was brighter. Examination of
the heart revealed a systolic murmur localised to the apex. By
July 8th the rash had faded. Characteristic desquamation
followed. The temperature, which was 101 *6° on admission,
did not sink below 98*8°, but remained partly continuous and
partly intermittent during the rest of her stay in hospital On
the 11th she vomited three times, and complained of pain in
the region of the spleen. There was some tenderness over that
area, but no enlargement of the organ could be detected till the
18th, when its lower border could be felt one finger’s breadth

HEMIPLEGIA FOLLOWING SCARLET FEVER 535

below the costal margin. On the 13th the urine, which had
hitherto been normal,, showed a cloud of albumin, and on the
18th haematuria developed. Blood disappeared from the urine
the following day, and subsequently was present only on the
22nd and 23rd of August. Albuminuria, however, persisted.

On July 15th petechise appeared on the trunk. On the
22nd and 23rd she complained of pain throughout the left
lower limb. On the 24th the pain became localised to the
upper part of the calf and then disappeared. The same day
the cardiac apex beat was found to be outside the nipple line,
the dulness extending 1 £ inches beyond it. The systolic
murmur was now conducted into the axilla. A few fresh
petechise were noted on the trunk. On the 27th she woke
up suddenly at 1 a.m., muttered something inarticulate, and was
unable to move her right arm and leg. Examination in the
course of the morning showed complete right hemiplegia. In
addition to the motor palsy, anaesthesia was present in the parts
affected. The tongue was deviated to the right. Well-marked
ankle clonus and Babinski’s sign existed in the right foot.
There was partial motor aphasia. The cardiac condition was
unchanged. On the 28th the aphasia was complete, and the
tongue was more deviated to the right. The right lower limb
could be moved slightly, movement taking place at the pelvis.
Sensation was returning in the right side of the face, right side
of the trunk, and right lower limb. There was still anaesthesia
but not analgesia of the right arm. On the 30th sensation
began to return in the right arm. Ankle clonus was still very
readily obtained in the right foot. The aphasia continued as
before. On the 31st a few fresh petechiae were noted on the
neck and trunk. She was now able to say a few short words at
a time and to read aloud from a book. On August 1st the
right arm and leg, which since the ictus had been quite flaccid,
were now becoming somewhat rigid. There was still some
anaesthesia of the paralysed side. On the 2nd she could speak
a little more, but could not distinctly articulate polysyllabic
words. Slight impairment of the intellectual faculties was
shown (1) by an inability to perform simple sums in mental
arithmetic. Though she could multiply 5 by 4, she could not
give the product of 12 by 12. (2) By a certain degree of

amnesia. She was unable to say more than the first few words

536

J. D. ROLLESTON

of the Lord’s Prayer. (3) By inability to read without soon
feeling tired. On the 3rd she was able to write the words
“ wrote ” and “ millinery,” but when asked to write “ haber¬
dashery," "crinoline,” or “cashmere,” a look of vacuity came
over her face, and she was unable to proceed. On the 6th,
improvement was shown by her being able to write the words
“ impossibility ” and “ haberdashery.” She could also recite the
whole of the Lord’s Prayer with very little prompting, and read
to herself longer without being tired.

Daring the rest of her stay in hospital fresh petechiae were
noted almost daily on the trunk and limbs. The spleen gradu¬
ally increased in size, and the heart became more dilated.
During the last three weeks of her stay she had frequent attacks
of severe pain in the abdomen and lower limbs, which yielded
only to the injection of morphia. On September 3rd, being free
from scarlatinal infection, she was discharged. Her condition
was then as follows:—The facial palsy had almost gone. There
was Btill some hesitancy in speech and deviation of tongue to
the right. The right arm was quite powerless, and there was
some rigidity at the shoulder and elbow. The fingers were kept
flexed, but could easily be extended. The right lower limb
could be moved fairly freely, but there was some stiffness of the
knee. Death, preceded by coma of two days’ duration, took
place on November 26 th.

Though no autopsy was held in this case, the causation of
the hemiplegia was obviously cerebral embolism, due to infective
endocarditis. Multiple embolism doubtless existed. Not only
were the brain, kidneys, and spleen affected, but the attacks of
pain in the abdomen and limbs were probably due to the dis¬
charge of minute clots from the diseased valves. The only other
recorded case of scarlatinal hemiplegia associated with multiple
embolism is that of Fyshe and Hunter. Their diagnosis was
based on the occurrence of sudden and transient attacks of pain
in the abdomen and lower limbs, the sudden onset of Jacksonian
epilepsy, transient left hemiplegia, and the presence of blood in
the stools. Recovery took place. The history of anaemia in the
present case suggests that the heart condition may have been
present before the onset of scarlet fever, but in any case the
rapid subsequent progress of the disease showed that the acute
exanthem considerably aggravated, if it did not actually originate,

HEMIPLEGIA FOLLOWING SCARLET FEVER 537

the cardiac lesion. Of special interest is the age of the patient.
Although, as already stated, scarlatinal hemiplegia is not confined
to young children, the only other cases in adults are two reported
by Ferrier in soldiers whose ages are not given, and one by
Achard in a man of twenty.

Case II.

A girl, aged 13 years, was admitted to hospital on March
28th, 1905, on the second day of a typical attack of scarlet
fever. Characteristic desquamation followed. On the 31st she
had some rheumatism in the hands, and from April 4th to April

7 th there was slight albuminuria. The heart was not affected.
The urine subsequently remained clear till the 18th, when it
showed a cloud of albumin, and the patient complained of
headache. There was frequent but slight epistaxis. On the 19 th
the urine contained blood and was scanty (8 oz. in twenty-four
hours). The face was puffy, especially round the eyes. The
temperature, which had been normal since the 6th, rose to 99° at

8 PJi. A drachm and a half of liquorice powder was given, and
the bowels acted freely. On the 20th the headache was less,
the face was not so pufly, and the flow of urine had increased to
47 ounces in the twenty-four hours. There was still some
epistaxis.

On April 21st, the twenty-sixth day of disease, there was
only a faint trace of albumin in the urine, but there was still
occasional epistaxis. Nothiug unusual was observed till 2.45 p.m.
that day, when the nurse first noticed some twitching of the face.
When I saw the patient ten minutes later, there was loss of
power and sensation in the right arm and right lower limb.
Ankle clonus was very readily obtained in the right foot. There
was no plantar response. The right conjunctiva was insensitive,
the left conjunctival reflex was normal. Though she did not
speak, she showed that she was conscious by putting out her
tongue and shaking her head when told to do so. At 3 p.m.
twitching of the right side of the face began, and spread to the
opposite side. Shortly afterwards generalised convulsions super¬
vened with loss of consciousness. Cyanosis of the face was very
marked. The heart sounds were rapid and irregular in force and
rhythm. About 12 oz. of blood were withdrawn from the right
elbow, and inhalations of chloroform were given. A minim of

2 Q

538

J. D. ROLLESTON

croton oil in butter was also placed upon the tongue. After the
venesection the convulsions ceased, and the cyanosis gradually
passed off. By 4.30 p.m. the child was somewhat restless, but
was gradually regaining consciousness. The right arm, though
not absolutely flaccid, was immobile, while the left could be
moved freely. At 4.35 p.m. slight vomiting occurred. The
right hallux now gave a decided extensor response. The tongue,
on being protruded, was deviated to the right

At 5.35 p.m. consciousness was regained. The right arm
could now be moved freely. She could speak a few words, but
not distinctly.

At 6 p.m. Babinski’s sign was present in both feet. There
was now no ankle clonus. The tongue was still deviated to the
right.

At 10 p.m. Babinski’s sign was replaced by a flexor response.

The temperature was 100° at 8 p.m., but fell to normal at
midnight, and subsequently remained subnormal. The urine
record for the 22nd and 23rd was 16 and 15 ounces respectively,
but on the following days the output considerably increased, the
average amount passed during the twenty-four hours being 40
ounces.

On the 23rd the patient seemed quite herself again. The
tongue was no longer deviated to the right, but was still sore
where it had been bitten during the convulsions.

The urine became free of albumin on the 28 th. Beyond the
occurrence of pigmented striae atrophicae on the breasts, which were
first observed on the 28th, nothing further of note occurred, and
the patient was discharged on May 24th, 1905. At the time of
writing (December 1907), her father informs me that she has
enjoyed the best of health since leaving the hospital.

The prodromal headache and epistaxis, the diminution of the
urinary secretion, the presence of blood and albumin in the
urine, the transient character of the palsy, and the rapid and
complete recovery, justify the diagnosis of uraemic paralysis in
this case. In the absence of endocarditis, which could have
given rise to cerebral embolism, the possibility of cerebral
haemorrhage was at first suggested by the sudden character of the
onset and the condition of the reflexes, but this hypothesis was
soon set aside by the rapid disappearance of the paresis, and by
the restoration of the reflexes to their normal condition. The

HEMIPLEGIA FOLLOWING SCAELET FEVER 539

difficulty, and even impossibility, of diagnosing uraemic paralysis
from paralysis due to cerebral haemorrhage, embolism, or throm¬
bosis have been dwelt upon by many writers, who point out that
there is nothing characteristic in the onset of uraemic hemiplegia
to distinguish it from hemiplegia due to other causes. As was
illustrated by the autopsy in Alexeffs case, the mere presence of
nephritis does not justify the diagnosis of uraemic hemiplegia.
In that case, in addition to nephritis, endocarditis and embolism
of the middle cerebral artery were found. Further, it is well
known that cerebral haemorrhage is liable to occur in Brights’
disease, and it was to this cause alone that any paralysis was
attributed by Lasbgue, who, like Addison, denied the existence of
uraemic paralysis. The imitative character of uraemia has been
happily expressed by Chau Sard in the following words :—“ En
matibre de pathologie cbrbbrale, l’urbmie est comme la syphilis et
l’hystbrie: elle peut tout rbaliser ou, du moins, tout simuler.”

It is noteworthy that, though there was some diminution in
the urinary secretion, there was by no means anuria. As has
been pointed out by Dr Rose Bradford in his Goulstonian
lectures, and as is exemplified in Cose III., rapidly fatal uraemia
may occur while the patient is passing quite considerable
quantities of urine. Leichtenstern has also recorded cases of
scarlatinal nephritis, in which oliguria and haematuria were
replaced by polyuria with rapid disappearance of albumin, and in
which, nevertheless, grave uraemic phenomena supervened.

Provided the patient recovers from uraemia, which is always
a condition of considerable gravity, the prognosis of uraemic
paralysis is good. The paralysis is usually transitory and leaves
no sequelae. Bohn’s case is exceptional, in that the child, who
before her illness had been highly gifted, became mentally
deficient, though she recovered from the hemiplegia and aphasia.

Case III.

A girl, aged 11 years, was admitted to hospital on October
19th, 1907, on the third day of a mild attack of scarlet fever.
On November 6th, the twenty-first day of disease, a trace of
albumin appeared in the urine. During the next few days the
albumin increased. On the 10th haematuria developed, and the
temperature, which had been normal since October 9th, rose to

540

J. D. ROLLESTON

9 9‘6° at midnight. On the 11th she had numerous fits, followed
by loss of power in her right arm and leg. Sensation apparently
was not affected. Motor aphasia was present, but she appeared
to understand what was said to her. Babinski’s sign and
ankle clonus were present in her right foot, and the right
abdominal reflex was absent. The following day the palsy
disappeared. In spite of hot packs, croton oil, lumbar puncture,
and phlebotomy, the fits continued. Coma supervened, and death
occurred on November 14th, the twenty-ninth day of disease.
So far from there being anuria, urine was passed freely during her
fits. As much as 30 oz. were collected in the last twenty-four
hours.

No autopsy was performed.

The occurrence of aphasia in Cases II. and III. deserves
special mention. Uraemic aphasia is rare. Like uraemic paralysis,
it is usually of short duration. Riesman in 1902 had collected
29 cases, including two of his own, 15 of which were unaccom¬
panied by paralysis, while in the remainder some form of
paralysis existed. It is remarkable that Monod, who, faithful to
the doctrine of the time, denied the existence of paralysis in
uraemia, should have recorded two cases of uraemic aphasia
following scarlet fever. In both aphasia was associated with
convulsions, as in Cases II. and III., and in both recovery took
place.

The occurrence of aphasia was noted in 25 of the 66 cases of
scarlatinal hemiplegia which I have collected. In 14 of the 24
cases there was nephritis, but in 4 of these cardiac lesions were
also present, and the aphasia was attributed to embolism (Alexeff,
Barlow, Cheripin, Rosenberg). It is probable that the same
explanation would account for the aphasia in some, if not in
most, of the rest.

Dupr4, who in 1894 drew special attention to the existence
of uraemic aphasia, recorded a case very similar to those under
discussion. A boy, aged nine years, while suffering from scarla¬
tinal nephritis, was suddenly seized with complete motor aphasia,
agraphia, and paresis of the right upper limb. Within twelve
hours speech began to return, and three days later was completely
restored. It may be mentioned that aphasia may occur as an
isolated symptom in scarlet fever apart from paralysis, just as,
but much less frequently, than aphasia does in typhoid fever.

HEMIPLEGIA FOLLOWING SCARLET FEVER 541

A case of the kind has been recorded by Brasch, in which
aphasia developed at the onset of scarlet fever.

The pathogeny of uraemic paralysis is not yet fully elucidated.
Though the occurrence of cerebral symptoms in kidney disease
was described by Addison in 1839, uraemic paralysis was practi¬
cally unknown before the appearance of Raymond's monograph
in 1885. It is a remarkable fact that the earlier writers, such
as Addison and Las^gue, laid special stress on the absence of
paralysis as characteristic of uraemia. That such excellent
clinicians should have denied its existence is sufficient proof that
uraemic paralysis is rare. On the strength of some post-mortem
findings the paralysis was at first ascribed to cerebral oedema, but
this explanation was contested by others on the ground that in
many autopsies no trace of oedema could be found, nor was it
clear why in cases in which it had been found a diffuse cerebral
CBdema should produce a unilateral paralysis. The theory of a
toxic paralysis sine materia was, therefore, substituted, similar to
that which may follow such poisons as carbon monoxide, mercury,
or lead. More recently Raymond, on the ground of experimental
and clinical facts, states that uraemic intoxication very probably
produces an acute or subacute encephalitis. In the immense
majority of cases the encephalitis clears up, since most of the
patients recover from their hemiplegia, but in a few the lesion
persists and entails a permanent palsy.

It is surprising that in spite of the frequency of nephritis in
scarlet fever uraemic paralysis should be so rare. Such cerebral
symptoms as headache, vomiting, drowsiness, and twitching in
scarlatinal uraemia are not uncommon. Generalised convulsions
are much less frequent, but are less rare than any kind of
paralysis. Ferrand in 1893 attempted to explain the rarity of
nervous symptoms in uraemia by saying that a specially sensitive
nervous system is required for their development, and supporting
this hypothesis by the relative frequency of eclampsia in preg¬
nancy. In 1904, in conjunction with Castaigne, he brought
forward clinical and experimental evidence to show that uraemic
paralysis is due to old lesions of the cerebral motor zones, which
for that reason are less resistant to the mechanical and toxic
action of cerebral oedema.

This view is of considerable interest, but needs further con¬
firmation. In the absence of any history or evidence of old

542

J. D. ROLLESTON

cerebral trouble this explanation of uraemic paralysis can hardly
be applied to the cases under discussion.

Conclusions.

1. Hemiplegia in scarlet fever is rare.

2. It is not confined to children.

3. It is usually due to cerebral embolism, but may also
follow thrombosis, haemorrhage, or acute encephalitis. Under this
last heading uraemic hemiplegia may probably be placed.

4. The prognosis of hemiplegia in scarlet fever is generally
good as regards life, but unfavourable in respect to complete
recovery.

5. Uraemic hemiplegia, which probably occurred in only a
few of the recorded coses, is exceptional in that it is almost
invariably of short duration and leaves no sequelae.

Bibliography.

1. Achard. Bull, el Mdm. de la Soc. MM. da H6p. de Paris, 1900, p. 330.

2. Addison. “ On Disorders of the Brain connected with Diseased Kid*
neys,” Guy's Hosp. Rep., 1839, p. 1.

3. Addy. Lancet, 1, 1875, p. 643.

4. Alexeff. Arch, fur Kinderheilk., Bd. 24, 1898, p. 319 (2 cases).

5. Baginsky. Lehrbuch der KinderkranJc., 1905, p. 160 (2 cases).

6. Barlow. Brain, 1906, p. 328 (3 cases).

7. Bassette. Jour. Nerv. and Ment. Dis., 1892, p. 467.

8. Bazin. Montreal Med. Jour., 1899, p. 856.

9. Bernhardt. Virchoufs Archie., 1885, Bd. 102, p. 26 (3 cases).

10. Bohn. Jahrb. ftir Kinderheilk., 1886, Bd. 24, p. 102.

11. Bradford, Rose. Lancet, 1, 1898, p. 919.

12. Brasch. Berl. Klin. IVoch., 1897, p. 30.

13. Bruns. Neurol. Gentralbl., 1888, p. 311.

14. Chauffard. Arch. gen. de mdd., ii., 1887, p. 19.

15. Cheripin. Pediatrics, 1904, p. 52.

16. Condie. Trans. Coll. Physic. Philadelphia, Vol. iii., 1857, p. 137.

17. Dejerine. Arch, de Physiol., 1891, p. 661.

18. Dupre. Bern, mdd., 1894, p. 496.

19. Ferrand. Sem. med., 1893, p. 154.

20. Ferrand et Castaigne. Sem. mM., 1904, p. 201.

21. Ferrier. Bull, et Mdm. de la Soc. MM. da H6p. de Paris, 1900, p. 325
(2 cases).

22. Finlayson. Obstet. Jour, of Gt. Britain and Ireland, 1876, p. 353.

23. Fisher. Jour. Nerv. and Ment. Dis., 1888, p. 562.

24. Fraser. Practitioner, i., 1882, p. 431, and ii, 1882, p. 26.

25. Freud. Die infantile CerebralUihmung, 1897.

HEMIPLEGIA FOLLOWING SCARLET FEVER 543

26. Fiirbringer. Dent. Med. Woch., 1889, p. 67 (2 cases).

27. Fyshe and Hunter. Montreal Med. Jour., 1907, p. 181.

28. Gowers. “ Manual of Dis. of Nerv. Syst,” 2nd ed., Vol. ii., 1893, p. 899.

29. Greidenberg. Arch, fiir Psychiatric, Bd. 18,1886, p. 187.

30. Gubler. Arch. gin. de mid., Tom. 15, 1860, p. 637.

31. Heine. Spinale KinderlUhmimg, 1860, p. 164.

32. Henoch. “Vorles. liber Kinderkrank.,” lOte aufl., 1899, p. 677.

33. Heubner. “ Lehrbucb der Kinderheilk.,” Bd. 1, 1903, p. 376.

34. Holt “ Dis. of Inf. and Child,” 4th ed., 1907, p. 970.

35. Hughlings Jackson. Med. Times and Gaz., ii., 1862, p. 575.

36. Imbert-Goubeyre. Gaz. mid. de Paris, 1863, p. 482 (3 cases).

37. Jendrassik et Marie. Arch, de Physiol., i., 1885, p. 94.

38. Kennedy. Dublin Quart. Jour. Med. Sci., Vol. ix., 1850, p. 91.

39. Krol. Arch, fur Kinderheilk., 1898, Bd. 24, p. 319.

40. Lammere. Quoted by Freud, loc. cit.

41. Landouzy. Des paralysies dans les maladies aigues, 1880.

42. Lasegue. Arch, gin de mid., 1852, Tom. 30, p. 128.

43. Leichtenstern. Deut. Med. Woch., 1882, p. 267.

44. Luukonen. Verhand. d. FinnlUnd. Gesellsch. d. Aerzte in Finska Inkers-
salk. hand., Bd. 49, 1907, p. xxv.

45. Moizard, in Comby’s “ Traits des inal. de l’enf.,” Tom. 1, 1904, p. 295*

46. Monod. “ Enccphalopathie albuminurique chez les enfants,” These
de Paris, 1868.

47. Montgomery. Pediatrics, 1900, p. 110.

48. Muls. Arch, de mid. des enf., 1907, p. 634.

49. Neurath. Neurol. Centralbl., 1900, p. 316.

50. Osier. “ Cerebral Palsies of Children,” 1889 (8 cases).

51. Pastore. Abstract in J fed. Review, 1906, p. 253.

52. Raymond. Rev. de Mid., 1885, p. 705 ; Gaz. des H6p., 1905, p. 1311.

53. Rhein. American Medicine, 1, 1905, p. 991.

54. Riesman. Jour. Amer. Med. Assoc., ii., 1902, p. 883.

55. Rolleston, J. D. Rev. of Neurol, and Psych., 1905, p. 722.

56. Rosenberg. Quoted by Freud, loc. cit.

57. Sachs. Samuil, klin. Vort., 1892, p. 450.

58. Semple. Med. Press and Circ., it, 1884, p. 480.

59. Smith, Lewis. Boston Med. and Surg. Jour., 1888, p. 509.

60. Smithies. Jour. Amer. Med. Assoc., ii., 1907, p. 389.

61. Southard and Sims. Jour. Amer. Med. Assoc., ii., 1904, p. 789.

62. Spiller. Jour. Nerv. and Mental Dis., 1897, p. 20.

63. Sufrin. Zentralbl. fur inn. Med., 1903, p. 894 (2 cases).

64. Taylor, F. Guy’s Hosp. Rep., Vol. xxiii., 1878, p. 15 ; Clin. Soc.
Trans., 1881, p 89.

65. Townsend. Dublin Quart. Jour. Med. Sci., Vol. xlvii., 1869, p. 487.

66. Walker. Med. ami Surg. Reporter, 1, 1884, p. 161.

67. Wallenberg. Jahrb.fiir Kinderheilk., Bd. 24, 1886, p. 384 (2 cases).

544

ABSTRACTS

Hbstracts

ANATOMY.

NOTE ON THE 00UB8E OF THE CEREBELLO-OLIVARY
(453) FIBRES, AS DEMONSTRATED IN A 0A8E OF TTTBER-
OULOSIS OF THE SPINAL OORD AND MEDULLA

T. K. Monro and Leonard Findlay, Glasgow Med. Jowm.,
July 1908.

A MAN, set. 22 years, was admitted to hospital suffering from
vomiting and pains all over body, but especially in the head
and neck, of two weeks’ duration. Later on he became uncon¬
scious, paralysis of the limbs and diaphragm developed, and he
died six days after admission.

Post-mortem, there was discovered general tuberculosis, with
a more recent basal meningitis. There was in addition an older
tubercular spinal meningitis, most extensive in the lower dorsal
and lumbar regions. In the fourth lumbar segment there was
situated a tubercular nodule, which, along with the spinal menin¬
gitis, had produced an extensive ascending degeneration of the
posterior columns, cerebellar, and antero-lateral ascending tracts.
Situated in the left half of medulla in the region of the olivary
nucleus was another tubercular mass, measuring 75 cm. in
diameter, and causing in great part the destruction of that
nucleus. In the immediate periphery of that nodule there was
degeneration of the left pyramidal bundle, left posterior basis
bundle and left restiform body, while on the opposite side there
was slight degeneration of the fibres in the hilum of the olivary
nucleus, but the restiform body and cerebello-olivary fibres seemed
almost entirely quite healthy.

From the above facts the authors conclude that the cerebello-
olivary fibres are descending in type. Author’s Abstract.

THE STRUCTURE OF THE AUTONOMIC NERVOUS 8Y8-
(454) TEM COMPARED WITH ITS FUNCTIONAL ACTIVITY.

C. V. A. Kappers, Jour, of Physiol., June 30, 1908, p. 139.

The author considers that the axon-reflex (described by Langley)
which passes along motor paths only is the prevailing one in the
sympathetic system, and has even been the moving agent in the
development of its peculiar structure.

From phylogenetic studies of the cranial nerves we know that

ABSTRACTS

545

the motor cells migrate from their original position in the direc¬
tion whence the maximum of stimuli reaches them. In the
central nerve system the way is shortened by the shortening
of the dendrites; the efferent way, the axis cylinder, is elongated
in consequence.

Conversely, in the autonomic system the distance between the
motor cells and the centres of stimulation (viscera) is shortened
by the shortening of the motor axis cylinders themselves. At a
distance where in the somatic system there is only one long axis
cylinder, there are here more neurons (two, perhaps sometimes
three). By analogy, the most frequent stimulation of the motor
sympathetic cells has not been from the spinal cord, but along
the axis cylinders themselves, i.e. an axon-reflex.

The neurobiotactic principle would explain the absence of
sympathetic ganglia (except the ciliary) from the cranial nerves
of Selachians. The possibility of stimulation of the sensory
endings of the cranial visceral nerves is so much greater in them,
owing to the endings being spread out over the gills, etc., that
the sensory-reflex has so prevailed over the axon-reflex that no
sympathetic system has developed. In higher animals these
parts are, like the viscera of the trunk, more protected from
strong outside sensory stimuli; the axon-reflex therefore prevails,
and a sympathetic system develops. The fact that in all animals
a ciliary ganglion is present is in perfect harmony with this ex¬
planation, as the ocular part of the trigeminus sensibility, as far as
concerns the iris, is carefully excluded from strong stimuli.

Another feature might find its explanation in the neurobio¬
tactic influence of the axon stimulation:—the fact that the more
distant from the central nervous system, the greater is the number
of motor cells; they increase in number the farther they have
migrated, because the nearer the cord the greater still is the
influence of the common sensory (spinal) reflex arc, and the
smaller that of the axon reflex, because the ganglion cells them¬
selves are only slightly, if at all, transgressible for the axon-reflex.

J. H. Harvey Pirie.

THE DIFFERENCES BETWEEN CENTRAL AND PERIPHERAL
(455) FACIAL PARALYSIS AND THE ANATOMICAL BASIS
OF THE SAME. (Die Unterschiede centraler und peripherer
Facialislfthmungen und die anatomische Gran diage derselben.)

Carl Hudovernig, Neurol. Cenlralbl., Juni 16, 1908, p. 577.

The well-known differences between central and peripheral facial
paralysis are described. The author holds that the reason why, in
lesions of the facial fibres above the nucleus, the upper part of

546

ABSTRACTS

the face escapes is to be found in the circumstances that there is
a special centre for this region in the cortex, while in the medulla
also the fibres which supply the upper face arise from a distinct
part of the facial nucleus. Edwin Bramwkll.

PHYSIOLOGY.

VASO MOTOR INNERVATION OF THE THYROID GLAND.

(456) (Eecherches sur l’innervation vasa mo trice du corps thyroide.)
Fran<?ois-Franck et Hallion, Jour, de Physiol, et Pathol,
gen., mai 15, 1908, p. 442.

From plethysmographic experiments (the technique of which is
given) on curarised dogs, the authors arrive at the following
conclusions with regard to the vaso-motor supply of the thyroid

1. There are vaso-constrictor fibres for the thyroid in the
rami communicantes as low as the 9th dorsal, but only very few
in the lower three of these. They pass in both divisions of the
annulus of Vieussens up to the superior cervical sympathetic
ganglion, join the external laryngeal nerve a little below where
it leaves the superior laryngeal, at least in part, if not entirely,
and so reach the thyroid.

2. There are vaso-dilator fibres in the superior laryngeal nerve.
Stimulation of the recurrent laryngeal nerve gave negative or

doubtful results so far as vaso-motor fibres for the thyroid were
concerned.

3. Although stimulation of the upper end of the cervical
sympathetic cord usually caused a vaso-constriction, a reflex vaso¬
dilatation could also be produced. This seems to be due to the
presence of sensory fibres in the cervical sympathetic coming
from the endocardium and inner coat of the aorta. Irritation of
the aorta and of the endocardium of the left ventricle near the
aortic orifice causes a bilateral thyroid vaso-dilatation. After
section of the cervical sympathetic this is not produced. These
fibres may possibly play a r61e in exophthalmic goitre.

J. H. Harvey Pirie.

ON HYPERTROPHY OP THE PITUITARY BODY IN ANIMALS

(457) AFTER EXCISION OP THE THYROID. (Sur lliyper-
trophie de l’hypophyse c4r£brale chez les animaux thyr6oidec-
tomisls.) Cimorini, Arch. Hal. de Biol., T. 48, f. 3, 1908,
p. 387.

Various writers have shown that the functions of the thyroid are
distinctly separate from those of the parathyroid. Excision of the
thyroid is followed by a chronic disease which ends after a time in

ABSTRACTS

547

cachexia and death; excision of the parathyroids results in rapid
and violent death from tetany.

In order to determine the origin of the changes which take
place in the pituitary body after excision of the thyroid and para¬
thyroids, the writer made numerous experiments on the dog and
the rabbit, using every possible care in the technique of his opera¬
tions. He comes to the following conclusions:—

(1) Hypertrophy of the pituitary body after excision of the
thyreo-parathyroid apparatus is due to the removal of the thyroid
glands, not to loss of the parathyroids.

(2) The data furnished by histological examination of this
hypertrophy are of a specific character, owing to the presence of
special cells, notable mainly for their large size, and are thus dis¬
tinguished from the appearances found on histological examination
of hypertrophy due to castration.

(3) The formation of these elements should in all probability

be attributed to the increase in functional activity in a particular
kind of pituitary cells, which cannot be clearly differentiated in
normal conditions or in hypertrophy due to castration, but which
become evident by their increase in size after removal of the
thyroid. A. N. Bkuce.

THE ACTION OF THE ACTIVE SUPRARENAL PRINCIPLE ON
(458) MUSCULAR FATIGUE. (Action du principe actif surrlna
sur la fatigue musculaire.) Panella, Arch. Hal. de Biol., T. 48
f. 3, 1908, p. 431.

This question, which is of fundamental interest as regards the
internal secretion of the suprarenal gland, has given rise to
evident differences of opinion on the part of many writers who
have studied the problem. In order to solve it, Panella has gone
very carefully into the matter, experimenting not only on hetero-
thermic, but also on homothermic animals. These experiments are
described in full detail, and the author sums up his results in the
following general conclusions:—

1. The functional activity of a striated muscle in heterothertnic
animals is markedly strengthened by the supra-renal principle
conveyed to the muscle by means of the circulation. Under the
influence of the myosthenine (which the author considers the most
suitable name for this product) the muscle can act rhythmically
for a much longer time than under ordinary conditions.

2. Myosthenine, administered to the frog or the toad in an
advanced period of fatigue, produces a recovery, marked, though
not complete, of the functional activity of the muscle.

3. When the myosthenine is injected after the muscle has

548

ABSTRACTS

become, as a result of the conditions under which it is acting
absolutely incapable of contracting, it has no effect upon the
muscular activity.

4. The same effects are also obtained in the muscles of homo-
thermic animals (guinea pigs, rabbits), on condition, however, that
by means of special treatment (section of the bulb, deep narcosis)
they are placed in some degree under the respiratory, circulatory
and thermogenetic conditions of heterothermic animals.

5. In homothermic animals it has not been possible to obtain
the effects of the myosthenine upon muscular fatigue when it was
injected into animals in which respiration, circulation and the
production of heat differed somewhat from the normal. This is
probably to be attributed to a profound modification which takes
place in this substance when in contact with the blood. In fact:

6. The myosthenine loses its effect upon the muscles of the
frog or toad when it has, for a comparatively short time, been in
contact with the fresh arterial blood of the dog or the rabbit.

7. In frogs and hibernating toads, the action of the myosthenine
is produced, if at all, only after a very considerable time. To
obtain the effect of myosthenine as in warm-blooded animals, they
need only be heated by keeping them in a temperature above
20° C. The cause of the difference between warm-blooded and
hibernating animals is probably that in the former absorption is
more rapid, and very much slower in the latter.

A. N. Bruce.

PSYCHOLOGY.

THE VARIATION OF THE ARTICULATORY CAPACITY FOR
(459) DIFFERENT CONSONANTAL SOUNDS IN SCHOOL
CHILDREN. Ernest Jones, Inter. Arch. f. Schulhyg ., Bd.
5, Ht. 2, S. 137-157.

This is a detailed investigation of (1) the order of frequency with
which defects are shewn in relation to different sounds, and (2)
the influence that the position of the sound in the word has on
the facility with which it is enunciated ; the two sexes are com¬
pared in respect to these questions. Amongst the conclusions
appeared the following findings :—Th (especially in initial and
final positions), Ng (especially final), The (especially final), and V
(especially intermediate) were the sounds shewing greatest diffi¬
culty of enunciation. On the whole the girls excelled decidedly,
most with (1) Th (especially final Them and Thed), Th (especially
intermediate Thr and Thu), and in all the compounds of these
two sounds, (2) in all sibilant sounds, and in nearly all their
compounds. The boys excelled most with Ng and Zm. The
influence of the position of the sound in the test word was

ABSTRACTS

549

greatest in regard to final Ng, final The, intermediate V, initial
Shr, which were all much harder to enunciate than the same
sound in other positions. Eight tables accompany the article.

Author’s Abstract.

THE IDEALS OF CHILDREN. (Les Ideals d’Enfants.) M. J.

(460) Varendonck, Arc. de Psy ., July 1908, p. 365.

This paper describes a research into the ideals of children, the
material being the answers of 745 school children to the question,
What person whom you know, either through study or conversa¬
tion, would you like to resemble ? Several specimen answers are
quoted. Five diagrams are given showing how choice is affected
by age and sex. Margaret Drummond.

GLASSIFICATION AND TABLE OF PSTOHOLOOIOAL METHODS.

(461) (Classification et Plan des Methodes Psychologiques.) Ed.

CLAPARfeDE, Arc. de Psy., July 1908, p. 321.

This paper is an attempt to give a systematic classification of all
the methods used in psychology. An elaborate scheme is ex¬
pounded ; four principal classes of methods are distinguished, and
each of these is subdivided into the same six species. Under each
of the twenty-four headings thus obtained illustrative examples
are given.

As an introduction to this the author briefly sets forth and
criticises the classifications recently advanced by Wundt, Ebbing -
haus, Kiilpe, aud others. Margaret Drummond.

PATHOLOGY.

CONTRIBUTION TO THE PATHOLOGY OF FORCED MOVE-

(462) MENT8 IN CENTRAL LESIONS. (Beitrag zur Pathologic
der Zwangsbewegungen bei zentralen Herderkrankungen.)

Muratow, Monatsschr. f. Psychiat. u New., Bd. 23, S. 510.

The author first describes the case of a man aged 54, who four
years previously had been attacked by a progressive right-sided
hemiparesis. Following this came athetosis and hemi-hyposesthesia
on the same side. At the autopsy was found an old gumma in the
lateral nucleus of the optic thalamus.

The author ascribes choreic and athetotic movement to implica-

550

ABSTRACTS

tion of the cerebello-thalamic tract at any point, and gives a
differential diagnosis between affections of various sections of the
tract, as also between cortical and thalamic lesions. He maintains
that there is no sensory tract in the internal capsule.

Ernest Jones.

CLINICAL NEUBOLOG7.

ON THE PATHOGENESIS OF OPTIC ATROPHY AND OF THE
(463) SO-CALLED TOWER-SHAPED SKULL. (Zur Pathogenese
der opticus-atrophie tmd des sogenannten Tnnnsch&dels.)

Meltzer (Chemnitz), Neurolog. Centralbl., June 16, 1908,
p. 562.

In this paper Dr Meltzer draws attention to the frequency of
peculiarly shaped heads in institutions for the blind, and in a
series of 20 cases he points out the association between optic
atrophy and a shape of head to which the Germans give the
suggestive name of “ Turmschadel ” or tower-shaped. The Turm-
schadel is symmetrical, the top of the cranium rises high above the
ears, and the apex of the tower is of very small dimensions Of the
20 cases 3 were scaphocephalic, 5 were sphenocephalic, and 12
oxycephalic, and most instructive sketches are given illustrating
these peculiarities. In tabular fashion various points of interest
are noted. Among these we may mention that 1 case had the
typical shape of head at birth, while 12 cases had a less
marked Turmschadel at birth, and the blindness came on between
the first and sixth years of life, and at the same period the
Turmschadel became more marked. The remaining 7 cases ac¬
quired the peculiar shape of head after becoming blind, and at ages
varying from three months to three years of age. Nineteen out of the
20caseshadnystagmus,and 18 showeddefinite ex-ophthalmos. Nine¬
teen had divergent and 1 convergent strabismus. Under etiology
meningitis serosa was ascertained to be present in 14 cases, and
6 were the result of injury, while 17 out of the 20 were more or
less definitely rachitic.

Dr Meltzer believes that meningitis serosa is the cause in most
cases, producing a degree of hydrocephalus sufficient to exert de¬
structive pressure on the optic, and in some cases also on the
olfactory nerves. The ventricles are the site of the affection. In
13 of his cases the condition had commenced either before or
at birth, while in the remaining 7 cases both the change in
the shape of the head and the optic atrophy developed later, but
within the first three years of life. The author believes that the
peculiar shape of the head is due to hydrocephalic pressure on bones

ABSTRACTS

551

which have a tendency to rickets. After ossification of the bones
and union of the sutures the developing brain aids reabsorption of
the fluid, while it may induce rarefaction of the vault and some
deformity at the base of the skull. The pressure in all cases is
responsible for the optic atrophy, and the interference also with
the olfactory nerves in some instances.

The author suggests that lumbar puncture should be tried
when the communication with the ventricular system is intact,
and when it is not, the lateral ventricles should be punctured or
trephining performed. Whichever operation is carried out, it
should anticipate the complete loss of sight. R. A. Fleming.

THE PATHOGENESIS OF TABES DORSALIS. Tom Williams,
(464) Amer. Joum. Med. Sc., Aug. 1908, p. 206.

Controversy as to the pathogeny of tabes has not ceased since
Duchenne surmised its sympathetic origin, and Charcot later
supposed it to be a posterior column dystrophy, similar to that
of Friedreich’s ataxia. His great authority prevented due atten¬
tion to the researches of Obersteiner and his followers until the
memoir of Redlich appeared in 1896. The views as to the syphi¬
litic etiology of tabes drew greater attention to the work of
Nageotte, who in 1894 had indicated the constancy of lesions of
the radicular nerve at the point where it receives its meningeal
sheaths. These lesions correspond to one or other of the stages of the
granulomatous process, varying as they do from simple round cell
infiltration to granuloma, and even breaking down with formation
of cavities. They are due to primary chronic meningitis, evidenced
by the lymphocytosis found by spinal puncture during life and
post-mortem when skilfully looked for, although the tendency of
the process to resolution and fibrous-tissue formation leaves only
a slight thickening in the membrane, already fibrous by nature.

The changes in the cord are consecutive to this. That this is
so is proved by similar changes of the posterior column after
disease or experimental section of individual roots, and by the
changes occurring in the radicular nerves as the result of increased
pressure due to the growth of cerebral tumours.

The noxa falls unequally upon the various root fasciculi, and
this corresponds to the disparate nature of the sensory troubles,
which are not confined so strictly as was formerly supposed to the
fibres which subserve the sense of attitude and of muscular move¬
ment ; for it is now definitely known that cutaneous sensibility is
always involved more or less, though probably later in the disease.

The superficial lightning pains described by Gowers and the
psychometric analysis of the sensibility of tabetics by Vaschide

552

ABSTRACTS

are an index of this; while the researches of Head enable us to
explain the modifications in terms of deep, protopathic, and epicritic
sensibility. The fibres subserving the life of internal relation
may differ morphologically from those subserving external rela¬
tion, as contended by Pierre Bonnier, with particular reference to
the VIII. nerve, where the cochlear portion, whose function con¬
cerns the outside world, is affected only rarely, while the vestibular
portion, concerned with intrinsic relationships, is involved very
commonly indeed in the tabetic process.

However this may be, it is certain that impaired sense of
attitude is always accompanied by impairment of the deep pain
sense, and of perception of the vibrations of the tuning-fork by the
bones, and as these sensory impressions are conveyed in the same
peripheral path, while they are separated within the cord, clinical
evidence is in entire harmony with the pathogenetic theory
advanced by Nageotte. The data furnished by the optic nerve
symptoms are similarly best explained by a meningeal affection,
involving in this case not a posterior root but a homologue of an
intra-spinal path.

The tabetic symptoms referable to the sympathetic do not
differ from those produced by experimental section of the spinal
roots, nor from those in syringomyelia, which, however, attacks
the cell bodies in the intermedio-lateral columns. Charcot’s nega¬
tion of changes in the sympathetic is effectively disproved by the
researches of Roux, who found the medullated fibres markedly
decreased in tabetics.

The anterior roots are not unaffected, but the relative absence
of serious myopathies early in the disease is accounted for by the
rapid regeneration of the fibres. This is shown by the “ termin-
aisons en croissance ” exhibited in Nageotte’s preparations and by
the results of section experiments. The regeneration of the
posterior root fibres extends only to Redlich’s ring, at which they
lose the neurilemma sheath.

Finally, evanescent lymphocytosis and reflex iridoplegia, the
two most characteristic signs of tabes, are found in many cases of
syphilis without other tabetic symptoms; indeed, both sometimes
occur in the secondary stage, the former in as many as 40 per
cent, of cases.

The contention of Babinski and Nageotte is therefore accepted
that a chronic syphilitic meningitis is responsible for what has
been called tabes dorsalis, and that it was formerly disregarded on
account of the tendency to the occurrence of resolution and fibrosis
of the lesions.

The practical application of this conclusion is of the greatest
importance in the treatment of the disease. Cases taken early
may be completely arrested, and in all cases the active manifests-

ABSTRACTS

553

tions may be resolved if adequately treated before the destruction
of the noble elements has occurred, though naturally the residues
of former exacerbations cannot be removed.

Author's Abstract.

TABES WITHOUT LIGHTNING PAINS. (Le tabes sans douleurs

(465) fulgurantes.) J. Abadie et Nogue, Jour, de mid. de Bordeaux,
1908, p. 37.

The writers examined 400 cases of tabes in Pitres’s clinique, and
found that 16, or 4 per cent., had never suffered from lightning
pains. Only 2 of these patients had suffered from tabes for more
than ten years, and only 4 for more than five and less than ten
years. In most of the cases the other symptoms of tabes were
ill-marked. Some of them presented other sensory disturbances,
e.g. numbness, stiffness, and lassitude, but these symptoms were of
slight intensity. J. D. Rolleston.

CO-EXISTENCE OF TABES IN THE MOTHER AND ACTIVE
(466) SYPHILIS IN THE INFANT. (Coexistence dn tabes chez
une malade et de syphilis en evolution chez son enfant
nonveau-nl.) H. Dufour et Cottenot, Bull, et mim. de la Soc .
mid. des E6p. de Paris, 1908, p. 953.

A child, aged one month, was admitted to hospital with typical
congenital syphilis. Death took place four days later. The
mother gave the following history:—Five years previously the
husband had been under treatment, the nature of which he had
concealed from her. The following year she had lost much of her
hair, and subsequently had given birth to a premature still-born
child. During the last two months she had suffered from lightning
pains. She had had no treatment. Examination showed that the
right knee-jerk was lost and the left was very weak. The right
ankle-jerk was very weak, and the left was lost. The pupils were
unequal. Reaction to light was very sluggish in the left, and
almost absent on the right. Lumbar puncture showed abundant
lymphocytosis. The case proves that, contrary to the opinion
expressed by many authorities, tabetics should undergo treatment,
since they are capable of transmitting active syphilitic lesions to
their offspring. J. D. Rolleston.

554

ABSTRACTS

THE JSTIOLOGIOAL TREATMENT OF TABES. (Le traitement

(467) Itiologique dn tabes.) Milian, Progrh midical, 1908, p. 301.

Of all parasyphilitic affections tabes seems to benefit most from
mercurial treatment. After mentioning the preventive action of
mercury, Milian states that complete cure of tabes by this drug
is not very rare, whilo arrest of the disease is still more frequent.
Certain symptoms, such as lightning pains, may be caused to
disappear entirely, but the action of mercury in this respect is not
constant, for it apparently aggravates the pains of tabetics in
whom ataxia is present, while it relieves those in whom the
symptoms are ill-developed (tab&iques frustes).

J. D. Rolleston.

A CASE OF ANTERIOR POLIOMYELITIS OF SPEOIFIO ORIGIN.

(468) (Oas de Poliomyllite ant&ieure d’origine sp&ifique.) A. van

Gehuchten, Le Ntvraxc, Juin 10, 1908, p. 331.

The case was that of a man of 32, who, twelve years after a syphilitic
infection, developed a muscular paresis and atrophy, leading in
about nine months to complete disappearance of the affected
muscles. The left upper arm was first affected; several months
later, the right. The order of involvement was the same in both,
starting in the muscles of the shoulder girdle (deltoid, supra- and
infraspinatus, and sub-scapularis (?)), theu spreading to the biceps
and brachialis anticus, and lastly, the muscles on the outer aspect
of the front of the forearm. The triceps, muscles on inner side of
and behind the forearm, and muscles of the hands, were spared
entirely. There were no sensory disturbances, the reflexes and
motility of the lower limbs were unaffected, there was no E.R.D.
in the affected muscles, simply a progressive loss of contractility.
Clinically, an atrophy of the Aran-Duchenne type, the author con¬
siders it to be probably an anterior poliomyelitis, the result of
syphilitic vascular disease, and arrested by vigorous mercurial
treatment. Apparently the 5th and 6th cervical segments were
involved. Some consideration follows of the relationship between
the segmentary nuclei of the cervical enlargement and the anterior
nerve roots. J. H. Haevby Pibie.

ANALYSIS OF SEVENTY-SIX OASES OF POLIOMYELITIS

(469) ANTERIOR AOUTA. Byrom Bramwell, Clinical Studies ,
July 1, 1908, p. 371.

The author analyses seventy-six cases of this disease according to
sex, age, initial symptoms, period of the disease at which the
paralysis was first noticed, distribution of the initial paralysis and
of the residual paralysis. Edwin Bramwell.

ABSTRACTS

555

DISEASE OF THE PRIMARY MOTOR NEURONES CAUSING
(470) THE CLINICAL PICTURE OF ACUTE ANTERIOR POLIO¬
MYELITIS : THE RESULT OF POISONING BY CYANIDE
OF POTASSIUM. Joseph Collins and Harrison S. Mart-
land, Joum. Nero, and Ment. Die., July 1908, p. 417.

In a fairly careful search of the literature, the authors have been
unable to find any cases of neuritis or poliomyelitis due to cyanide
of potassium. It is unnecessary to describe in detail the symp¬
toms of the case here recorded, for the reporters of the case say
that it is indistinguishable from an anterior poliomyelitis. The
patient was a silver polisher in a hotel. His work was to drop
the silver into a solution of cyanide of potassium and then to dry
it. His hands and arms had taken on a deep red brown colour,
were frequently distressingly itchy, and his finger nails were quite
black. His illness began with severe diarrhoea. The following
day he complained of severe headache and pain and stiffness in
the back of the neck. He was mildly delirious, and for a few
days had some neck retraction. On the fifth or sixth day his
arms and legs were so weak he could scarcely lift them On the
eighth day he had retention of urine. The patient made a slow
recovery, and at the time of writing was still improving.

The authors have made some experiments on rabbits, adminis¬
tering small but poisonous doses of potassium cyanide. Paralysis
of the hind limbs, with loss of the reflexes, convulsions, and incon¬
tinence, resulted. Central chromatolysis with nuclear eccentricity,
vacuolisation, and shrinkage, with almost complete solution of the
cell, was observed in the anterior horns from the lower cervical
region to the upper lumbar region, varying in degree, but most
marked in the mid-dorsal part of the cord. The changes observed
in the anterior horn cells were, in the opinion of the authors, due
to an extension of a peripheral multiple neuritis, i.e. of an axone
degeneration so severe that it ultimately affected the cell itself.

Edwin Bramwell.

SYRINGOMYELIA WITH SYRINGOBULBIA. John H. W. Rhein,
(471) Joum. Med. Research, March 1908.

This article consists of the clinical report of Syringomyelia with
Syringobulbia in a woman aged 59 with a sixteen years’ history,
of a careful pathological examination, of a full reference to the
literature bearing on the case, of descriptive plates, and of a dis-
cussiou of the case observations being put forward which warrant

556

ABSTRACTS

the conclusion that syphilitic disease of the cord and meninges in
syringomyelia is probably more than a coincidence.

The lesion in syringobulbia does not, except in one reported
case (Spiller), extend beyond the lower part of pons, and yet
cranial nerves above nucleus of facial nerve are frequently in¬
volved in cases of syringobulbia. The author states that symptoms
in distribution of nerves above the seventh may be due to pressure
upon them by a co-existing leptomeningitis. In case under con¬
sideration there was peripheral degeneration from pressure of
intense leptomeningitis found in third nerve, in fourth nerve, in
fifth nerve, in right ninth and tenth nerves, in both eighth nerves,
in right seventh and both optic nerves.

The distribution of the cavity and resulting degeneration is
very fully described, other clinical features of case being left
hemiplegia, ataxia, atrophy of hand muscles and of right half of
tongue. Characteristic sensory disturbances were observed.

W. Kelman Macdonald.

SPINAL SPRAIN: Its Complications and Consequences, with Report
(472) of Cases. P. Le Breton (Buffalo), Jour. Am. Med. Assn.,
May 23, 1908.

The object of the author is to review the general subject of spinal
sprains from a clinical and practical standpoint, emphasizing the
importance and frequent necessity of fixation.

The clinical groups are: (1) sprain; (2) sprain followed by
neurotic symptoms ; and (3) sprain accompanied by spinal cord
symptoms. Injuries are more commonly indirect than direct; the
site is most often the lumbar dorsal region.

The pathological changes are those of a sprain, the ligaments
about the spinal column are tom, muscle and fibrous tissue
lacerated, exudation of blood and serum into the tissues, and
often the formation of a blood clot in the spinal canal which
presses on the cord. As a direct result there may be temporary
loss of function, meningitis or pachymeningitis, but the commonest
condition is a subsequent zonal paralysis or mild transverse
myelitis, from which recovery is partial or complete.

The diagnosis is based upon the history of injury, change of
posture, stiff gait, drawn facies, contour of spine, tenderness, and
limitation of spinal motion (due to pain or spasm).

The outlook is better if the diagnosis is made early and treat¬
ment is prompt, and the author strongly approves of some sort
of mechanical support properly adjusted to the needs of the
individual case, and applied early.

His paper includes the case histories of ten patients whose
symptoms varied from those of simple sprain to neurotic and to
spinal cord symptoms. C. H. Holmes.

ABSTRACTS

557

THE THERAPEUTICAL VALUE OF LUMBAR PUNCTURE IN
(473) THE MENINGEAL FORMS OF TYPHOID FEVER IN
CHILDREN. (La ponction lombaire dans les formes mening&s
de la fievre typholde chez l’enfant. Son ntilitd th^rapeutique.)

Rocaz et Carles, Bull, et mim. de la Soc. de mid. et de chir. de
Bordeaux, 1907, p. 453, and Gaz. hebd. des sciences mid. de
Bordeaux , 1908, p. 39.

Typhoid fever in children is often accompanied by meningeal
symptoms, which may be slight and transitory, but are sometimes
more pronounced and persistent. Four chief forms are described.

1. In the second or third week the “ meningeal tripod" of head¬
ache, vomiting, and constipation appears, followed by cutaneous
hyperesthesia, irregular pulse and respiration, and ocular troubles.
The symptoms either disappear in a few days or end in death.

2. The complete picture of cerebro-spinal meningitis. In addition

to the symptoms present in the first form, Kemig’s sign and stiffness
of the neck and vertebral column, are present, and the hands and
feet assume the tetany position. This is the form most frequently
met with. 3. Typhoid fever at the onset may closely resemble
tuberculous meningitis. 4. A form peculiar to nurslings charac¬
terised by subintrant convulsions which prove rapidly fatal.
Lumbar puncture may show (a) pus containing typhoid bacilli
either pure or associated with staphylococci; ( b ) a turbid or even
transparent fluid in which typhoid bacilli and other organisms are
found on centrifugalisation ; (c) a clear fluid containing abnormal
cellular elements, and showing as a rule abundant lymphocytosis;
(d) a liquid of normal composition, but escaping in a jet. In the
first two cases there is a direct microbial infection of the meninges,
and in the last two probably a meningeal irritation due to microbial
toxines. Lumbar puncture is of value in that it removes the
microbes and their toxines, diminishes the compression of the
nerve centres, and causes disappearance of the symptoms. Eight
illustrative cases, hitherto unpublished, are recorded. All
recovered. J. D. Rolleston.

THE SYMPTOM-COMPLEX OF OCOLU8ION OF THE POSTERIOR
(474) INFERIOR CEREBELLAR ARTERY: TWO OASES WITH
NE0R0P8Y. William G. Spiller, Joum. Nerv. and Meni.
Dis., June 1908, Vol. xxxv., No. 6.

The symptom-complex of occlusion of the posterior inferior cere¬
bellar artery is usually sharply defined, although it may be difficult
to exclude implication of the vertebral artery. The onset is usually

558

ABSTRACTS

sudden and without disturbance of consciousness. The limbs are
not paralysed, or at most are paretic on the side opposite the lesion,
and the paresis is not persistent. Pain and temperature sensations
are diminished or lost in the limbs of the side opposite the lesion
and in the whole or a part of the fifth nerve distribution on the
side of the lesion, occasionally also in the face on the side opposite
the lesion. Spontaneous pain or paresthesia may be felt in the
area of disturbed objective sensation. Tactile sensation and sense
of position are usually intact. Ataxia may be present in the
limbs on the side of the lesion, with a tendency to fall toward the
side of the lesion. Paralysis of the muscles of deglutition, of the
soft palate and larynx occurs on the side of the lesion, with small¬
ness of pupil, retraction of eyeball and narrowing of palpebral
fissure (sympathetic paralysis) on the side of the lesion. Hiccough¬
ing and vomiting may be obstinate, and the pulse may be rapid
from paralysis of the vagus. The deep reflexes usually are dimin¬
ished or lost, but may be exaggerated. Headache may be intense.
These are the principal symptoms, but there may be others—
nystagmus, vertigo, disturbance of micturition, paresis of the tongue,
of the seventh nerve distribution and external rectus, and impair¬
ment of taste on the side of the lesion, etc., depending on the
extent of the thrombus. The author has found sixteen reported
cases in which necropsy was obtained; there are others purely
clinical. The right posterior inferior cerebellar artery is sometimes
absent, and the lesion is more commonly left-sided. The occlusion
affects the lateral and posterior part of the medulla oblongata
without extending to the periphery and without producing lesions
of the cerebellum, as the anastomosis in the latter is usually suffi¬
cient to prevent softening. The symptoms are explicable by the
anatomy of the part affected. The author reports two cases with
necropsy in which the symptoms and lesions were typical, although
in the second case the lesion extended a little further anteriorly
than in some of the reported cases. Author’s Abstract.

A CASE OF CHRONIC MIDDLE EAR 8UPPURATION COM-
(475) PLICATED BT TUMOUR OF THE PONS (GLIOSARCOMA).
(Ein Fall von chronischer Mittelohreiterung kompliziert mit
Ponstumor (Gliosarcom).) W. Kustner, Arch. f. OhrenMJcde.,
H. 3, p. 181, 1908.

The patient, a woman set. 23, had suffered from running ears for
six years. Four months and two months before admission she had
had attacks of giddiness coming on after dancing, and on the
second occasion she also noticed weakness of the right leg. Three
weeks later she had an attack of vomiting, and this recurred every

ABSTRACTS

559

morning. She also suffered from severe headaches, her condition
became so rapidly worse that she was admitted to hospital. On
examination, the sixth nerve on the left side was found to be
paralysed, there was some redness of the left disc, the face was
paralysed on the left side, and taste (anterior two-thirds of tongue)
and smell were also impaired. Nystagmus appeared on deviation
of the eyes to the right. There was loss of power in the right arm
and leg, and the sense of touch was impaired. The deep reflexes
were exaggerated and the plantar reflex showed dorsiflexion.

A radical mastoid operation was performed on the left side,
and the temporal lobe was also explored, with a negative result.
Two months later the patient died. At the sectio a glioma was
found in the left half of the pons. W. G. Porter.

THE INDICATIONS FOB OPEBATIVE TBEATMENT IN CHBONIO
(476) INFLAMMATIONS OF THE FBONTAL SINUS. (Ueber
Indik&tionen zur operativen Behandlung bei der chroniscben
Stirnhohlenentzimdung.) M. Hajek, Wien. med. Wchnsch., Bd.
58, H. 26, S. 1466.

The author asserts that the indications for operative treatment in
inflammation of the frontal sinus have not been sufficiently dis¬
cussed, for the views of various authorities are widely at variance.
In acute inflammation opinions cannot differ widely. Most cases
heal without operation, a number with endonasal treatment, and
those alone require a radical operation where the bone is also
diseased.

Chronic Inflammations .—Apart from those cases in which there
is diseased bone and evidence of intracranial complications, and
where there is no question but that a radical operation is required,
the majority of cases consist of those showing a clinical picture
of nasal discharge accompanied by headaches. If treated by the
usual endonasal methods these can be divided into three classes:

1. A few cases which entirely heal in a short time.

2. Many cases which are cured of headache but where the
discharge continues.

3. Many cases in which the headaches are not cured and the
discharge does not stop.

If we consider groups 2 and 3, the question arises—How long
are we to wait before proceeding to the radical operation ? Hajek is
of the opinion that we can safely wait for months, especially if the
pain is relieved, for the risk of intracranial complications is ex¬
aggerated. It should also be remembered that the radical opera¬
tion is not unaccompanied with risk. W. G. Porter.

560

ABSTRACTS

TUMOUR OF THE FRONTAL LORES, WITH SYMPTOMS SIMD-
(477) LATINO PARESIS. F. X. Dkrcum, Joum. Nerv. and Merit.
Dis. t July 1908, p. 438.

The mental symptoms in this case “ in a way suggested paresis.”
The patient’s manner was very like that of a paretic. He did not
realise that he was ill. He treated everything as a joke. His
habits and conduct were greatly changed. He became indifferent
as to his professional duties and unpunctual in his appointments.
Headache, defective vision, more especially in the right eye, and
due to a postneuritic atrophy, loss of smell, and some tremor of
the tongue and lips were practically the only additional positive
signs present. Post-mortem, an enormous encapsulated sarcoma
was found involving both frontal lobes. Edwin Bramwell.

HERPES ZOSTER AND MUMPS. (Zona et oreillons.) Apert,
(478) Midecine Modeme, 1907, p. 210. (Soc. de P6d.)

A child, aged 8 years, developed herpes zoster forty-eight hours
before the appearance of mumps. Lumbar puncture gave issue to a
clear fluid which contained only a few lymphocytes. There was,
therefore, no meningeal reaction. J. D. Rolleston.

DYSPRAXIA IN LEFT HEMIPLEGIA (Dyspraxia bei linksseitiger

(479) Hemiplegie.) Hildkbrandt, Neurol. Centralbl., Juni 16, 1908,
p. 576.

A case of left hemiplegia in which there was dyspraxia in the
right hand. The patient was left handed, but had practised move¬
ments with the right hand. This observation, in the author’s
opinion, supports the view advanced by Liepman that the condi¬
tion is intimately connected with right-handedness.

Edwin Bramwell.

URjEMIO HEMIPLEGIA AND APHASIA. (Hfcnipllgie droite et
(480) aphaaie urlmiques.) R. Dup£ri£, Jour, de mid. de Bordeaux.
1908, p. 119.

A female, aged 73 years, who was supposed to have senile
myocarditis, suffered from syncopal attacks in which considerable
increase in the volume of the liver, oliguria, and albuminuria were

ABSTRACTS

561

observed. After appropriate treatment the hepatic dulness
diminished, and the urine became normal in twenty-four hours.
An unusually severe syncopal attack subsequently developed, in
which right hemiplegia and aphasia occurred. Oliguria and
albuminuria were pronounced. Death, preceded by coma and
Cheyne-Stokes breathing, took place five days later. The diagnosis
of cerebral embolism was made, but at the autopsy no trace of
endocarditis or cardiac thrombosis was found. The kidneys
showed the lesions of chronic nephritis. There was no cerebral
oedema, and no recent macroscopical lesions of the left hemisphere
could be found, but only a small and old-standing erosion of the
inferior parietal convolution. Dup&id concludes that the nerve
centres were intoxicated by the accumulation of urinary poisons,
and attributes their localisation to the presence of the pre-existing
lesion. J. D. Rolleston.

SPLITTING OFF OF THE COLOUR-SENSE. (Ueber Abspaltung
(481) der Farbensinnes.) Lewandowsky, Monatsschr. f. Psychiat. u.

Neur., Bd. 23, S. 488-510.

The essential points of the case here carefully described and
analysed are as follows:—A man of 50 suffered from sensory
aphasia (of the typical complete Wernicke form), due probably to
embolism. As this recovered certain remarkable symptoms were
left behind. Thus, though the patient could distinguish all shades
of colour, and so had no colour-blindness, he could not (1) name
the colour of any object shewn or mentioned to him, (2) pick out
named colours, (3) pick out colours of objects known to him. The
condition was obviously not a part of any agnosia, for the patient
recognised the use, meaning, and name of all objects.

Wilbrand described twenty-four years ago a condition that he
called amnesic colour-blindness, in which the patient was unable
to name the colours of objects, though he had no true colour¬
blindness. Many similar cases have been described, but Lewan¬
dowsky doubts the existence of any such condition, inasmuch as
the presence of other defects above-mentioned was never inquired
into in the cases recorded. He therefore refuses Wilbrand’s
explanation of them as being due to a separation between the
colour-sense centre and the speech centre (a form of transcortical
motor aphasia), and with very ingenious and close reasoning,
supported by various forms of testing, traces the defect to an
inability to associate the colour and form of an object. The
patient could not conceive the colour or name of red, for instance,
because he could not associate the colour with objects, blood,
cherries, etc., that it was previously associated with.

Ernest Jones.

562

ABSTRACTS

THE 8IONIFIOANOE OF PHRIOTOPATHIO SENSATION. Ernest

(482) Jones, Joum. Nero, and Ment. Dis., July, Vol. xxxv., p. 427.

This article contains, first, a description, and then an analysis of
this syndrome that is met with during the recovery from certain
forms of hysterical anaesthesia. The six characteristic features of
it are as follows:—(1) Abnormal persistence; instead of the
sensation ceasing to be experienced immediately the cutaneous
stimulus is withdrawn, as in the normal, it here persists in
unabated intensity for a variable time, even up to sixty seconds.
( 2 ) Delayed reaction time; an interval of a few seconds elapses
before the stimulus is apprehended. (3) Non-perception when a
more normal sensation is present; the stimulus is not appreciated
if a normal part is simultaneously stimulated, and the abnormally
persisting sensation is instantly abolished if a normal part is sub¬
sequently stimulated—this even if there is no trace of hypo-
aesthesia in the abnormal part. (4) Tendency to immediate motor
response ; stimulation is followed by an irresistible sudden jerk.
( 5 ) Disagreeable quality; the quality is that of a disagreeable
radiating shudder, which may be intensely unpleasant. (6)
Impairment of the sense of personal owneiship of the part; this
sense may be diminished or totally abolished.

The fourth and fifth of these features were erroneously de¬
scribed as haphalgesia seventeen years ago by Pitres, who was
under the impression that they could be induced only by the
application of certain precious metals.

The explanation given of the syndrome is as follows:—
ASsthesic sensibilities—(a) common, ( b ) coenaesthesic— can be
abrogated by either physical or mental disease; autosomatognostic
memories of a given part of the body only by mental. Hence we
have two forms of hysterical anaesthesia: (1) the common one in
which only the various sensibilities are lost, and (2) a less com¬
mon one in which the memories concerning the part are also lost.
In the latter case, when recovery occurs, both groups of mental
processes are usually recovered together. If the former group is
recovered before the latter, phrictopathic sensation occurs. Thus
the intensity of the features of the phrictopathic sensation is an
accurate measure of the extent of the cleavage between the
aesthesic sensibilities and the autosomatognostic memories.

Author’s Abstract.

A CASE OF BEOUBBENT AUTOH7PNOTIO SLEEP. Bernard

(483) Oettinger, Joum. Nerv. and Ment. Dis., March 1908.

After a prolonged sleep of thirty-five days, patient woke up mute,
nd on day after was apparently deaf, the deaf mutism lasting

ABSTBACTS

563

for four months and nineteen days. An actual delirium was later
developed after a temporary state of hypomania.

The author advocates the extension of the scope of psycho¬
therapy by systematic use of disagreeable as well as pleasing
emotions, especially when avenues of sight and hearing are not
available to conversational suggestion. In reported case patient
was aroused by frequent cool baths after apomorphine (in emetic
doses) and strong induced faradic current had failed.

W. Kelman Macdonald.

COLONY AND BROMIDE TREATMENT OF EPILEPSY. A. J.

(484) M'Callum, Brit. Med. Joum., March 14, 1908.

After giving statistics of results obtained at the Epileptic School
for Boys at Stamthwaite, Westmorland, the author discusses the
cause of epilepsy, throwing aside the “ abnormal state of chemical
nutrition” adduced by Gowers, and maintaining that epilepsy
becomes a reflex act in its origin and a cerebral vice in its fuller
development and perpetuation.

Bromide of potassium is used in the treatment, the dose being
the amount necessary to control the fits—40 grs. sometimes, 100
grs. often, and even 300 grs. per diem.

Method is to give 20 grs. night and morning, and increase by
10 grs. per day as often as fits recur. Diet is summed up in three
meals a day, everything fresh, everything limited, flesh never
oftener than once a day, and three times a week is ample.

W. Kelman Macdonald.

THE MENTAL STATE IN OHOREA AND CHOREIFORM
(485) AFFECTIONS. Charles W. Burr, Joum. Nerv. and Ment.
Dis., June 1908.

Fob the better study of this subject cases are divided, as far as
mental symptoms are concerned, into four groups:—First, peevish¬
ness, fretfulness, and selfishness ; second, transitory hallucinations ;
third, delirium; and fourth, stupor or acute dementia. No mental
symptoms are regarded as pathognomonic of chorea, and the
author denies existence of a disease “chorea insaniens,” but
regards chorea in childhood as an indication of inherent nervous
instability requiring careful teaching of child in self-control.
Numerous illustrated cases are given.

W. Kelman Macdonald.

564

ABSTRACTS

BLOOD PRESSURE IN NEURASTHENIC STATES AND THE

(486) EFFECT OF CERTAIN FORMS OF TREATMENT THEREON.

Eric D. Macnamara, Lancet , July 18, 1908, p. 151.

The author summarises his conclusions as follows:—

1. In many cases of neurasthenia there is an alteration of the
level of the blood pressure from the normal, the level being some¬
times higher and sometimes lower than normal.

2. Patients who show such alterations and who undergo certain
sorts of treatment manifest, in some cases, at the end of a course
of treatment a level of pressure different from that which existed
before treatment began. If the pressure at the beginning be
abnormally high it will probably descend, while if it be abnormally
low it will probably ascend.

3. The number of patients whose blood pressure is different at
the end of their course of treatment from that which it was before
treatment began is greater among those without a family history
of nervous instability than among those with such a history.

4. In a very large majority of cases the application of high-
frequency currents produces a lowering of blood pressure, while
the static bath (plus charge) and massage produce a raising of
pressure. The discharging of a patient charged with static elec¬
tricity results as often in a rise as in a fall of blood pressure.
The application of the faradic current tends rather to lower than
to raise the blood pressure, and the galvanic current cannot be
said to effect much change in either direction.

5. It is difficult to institute treatment with any confidence
that there will be at the end of the course such an alteration as
might perhaps have been expected from a knowledge of the altera¬
tion that is likely to follow each application of the therapeutic
agent employed, though we may look for a change of level when
the level was at the commencement abnormal to one that is nearer
the normal.

6. There is no evidence that the differences of variation of
level before and after treatment which may sometimes be noted
can be correlated with improvement of health.

Author’s Abstract.

AUTO-SUOOE8TION IN NEURASTHENIA. (L’Antosuggestiou

(487) chez les neurasthlniques.) Hartenberg, Rev. de M6d., Juin,
p. 561.

The author briefly mentions ten cases in support of his opinion
that auto-suggestion plays no part whatever in true neurasthenia,
and that when it is present some other condition exists, such as
hysteria, disequilibration, neuropathism, etc.

Ernest Jones.

ABSTRACTS

565

INCOMPLETE M7XCEDEMA. A. R. Elliott (Chicago), Jour. Am.

(488) Med. Assn., May 3, 1908.

The object of the paper is to draw attention to a condition of
hypothyroidia or insufficiency of the gland secretion, which is prob¬
ably an incipient or early stage of myxoedema. The symptoms
are so slight that they are often not recognized, or are mistaken
altogether. They are the same as in fully-developed myxoedema,
but less intense, and not typically grouped. They disappear
under thyroid feeding, as do those of the fully-developed disease.
Most of these cases of hypothyroidia are encountered in women
about the time of the climacterum, and are often attributed to the
menopause—the predominance of all myxoedematous states in the
female over the male is in the ratio of 7 to 1.

Some of the most important symptoms by which this con¬
dition is recognized are: transient oedemas, scaly skin, joint pains,
neuralgias, parasthesias, extreme susceptibility to cold, yellow
tinging of the skin, disposition to obesity, mental dulness; the
thyroid may or may not be diminished in size, sometimes it is
even enlarged.

Elliott reports two of his own cases which were diagnosed
early, given prompt treatment by thyroid feeding, and made good
recoveries. C. H. Holmes.

TO WHAT EXTENT IS MIGRAINE AMENABLE TO TREATMENT

(489) OP THE EYES? E. M. Alger (New York), N.Y. Med. Jour.,
June 6, 1908.

After a brief discussion of the symptoms and course of the
disease, with an attempt to define clearly his position as to what
should warrant a diagnosis of “ Migraine,” the author turns to the
importance of eye strain as a causative factor in its development.
He states that three per cent, of cases develop between the ages of
5 and 10 years, or at the time when school life first puts a strain
on the eyes; in old age, when accommodative power has practically
disappeared, migraine attacks almost never occur; abuse of the
eyes often precipitates an attack in apparently healthy people.
The three ocular disturbances which are most concerned in the
development of this condition are: (1) over-use of the ciliary
muscle in accommodation, such as occurs in hyperopia and astyg-
matism; (2) conditions in which binocular vision is impossible
without undue strain of the extrinsic ocular muscles; (3) cerebral
fatigue that comes from the continual interpretation of distorted
retinal images, such as are present in astygmatism and aniso-

566

ABSTRACTS

metropia. Ten cases are cited in which, after careful study, it was
decided that ocular disturbances were the cause of the trouble.
Attempts were made to correct these, and improvement with
ultimate recovery followed. C. H. Holmes.

HEART FAILURE IN EXOPHTHALMIC GOITRE (L’asystolie
(490) mortelle dans la maladie de Basedow.) G. Mouriquand et
L£on Bouchut, Semaine mid., 8 Juillet 1908, p. 325.

A critical analysis of the literature upon this subject leads the
authors to conclude that there is no convincing evidence of heart
failure, induced simply by tachycardia, being ever the sole cause
of death in exophthalmic goitre. In most of the cases which
terminated by heart failure there was some antecedent cardiac
disease, and the fatal issue was merely accelerated by the tachy¬
cardia. In a second group of cases there was some other con¬
comitant disease, such as pleurisy or Bright’s disease, but in these
cases the heart would probably not have been regarded as healthy
had the myocardium been examined microscopically. Finally,
there are cases where at first sight there did not appear to be any
other cause for the heart failure than the tachycardia. These
cases, however, have usually run a rapid and progressive course,
and the morbid changes both in the thyroid and in the heart can
be referred to some recent and general infective disease, and most
commonly to a rheumatic infection. W. F. Ritchie.

THE X-RAY TREATMENT OF EXOPHTHALMIC GOITRE.

(491) C. Thurstan Holland, Arch, of the Roentgen Ray, July
1908.

The writer publishes his results in a series of twenty cases. The
method adopted was to expose either side of the neck alternately
to X-rays for ten minutes two or three times a week. The most
prominent results were an immediate drop in the pulse-rate in
nearly all the cases, together with marked improvement in the
muscular tremor and general nervousness. The gland itself some¬
times diminished in size, but what was more noticeable was the
fact that in the cases where the gland was hard and tense, after a
very few exposures it became much softer. The exophthalmos
did not materially alter. It was pointed out that there was &
danger in these cases of producing myxoedema, and the suggestion
was made that in future cases it would be wise to treat one side
of the gland only.

ABSTRACTS

567

The author is strongly in favour of this method of treatment,
which, of course, can be combined with the usual medicinal
methods. Author’s Abstract.

MENTHOL POISONING IN MAN. (Ueber Mentholvergiftung des

(492) Menschen.) Schwenkenbecher, Munch, med. Woch ., 1908,
No. 28, p. 1495.

It is known that the external application of menthol produces a
cold sensation. The writer has shown that by stomach adminis¬
tration of 8 grammes of menthol there is induced, in addition
to slight symptoms of general intoxication, a condition of local
and remote temperature parcesthesia.

Thus a cold sensation is felt in the mouth, throat, and oeso¬
phagus immediately on swallowing the menthol, in the nose a little
later, and in the anus during excretion of menthol in the faeces.
The absence of this sensation in the stomach and abdomen agrees
with the observation that the mucous membranes of the stomach
and intestines possess no “ cold sensitive ” nerves.

There is also produced a hyperexcitability of the “cold
sensitive” nerves in the skin, so that anything touched by the
hand feels ice-cold, showing that menthol exerts a selective
stimulating action on these nerves also when conveyed to them
by the blood. J. A. Gunn.

MULTIPLE RELAPSING GANGRENE OF THE ARMS AND

(493) FOOT. AMPUTATION OF THE LEFT ARM DISCUSSION
ON THE NATURE OF THE GANGRENE. PATHOMIMESIS.
(Escarres multiples et recidivantes depths deux ans et demi
aux deux bras et un pied. Amputation du bras gauche.
Discussion but la nature des escarres. Pathomimie.) Disu-
lafoy, Bull, de VAcad. de mid., 1908, p. 635, and Presse
Midicale, 1908, p. 369.

A well-educated man, aged 30, free from any alcoholic or nervous
taint, consulted Professor Dieulafoy in April 1908 for a gangrenous
affection of the arms of two and a half years’ duration. During
this period he had consulted numerous physicians and surgeons,
who had respectively diagnosed neuritis, syphilitic or tuberculous
ulceration, and hysterical trophic troubles, and subjected him to the
most varied treatment without effect. A surgeon who diagnosed
trophic ulceration following neuritis performed elongation of the
nerves of the left brachial plexus. The pain in the arm then
became intolerable, requiring injection of morphia day and night,

568

ABSTRACTS

and there was a commencement of claw-hand in the ring and little
finger. The surgeon now declared that amputation was the only
means of avoiding the reproduction of the gangrene, and the
operation was performed through the upper third of the upper
arm on August 21, 1906. All went well until February 1907,
when patches of gangrene began to appear again on the right arm.
Elongation of the corresponding brachial plexus was recommended,
but this time was refused. At his first visit to Dieulafoy the
patient had no less than 98 lesions on his arms, and a few days
later similar lesions began to appear on one foot. Dieulafoy found
no evidence of syphilis, diabetes, tabes, or neuritis, and never
having seen trophic troubles following hysteria (v. Rev. of Neurol,
and Psych., p. 426, 1908), he concluded that the lesions were the
result of simulation and were due to the application of caustic
potash. The accuracy of this diagnosis was admitted by the
patient, in a dramatic scene, in which Dieulafoy told him that
though up to that moment he had been acting under an irresistible
impulsion, persistence in such conduct would stamp him as an
impostor. Dieulafoy has adopted the term “ pathomimie ” (patho¬
mimesis), supplied him by the well-known writer Paul Bourget, to
designate the mental condition of such persons, who, in addition to
the systematic fabrication of falsehoods (mythomania of Duprd),
simulate diseases either with a fraudulent intent, or, as in the
present case, without any such motive, but simply from a disin¬
terested love of mystification. J. D. Rolleston.

PSYCHIATRY.

PUPILLARY PHENOMENA IN THE INSANE. (Contribution A
(494) l’dtude do la pupille des Alidnds.) J. Chardinal and Gastao
de 0. Guimaraes, Arch. Brasil, d. Psych. New. e Med. Legal.,
Anno iv., Nos. 1 and 2, 1908.

In this paper the authors state the results of an investigation into
the pupillary phenomena of 1651 inmates of the Hospital for the
Insane at Rio de Janeiro. The cases comprised 72 general para¬
lytics; 364 cases of “alcoholism”; 116 of precocious dementia;
150 of epilepsy; 267 of hysteria; 7 of cerebral syphilis; 72 of
paranoia; 12 of cerebral sclerosis; 170 of senile dementia; 45 of
manic-depressive insanity; 17 of mania; 64 of lypemania; 51 of
episodic delirium in degenerates; 37 of mental confusion; 63 of
imbecility; 53 of feeble-mindedness, and 16 of idiocy. A note¬
worthy feature of the author’s results was the frequency of
abolition of light-reflex in almost every class of the insane.
That the general paralytics gave the high proportion of 54'9

ABSTRACTS

569

per cent, is perhaps not surprising, but the remaining categories
naturally excite remark. Thus in the alcoholic class the propor¬
tion of male patients with abolition of the light-reflex was 18 2
per cent., dementia prsecox 18 per cent., epilepsy 14 6 per cent.,
hysteria 18*1 per cent., senile dementia 28*5 per cent., manic-
depressive insanity 19 per cent., mania and lypemania each 14
per cent., and episodic delirium in degenerates 18*3 per cent. On
the other hand, anisocoria, or inequality of the pupils, which is
generally believed to be more common in alcoholics, was only found
in 6*5 per cent, of the authors’ cases. The authors give useful
references to the results of other investigators.

R. CUNYNGHAM BROWN.

TWO OASES OF DEMENTIA PESOOZ. (Osservarioni ana-

(495) tomiclie e cliniche intorno a due casi classificabili fra le
demenze precoci.) Benigni and Zilocchi, Riv. Sper. di
Freniatr., Vol. xxxiv., Fasc. 1-2, pp. 23-56.

Two typical cases of dementia praecox are described in great
detail, both clinically and pathologically. In both cases marked
necrobiotic changes were found in the cortex, particularly in that
of the frontal lobes and cerebellum, with degenerative vessel
changes. The authors uphold the toxin hypothesis, and consider
the more probable origin of the toxin to be the internal glands.
They describe marked fatty degeneration of the parenchyma of the
thyroid, suprarenal, and pituitary glands. Ernest Jones.

“ DEMENTIA P&SOOX IN INDIA.” G. F. W. Ewens, Indian

(496) Med. Gaz., June 1908.

Major Ewens in this paper points out that there is in India a
mental disorder of the period of adolescence which conforms in
almost every particular with the “ Dementia Praecox ” of Kraepelin.
This, he states, among Indian insanes is never recovered from: its
duration is prolonged. It commences with mild excitement or
depression, always accompanied by hallucinations. Its main
features are "a peculiar tendency to grimacing, silly tricks of
behaviour, a characteristic speech and manner, a peculiar com¬
bination of apathy, emotional dulness, and defect of volition, the
whole passing inevitably into a characteristic weakness of intellect,
in which very early defect of voluntary control over the sphincters
and general feebleness of judgment and reasoning power contrast
markedly with perfect retention of memory to a very late period.”
Ewens has no doubt but that such a disease exists in India as a
clinical entity, and those who have had experience of insanity
in that country will be found to agree with him. A detailed

570

ABSTRACTS

description is then given of the general clinical features, modes of
onset, the symptomatology and progress of the ailment, together
with a note of the pronounced physical defects commonly met
with among these persons, such as hypersalivation, polyuria, a
tendency to diarrhoea, slow shallow respiration, etc. No treat¬
ment is of any avail, and the pathology is obscure. The complete
notes of a typical instance of the hebephrenic variety is given, and
this, it is interesting to note, is in a European born and bred in
India. The hebephrenic type is the commonest, but Ewens records
that he has two examples of the paranoidal form in his asylum at
present The katatonic variety is also fairly common, and a
description of it is promised in a future paper, which will be
looked for with interest. C. J. Robertson Milne.

THE FINAL STAGES OF DEMENTIA PB£OOX. (EndzustSnde

(497) der Dementia Praecox. Gruppiemng und Prognose der Dem.
Praecox, L) Jahemarker, Zeniralbl. f. NervenheWc. u. Psyehiai .„
Ht 13, S. 489.

This paper, read before the annual meeting of the German Society
for Psychiatry, deals principally with the question as to how far
the dementia praecox group can legitimately be split up. On
this point the author is very sceptical as to the adequacy of our
present knowledge. After some remarks on the importance of
premonitory symptoms which, he insists, belong to the disease
itself, he considers the various factors that account for the
differences in clinical type observable. These he divides into:—
(1) Factors which are accidental in that they lie outside the
disease-process itself; such are personality, social and physio¬
logical differences, external factors, as alcohol, infection, etc.; the
results of these may be temporary or permanent. (2) Factors
which are part of the disease-process itself; rapid or chronic
course, continuous or intermittent progress, etc.

The author accepts the new term, schizophrenia, that Bleuler
has proposed, as a more accurate one for dementia praecox.

Ernest Jones.

THE EYE SYNDROME OF DEMENTIA PR.EOOX H. H. Tyson

(498) and L. Pierce Clark (New York), Joum. Amer. Med. Assoc.,
May 2, 1908.

A systematic attempt is made by the authors to analyse the
significance of eye changes in 115 consecutive cases of dementia
praecox. The work of Siglas in 1899, Meyer, Morro, 1900; Blin,
1905; and Dide and Ascot, 1901, is quoted and criticised as not
having been sufficiently exhaustive to produce definite results.

ABSTRACTS

571

The evidence that dementia praecox is of an autotoxic nature has
been grouped as follows:—

1. “There is a coincidence of certain ocular symptoms with

gastro-intestiual auto-intoxication, similar in many respects
to these seen in typhoid, lead colic, and simple intestinal
putrefaction.”

2. “ The urine in dementia praecox shows very defective elimi¬

nation.”

3. “ Fully one-half of the subjects of dementia praecox die of

tuberculosis.”

4. “ The co-existence of certain toxic dermatoses, such as certain

types of erythema, vasomotor paresis, with chronic gas¬
trointestinal intoxication, is noteworthy.”

5. “ Some additional facts are at hand, as shown in the

co-existence of psychic excesses, neurasthenia, etc., with
states of auto-intoxication.”

6. “ The study of the blood in dementia praecox shows evidence

of a toxic state.”

The authors summarise their findings as follows :—

1. “ They indicate that dementia praecox is attended by such

an early and constant syndrome of alteration of disc,
visual field, pupil and corneal sensibility, as to materially
aid in diagnosticating this psychosis. Consideration of
the syndrome will particularly aid in the differential
diagnosis of dementia praecox from the manic-depressive
group, acquired neurasthenia, hysteria, and the various
forms of imbecility and constitutional inferiority.”

2. “ The syndrome is a distinct contribution to the theory that

dementia praecox is an autotoxic disease, and that the
poison is primarily vascular, which finally induces neuronic
degeneration. It points to a toxin of some sort, which is
either a metabolic defect in the tissues (ductless gland
defect), or, what seems more probable, that the poison is
generated in the liver or in the gastro-intestinal tract
itself.”

3. “ The syndrome is of prognostic value, as the severer grades

of eye changes are found in the more rapidly deteriorating
cases.”

4. “ Finally the optic nerve lesion is quite in accord with our

best knowledge of the pathologic anatomy of dementia
praecox, in other tracts of the brain (than the optic nerve,
which itself may be counted an analogue). The early
vascular changes in the brain ought to receive more
serious investigation.”

While the paper is ingenious and somewhat novel, actual
experience seems to show that there are so many well-defined cases

572

ABSTRACTS

of dementia prsecox in which uo ocular phenomena are found, and
again, so many “ congested discs, pallid discs, dilated veins, con¬
tracted arteries, low-grade perineuritis,” etc., found in patients who
are certainly not suffering from dementia prsecox, that the deductions
drawn are more likely to confuse than to clear the situation.

C. H. Holmes.

THE PSYCHO ANALYTIC METHOD AND THE “ ABWEHR-

(499) NETJEOPSYCHOSEN ” OF FREUD. (La methods psycho-
analytique et les “ Abwehr-Neuropeychosen ” de Freud.)

Schmiergeld and Provotelle, Journ. de Neurol., 5 and 20
avril, pp. 221 and 241.

This is one of the first attempts to introduce the knowledge of
Freud’s work into France, and consists in a short exposd of some
of the principles underlying it, together with an abbreviated
account of the analysis published by Freud in 1905. They give
a few notes of four cases they have analysed, with confessedly
very imperfect technique, and conclude by expressing their agree¬
ment with most of Freud’s theory, though they do not follow him
in many of his interpretations. Ernest Jones.

NEW FACTS IN REFERENCE TO THE SERUM REACTION OF

(500) SYPHILIS IN GENERAL PARALYSIS BY WA8SER-
MANN’S METHOD. (Les nouvelles donates relatives & la
stoo-reaction de la syphilis dans la Paralysis Gdn6rale par la
methods de Wassermann.) Soutzo fils, Ann. Mid. Psychol,
July-August 1908.

The paper is a r£sum£ of articles written on Wassermann’s serum
reaction in syphilis. Within the last two years much work has
been done on this subject, and this goes to show that in the fluids
of syphilitic, tabetic, and general paralytic patients there are specific
antibodies. These antibodies are produced by specific antigens.

Bordet and Gengou, as well as Moreschi, Neisser, and Sach are
credited with the discovery of the phenomenon known as the
“fixation of the complement.” This means that the antigen,
meeting with the corresponding antibody, prevents haemolysis.
Wassermann and Bruck have demonstrated that not only bacteria,
but also diseased extracts from organs, can be used as antigens
to prove the presence of antibodies. It is this discovery which has
been the basis of their experiments in syphilis, tabes, and general
paralysis. It has been shown that the blood serum of monkeys
treated with syphilitic material of monkeys or man, and mixed
with an extract of syphilitic organs, gives rise to fixation of the
complement. To obtain the reaction, Wassermann mixed an

ABSTRACTS

573

extract of an organ of a syphilitic foetus with blood serum of a
syphilitic patient This serum had been rendered inert by being
heated to 56* C. A complement, e.g. the fresh serum of a guinea-
pig, was added, and finally red corpuscles of a sheep. It
was found that in every case haemolysis did not occur because
fixation of the complement had taken place. This result was not
obtained when the serum was mixed with an extract of normal
liver, or when normal serum was used with a syphilitic liver.
Levaditi and Marie have found that the reaction is obtained when
one makes use of a normal liver extract, and other investigators
were successful with lecithin, cholesterin, vaseline, bile salts, etc.
Weil and Braun are opposed to Wassermann’s teaching. They
believe that auto-antibodies are produced by long-continued de¬
generative changes in the tissues.

Marie and Levaditi, in France, have made an extensive study
of the reaction with cerebro spinal fluid. They obtained a positive
result in 73 per cent, of general paralytics. This is a smaller per¬
centage than that of most German investigators, which varies from
80 to 88 per cent. They explain the relatively low proportion of
positive results by the fact that their experiments have been
garried out in early as well as in far advanced cases of general
paralysis, and that in the former class the reaction is not so con¬
stant, because the antibodies are in smaller amount.

Levaditi and Jamanouki carried on the research with blood
serum and cerebro-spinal fluid simultaneously in the same patients.
They concluded that, with the latter, deviation of the complement
is almost always present in general paralysis, very rarely present
in cases with cerebral lesion, and never in other forms of insanity.
Less constant results were obtained by them when blood serum
was made use of.

Plaut, on the other hand, found that, where a reaction with the
spinal fluid was obtained, a similar reaction was present with blood
serum, but where the cerebro-spinal fluid gave a doubtful reaction,
that obtained with the blood was always positive.

The writer concludes that deviation of the complement is
evidence of acquired syphilis, but that the inability to obtain a
positive result does not necessarily exclude syphilis. In any case
it may be present at one time and absent at another.

A very complete bibliography is given.

R. Dods Brown.

A MEDICAL STUDY OF CHATEAUBRIAND. (&ude mddicale
(501) sur Chateaubriand.) E. Masoin, Bull, de VAcad. roy. de mid.
de Belgique, Tom. xxii., 1908, p. 24.

Chateaubriand derived his literary talent and “prodigious
imagination" from his mother, and from his father his melancholy

574

ABSTKACTS

and pride. A sister from an early age showed signs of melancholia
and delusions of persecution, and probably committed suicide. The
so-called confluent smallpox, from which he says that he suffered
at the age of twenty-three, was, in Masoin’s opinion, most probably
urticaria, a highly probable hypothesis, from what is known of
mistakes made during epidemic times at the present day, and
from the fact that Chateaubriand, who was a remarkably hand¬
some man, never presented any scars. Shortly afterwards he
appears to have had an attack of melancholia which lasted four
months, but the lamentations which he gave vent to throughout
life were probably rather the outcome of a pose and of the force
of habit than of any real conviction. So well-occupied a life
would have been impossible had he suffered from the depression
of persistent melancholia. During his stay in London, in 1793, he
showed sigus of tuberculosis, and was doomed by an eminent
physician to an early grave. This gloomy forecast was not
realised, since death, which was due to pneumonia, did not occur
till fifty-five years later, at the age of eighty.

Frequent attacks of gout and rheumatism, as well as some liver
trouble of indefinite nature, played only a secondary part in
explaining his view of life. His acts and writings show that he
possessed the erotic temperament in a high degree. The dark
hints of his contemporaries as to his impotence lack confirmation.
“This problem will remain an eternal riddle to excite the
curiosity of investigators and the verve of physicians.” In spite
of his eccentricities and extravagances, his lively passions, his
exuberant and sometimes ill-balanced imagination, Masoin thinks
that there is nothing to justify Chateaubriand being ranked as a
superior degenerate. “Physiology and psychology claim him as
their own.” The essay ends with a vigorous protest against the
tendency originated by Lombroso and Nordau to stigmatise as
degenerates some of the most illustrious men, too often on the
strength of doubtful facts and apocryphal anecdotes.

J. D. Rolleston.

THE INSANITY OF MAUPASSANT. (La folie de Maupassant.)

(502) Z. Lacassagne, Th&ses de Toulouse, 1906-1907, No. 717,
Rtmond et Voivenel, Progrh Mtdical , May 30, 1908, p. 270.

The writers reject the view that Maupassant was a victim of
general paralysis, and think that he suffered from the chronic
delirium described by Magnan and Sdrieux.

Maupassant’s heredity is of interest. His mother was a gifted
woman, the friend of Flaubert, and of a highly nervous disposition.
The father was a man of mediocre intelligence and of licentious tastes.
Furthermore, Maupassant was predisposed to insanity by reason

ABSTRACTS 575

of the sexual excesses of his early life, to which is to be added
intoxication by ether, morphia, haschisch and cocaine.

The disease began in 1878, when he was 25 years old, and ran
through the four periods of chronic delirium, uneasiness delusions
of persecution, delusions of greatness, and, lastly, dementia.
Death did not occur till 1893. Maupassant continued to write
until the final period. J. D. Rolleston.

THE MENTALLY DETECTIVE IN PKISON. J. Milson Rhodes,
(503) Brit. Med. Joum., June 27, 1908.

The writer in his article on the mentally defective under sentence
has opened up a very important question for discussion. As a
visiting justice he has been studying that bite noir of the alienist
and the penologist, viz., the redevivist, the so-called habitual
criminal, that the recidivist deserves far more attention than he
has yet received appears to be proved by the fact that out of
182,645 prisoners convicted in 1906, 107,408 had previous con
victions against them. Of this number

7,458 had been convicted four times.

5,612 „

„ five times.

17,093

„ six to ten times.

12,592

„ eleven to twenty.

10,700 „

„ above twenty times.

The “above twenty times” includes cases that have been one, two,
and even two hundred times before the court. Some of these
frequent offenders are specialists; one man will always steal fowls,
another boots, another barrows, and another ladders. The two last
should have directed attention long ago to the mental condition of
the offenders, as ladders and barrows, being usually branded, they
are very easy of identification, and therefore not likely to be stolen
by any one who was compos mentis. The very reverse appears to
have been the case. In a well-known work on penology we find
the doctrine set forth that “ such offenders must rather be dealt
with by means of gradually but certainly cumulative sentences,
and by subsequent police supervision.” As far as I know neither
of these will reform a feeble-minded prisoner. Both the so-called
remedies have been tried for half a century, and both have been
miserable failures. It is not the cumulative sentence, it is the
indeterminate sentence, that is required to deal with this class.

The fact that out of 183,000 prisoners only 9200 were able to
read and write well proves that the mass of prisoners are deficient
in intellectual power, or that their environment—mental, moral,
and physical—was so bad that their education has been confined to
two branches—vice and crime.

576

ABSTRACTS

Evil environment in youth is the commonest cause of men
going wrong; the vast majority of prisoners have no idea of any¬
thing approaching intellectual enjoyment; their sole delight is in
the lowest sensual pleasures—drink, gambling, and sexual vices.
For a very large number of prisoners the short sentence is of no
use ; what we want and must have is a better classification of
prisoners, which we are glad to see the Royal Commission on the
Feeble-Minded are in favour of. We must have something more
after the lines of the State Farm of the United States or the
Depot de Mendicity of France and Belgium, colonies where they
may have more liberty without more licence to do mischief or to
work untold injury to the generation following; and to attain this
end we must have power to detain the feeble-minded for an inde¬
terminate period in colonies where they may be made more
useful than in prisons.

That the number of feeble-minded prisoners is much larger than
most people imagine is a fact, and it appears as if some of our
prison medical officers fail to diagnose the true state of the case.
Only a short time ago a young man who had been sent to a re¬
formatory convicted of crime committed a murder two days after
being released from gaol, and yet a prison medical officer said he
was sane, against the opinion of two experts. Surely cases such as
this prove the necessity for experts being called. The verdict of
wilful murder against the man was quashed by the Court of
Appeal, but that does not alter the fact that a man was sentenced
to death for a crime the gravity of which he was mentally incap¬
able of appreciating at the time it was committed.

Author’s Abstract.

BOOKS AND PAMPHLETS RECEIVED.

H. S. Upson. “Insomnia and Nerve Strain." G. P. Putnam’s Sons,
London, 1908. 6s.

F. X. Dercum. “An Analysis of Psychotherapeutic Methods.” E. G.
Swift, Detroit, Mich., 1908.

Renato RebizzL “ Contribute alia Conoscenza della Nevroei Traumatica.”
Tipografia Perugina, 1908.

Julius Grinker. “Subacute Combined Cord Degeneration, with Report
of Cases.” Amer. Med. Assoc., Chicago, 1908.

Rebizzi. “ II bromuro di potaasio per iniezione ipodermica.” Tipografia
Peruigna, 1908.

IRevtew

IRe urology an6 flbs^cbtatr^

©dginal Brticle

A CASE OF INTRACRANIAL TUMOUR.

By EDWIN BRAMWELL, M.B., F.R.C.P.,

Assistant Physician to the Edinburgh Royal Infirmary.

The case which is here recorded presents the following features
of interest(a) The patient suffered for four and a half years
from epileptic attacks; (b) optic neuritis of slight degree con¬
stituted the only objective sign of organic disease; (c) death
occurred after five days’ illness, the patient having been absolutely
free from symptoms apart from fits for six months previously;
(i d ) a series of general convulsive fits occurred five days before
the fatal termination, and continuous movements of protrusion
and retraction of the tongue were observed shortly before death;
(e) a haemorrhage into a large glioma situated in the right
frontal lobe was the cause of death.

Report of Case. —C. M., a lady’s-maid, aged 28, was seen by
the writer at Leith Hospital on 24th November 1906. She
stated that she had suffered from fits for three years, that she
had had severe headaches for the last seven or eight weeks, that
three weeks ago she vomited for two days on end. She could
not recollect ever having vomited before, nor had she done so
since. From her medical attendant it was ascertained that Dr
J. V. Paterson, who had examined the optic discs a few days
previously, had noted the presence of double optic neuritis.

R. OF N. & P. VOL. VI. NO. 10—2 T

578

EDWIN BKAMWELL

Upon inquiry it was ascertained that she had suffered from
headaches, which appeared to be of the megrim type, since
childhood. Her health otherwise had been good, and, with the
exception of an attack of typhoid fever when nine years of age,
she had had no illnesses of importance. There was nothing in
the history suggestive of syphilis, nor was any evidence of that
disease detected upon examination. The family history was
unimportant, saving for the fact that her father had died, aged
fifty-six, from a tumour of the leg which recurred after operation.
No history of tubercle among the relatives was obtained.

The first fit occurred in February three years ago, between
seven and eight o’clock upon a Saturday evening. She was in
service in London at the time, and had been feeling particularly
well. She remained unconscious until the following Tuesday, hav¬
ing nineteen fits in all during that time. Four months later she
had another fit, and again another ten months after this. She
stated that she had had about fifteen tits from that date up to
November 1906. She had taken bromides regularly, but without
any apparent benefit. In June she went to America, where she
had a fit, another occurring about the beginning of October. No
accurate account of the character of the fits could be obtained.
She stated that they came on at any time of the day, that she
had no warning, that she used to fall down unconscious, that she
believed she was convulsed, that she had never hurt herself in
falling, that she passed water sometimes when unconscious, but
had never bitten her tongue. When in America, towards the
end of September, she suffered from headache, which was
distributed all over the head, and extended down the back of the
neck. So severe was the headache that for several nights she
obtained no sleep. The doctor who saw her at the time
attributed the headache to sunstroke. Lately the headache has
gradually improved; occasionally, however, she has a great deal
of pain over the eyes, while she states that at times she
momentarily loses her sight.

The patient is a well-built, though somewhat poorly-nourished
girl. Height, 5 ft. 6 ins.; weight, 8 st. 7 lbs. She is not
anaemic. She is intelligent, and presents no obvious mental
peculiarity. Her memory, she states, is fairly good, and this is
borne out upon examination. She speaks fluently, and never
appears to be at a loss for a word. She understands everything

A CASE OF INTRACRANIAL TUMOUR

579

that is said to her, and has no difficulty in reading or expressing
herself in written language. She is right-handed. There is no
history of left-handedness among her relations. Articulation is
perfectly distinct and phonation unimpaired. Although she
states that at times a cloud seems to pass over her eyes, upon
examination vision is found to equal f with either eye. There is
a slight degree of optic neuritis, the appearances being approxi¬
mately the same in both eyes. No alteration in the fields of
vision is detected upon rough examination. She has had no
diplopia. She hears a watch at about two feet from either ear.
There have been no subjective auditory phenomena. There has
been no discharge from the ears. She recognises the usual test
specimens for smell with both the right and left nostril, although
she cannot name them. There is no note as to the sense of
taste.

There is no ptosis, the optic axes are parallel, the ocular
movements are perfectly satisfactory, and there is no nystagmus.
There is no weakness of the jaw muscles, and no sensory dis¬
turbance in the distribution of the fifth nerve. There is no
facial asymmetry, and the facial movements are satisfactory.
No difficulty in swallowing. The palate moves well. The
tongue is protruded in the middle line, and shows no wasting.

The movements of the limbs are all well carried out.
Dynamometer: Rt. 70, Lt. 55. Co-ordination is perfect, and
there is no tremor and no astereognosis. There is no defect in
the gait.

The knee jerks and ankle jerks are brisk and equal. No
ankle clonus. The abdominal reflexes active and equal. The
plantar reflexes are of the flexor type.

The skull is symmetrical. There is no local prominence and
no area which is tender on pressure. Nothing abnormal is
detected on auscultation and percussion of the cranium.

The heart is of normal size and the sounds pure. Nothing
abnormal is found upon examination of the lungs and abdomen.
No striae gravidarum. The urine contains neither sugar nor
albumen.

On 28th November the patient was again examined by
the writer. It is noted that she had had, since last seen, some
headache on the top of the head, which, however, had not been
severe. It is also stated that there is no tremor of the hands.

580

EDWIN BRAMWELL

14th February 1907.—The patient remained fairly well
until 4th January, when she took another situation as lady’s-maid.
After she had been in service for a week there was a return of
the headache, which was severe and situated over the top and
back of the head, and was accompanied by vomiting which
lasted throughout a whole night. Last week she had another
bout of vomiting which persisted all day. Headache has been
present every day, though not severe ; it often feels merely “ like
a stiffness ” at the back of the neck, she says. Upon examination
there is nothing to add to the previous notes excepting the pre¬
sence of (?) slight right facial weakness. There is no tremor of
the hands.

Patient was admitted for observation to the Royal Infirmary
under the care of Dr Byrom Bramwell on 15th February, and
remained in the ward until 25th March. During the whole of
this time she was free from headache and had neither giddiness
nor vomiting. Her eyes were repeatedly examined during her
stay in hospital. The acuity of vision remained at £. The
fields of vision were slightly contracted. The optic neuritis did
not progress. The temperature remained sub-normal throughout.
The pulse ran from 68 to 96. It was noted that she was rather
irritable at times and that her memory was slightly defective.
She had no fits during her stay in hospital. The slight degree
of weakness of the right side of the face is again referred to.
The patient was given 30 grains of potassium iodide three times
a day over a considerable period. The question of operation was
carefully considered, but decided against, since the headache had
disappeared and the optic neuritis had not increased, while no
new symptoms had developed.

The patient died on 18th November 1907. Her medical
attendant kindly sent me the following account of her illness
during the five days which preceded death.

“ During the last six months, ever since she left the Infirmary,
she has had no headaches, and her eyesight seemed to improve.
On the day she took ill (13th November) she said to a friend that
she had never felt better in her life. She was a great sleeper,
went to bed at 10 p.m. and did not rise till 11 A.M., sleeping
the whole time, except when wakened to take her breakfast.
She was always very bright, except on days following the fits.

“At 11 p.m., 13th November, had a fit during her sleep (has

A CASE OF INTRACRANIAL TUMOUR

581

not had fits since July, when she had two in one week). Two
other fits occurred before 12*30 a.m., when a sixth of a grain of
morphia was given hypodermically. Three more fits during the
next hour, but no more till 2 P.M., 14th November. During the
forenoon she was sick, and heavy retching at times, but had risen
from bed in order to go to bathroom. At 2 p.m. fits recurred,
and she lapsed into unconsciousness, having fits almost every
quarter of an hour. They began by her opening her eyes and
staring, then a general convulsion, with head retraction and turning
of face over left shoulder, followed by clonic movements of
whole body. Stertorous breathing and bubbling r&les in bronchial
tubes were continuous. Heart’s action vigorous and pulse
regular.”

On Friday, 15 th November, the patient was seen by the
writer at 11 A.M. She was comatose. Babinski’s sign was
present on the left, not on the right side. The pupils were
equal, and of medium size. There was no deviation of the eyes
or head. There had been no fits for some hours previously.

“ The fits recurred at 3 p.m., twelve taking place in a few
hours. No special order of movements, but the left arm and leg
were not moved to the same extent as the right. Fits ceased
later in the evening, and did not return. On Saturday evening
there was noticed continuous movement of the tongue and lower
jaw. The tongue was protruded, then retracted, and swallowing
movements took place, but fluid placed in the mouth ran out at
the sides. Temperature, 105 ; pulse, 110.”

17 th November.—“ Has lain quietly all day. When spoken
to, opens her eyes, but without sign of recognition. Has not
spoken since 14th November at 2 p.m. The last fit occurred
on 15th November, in the evening.”

18th November.—“Died at 8 a.m,”

Post-mortem .—Permission was obtained to examine the head.
Nothing abnormal was noted until the dura was opened and the
brain removed. It was then observed that the second and third
frontal convolutions on the right side were much wider than
those on the left, and that the brain in this region was somewhat
fuller, and seemed slightly more resistant on palpation.

After the brain had been hardened in 10 per cent, formalin,
a series of transverse vertical sections were made and examined.

In a transverse vertical section passing through the genu of

582

EDWIN BRAMWELL

the corpus callosum (corresponding to No. 37 of Dejerine’s series)
the right frontal lobe is seen to be distinctly larger than its
fellow. The lower end of the superior longitudinal fissure is
pushed up and to the left The greater part of the centrum
ovale on the right side is evidently occupied by a tumour which
is not encapsuled, and which, both in its colour and consistence,
closely resembles the normal white matter of the brain. The
grey matter of the second and third frontal convolutions is quite
indistinguishable from the subjacent white matter. On the
other hand, the line of demarcation between cortex and sub-
cortex is clearly defined in the case of the first frontal and the
upper temporo-sphenoidal convolution in this section. A large
recent haemorrhage, more or less circular in outline, and measur¬
ing from 2 to 2\ inches in diameter, is situated in the right
centrum ovale. Although the haemorrhage has found its way to
the right lateral ventricle, no blood was found in the other
ventricles of the brain. In a transverse vertical section imme¬
diately posterior to the tip of the temporo-sphenoidal lobes (cor¬
responding to No. 55 of Dejerine’s series) the cortex of the first,
second, and ascending frontal convolutions is seen to be clearly
distinguishable from the subjacent white matter. The nucleus
caudatus and internal capsule have been destroyed, but the
lenticular nucleus has not been implicated in the haemorrhage.
Upon microscopical examination the tumour was found to be a
very vascular glioma, the blood vessels having very thin walls.

Remarks .—The possibility of gross intracranial disease was first
suspected by the patient’s medical man in November 1906, when
he obtained the history of the severe headaches from which she had
suffered two months previously when in America. The circum¬
stance that she had been troubled with headaches ever since
childhood probably led the patient to attach less importance to
this symptom than she would otherwise have done. The detec¬
tion of optic neuritis by Dr Paterson suggested the probability
of organic disease.

When I examined the patient on 24th November I made the
diagnosis of “ ? Intracranial Tumour,” but detected no signs
which enabled me to locate the growth, should one exist. No
description of the fits was obtained; the headache, which had
not been unilateral, had been chiefly vertical and down the back
of the neck. The dearth of positive signs and symptoms sug-

A CASE OF INTRACRANIAL TUMOUR

583

gested to me the possibility of a frontal growth. There was,
however, no defect of speech and no obvious mental impairment.
I noted that vision was 4 in both eyes; that there was no tremor
of the hands; that smell was normal; and that the abdominal
reflexes were active and equal. After examining the patient on
13th February, I wrote to her doctor: “There must, I think,
be an intracranial tumour, but I do not feel at all sure as to
its exact location. I thought to-day there was just a suspicion
of a little weakness on the right side of the face. I agree with
you that the best thing to do would be to have her under
observation in hospital, when she will be put on a thorough
course of iodides, while her acuity of vision is at the same time
carefully watched.” On 4th March I wrote: “ She has been
almost free from headaches since admission, and we have
obtained no further data bearing on the position of the growth.
The acuity of vision is perfect, and there is only one dioptre of
swelling of the discs. We shall test the visual acuity again
carefully, and if there is no deterioration since admission, I think
there is nothing to be gained by keeping her longer in hospital
in the meantime.”

The patient was discharged on 25 th March, and I heard
nothing of her until her doctor communicated with me on the
morning of 15th November, asking me to see her with him.

Although general epileptic attacks are far from uncommon
in the later stages of cases of intracranial tumour, the occurrence
of a series of fits, practically amounting to a condition of status
epilepticus as the initial symptom, is very unusual The most
reasonable explanation of the initial fits and coma in this case would
seem to be, in the opinion of the writer, a haemorrhage into the
gliomatous tumour, which up to that date had remained quiescent
in the sense that it had given rise to no symptoms. The recent
haemorrhage into the tumour, which was found post-mortem, and
which was undoubtedly the cause of death, lends support to this
view. The writer has met with three other cases in which a
haemorrhage into an unsuspected tumour was attended with fatal
results.

A case observed by Bruns and Oppenheim, and referred to
by the latter writer, 1 is of interest in connection with the case
above described. “ A woman, aged 39, had had epileptic

1 Oppenheim, Gesch will sic dcs Gehims , Zweite Auflage, Wien, 1902, S. 68.

584

A CASE OF INTRACRANIAL TUMOUR

attacks now and again from the time she was 17 years of age.
In 1886, after the birth of her last child, for several weeks these
attacks were more frequent. Latterly the attacks became less
frequent, their place being taken by very severe attacks of
megrim. In April 1892 a definite diagnosis of brain tumour
was made. Post-mortem a large sarcoma was found in the
right frontal region.”

Jastrowitz, quoted by the same writer, describes the case of a
patient, an inmate of an asylum, who for a number of years had
suffered from epilepsy, and who was free from attacks during the
last few years of his life. At the autopsy a tuberculous tumour
was found at the apex of the right frontal lobe.

The movements of protrusion and retraction of the tongue
are of interest, although the description of them is meagre, since
they suggest irritation of the centre in the frontal lobe described
by Horsley and Beevor, 1 stimulation of which is followed by
similar movements.

It is interesting to note that at no time while this case was
under observation were the homolateral tremor and the loss of
the abdominal reflex on the side opposite to the growth, signs
shown by Grainger Stewart to frequently accompany a frontal
tumour, 2 observed though repeatedly looked for.

Hbstracts

ANATOMY.

THE MIDDLE CELLS OF THE GREY MATTER OF THE SPINAL

(504) OORD. J. H. Harvey Pirie, Proc. Roy. Soc. Edin., Vol.
xxviii., Pt. 8, No. 36.

The middle cells are present throughout the whole length of the
spinal cord. They are situated in the middle portion of grey
matter at the junction of anterior and posterior cornua ; but they
sometimes also extend into the regions usually occupied by the
motor cells, by the intermedio-lateral tract and by Clarke’s column.
They cannot be sharply separated from the “ scattered cells ” at
the base of the anterior horn, nor yet from the small cells at the
base of the posterior horn. They have a more or less typical

1 Phil. Trans. Roy. Soc., 1894, Vol. 185, B.

* Rev. of Neurol, and Psychiat., 1906, p. 809.

ABSTRACTS

585

Arrangement in each segment. This is described in detail and
figured in the paper. In the cervical enlargement they appear as
a broad band of cells extending from the formatio reticularis to
about the anterior grey commissure. In the dorsal region they.
are fewer in number, and may be found scattered irregularly, or
more often occurring in small groups either centrally, about on a
level with the central canal; or post-central, between Clarke’s
column and the reticular group of the intermedio-lateral tract. In
the lumbo-sacral enlargement they are very abundant, and their
field extends until in the lower sacral segments they occupy in
addition practically the whole anterior cornua. At all levels, as
studied in serial sections, their distribution is seemingly erratic,
there is no segmentation (as Argutinski described) like that so
well seen in the intermedio-lateral tract. Sometimes they are
dotted about singly, or they may be found as little cell groups, but
never very closely packed. They may be divided apparently into
three groups:—(1) The middle cells proper or central cells,
■occurring chiefly in the central area, and very similar individually
to cells of the apical group of the intermedio-lateral tract; (2)
anterior or scattered cells in the base of the anterior horn, fewer
in number and seldom grouped, but larger individually; (3) post-
central cells, lying chiefly between Clarke’s column and the
reticular group of the intermedio-lateral tract, mostly smaller in
size than the others.

The course and termination of the cell processes have not been
ascertained. Author’s Abstract.

PHYSIOLOGY.

THE PHYSIOLOGY OF THE PONS AND OORPOEA QUADRI-
(505) GEMINA. (Beitrag zur Physiologic der Varolsbrucke (Pons
Varolii) und der Vierhiigel (Corpora bigemina).) Oswald
Polimanti, Arch. f. Amt. u. Physiol Heft iii. and iv., 1908,
p. 271.

The author records experiments on dogs and cats where solutions
of morphine, curare, quinine, or cocaine were injected in the region
of the pons and corpora quadrigemina. The solutions were tinged
with thionin, whereby the parts affected could be ascertained on
post-mortem examination.

Morphine and curare, so injected, are found to act as con-
vulsants; quinine similarly, but in a less degree. The convulsions
produced are not bulbar in their origin, since the bulbar respiratory
centre is not paralysed as it is in cases of bulbar poisoning through
strychnine or nicotine. The convulsive attacks have a relation to

586

ABSTRACTS

acoustic and visual stimuli, as is to be expected from the anatomical
connections of the part of the brain affected. They are of a tonic-
clonic character. Morphine and curare give rise to genuine
epileptic attacks, and we have to do here with epilepsy of sub¬
cortical origin, quite independent of the cortex. The stimulation
of pons and corpora quadrigemina is so great that the inhibitive
influence of the cortex is entirely cut out. The animals are often
observed to run in a circle, and rotatory movements towards the
side opposite to the injury are seen.

Emotional phenomena are induced. The animals show great
excitement, springing and barking, and making aggressive move¬
ments, as though they saw spectres.

The author brings his results into relation with those of Sher¬
rington, where a dog whose brain is separated from the spinal cord
exhibits the customary movements expressive of fear, pleasure,
anger, and disgust; and discusses Bechterew’s findings with regard
to the independence of emotion and emotion mimicry. He con¬
cludes, from his own experiments and those of others, that all the
grey masses at the base of the brain take part in the various
expressions of primitive emotions, and recalls Goltz’s experiment
where psychical manifestations were given by a dog whose brain,
including almost the whole of the basal ganglia and part of the
mid-brain, was destroyed.

Many animals, after injection in the pons or corpora quadri¬
gemina, exhibit raising of the hair, especially of the back and tail.
It is probable that we have here a centre presiding over the
arrcdores pilorum, and its action appears to be independent of the
emotional condition of the animals.

In all the operated animals the reflex activity is heightened.
A knock on the box in which the animal is kept suffices to call
forth vigorous motor reactions. It follows that an inhibitory
centre must be present in the pons or corpora quadrigemina, or
that damage to these parts prevents the higher inhibitory centres
from exercising their function.

Rhythmical contractions of the face muscles, observed in the
animals, are referred to damage of the 7th nerve, and nystagmus
and other abnormal movements of the eyes to involvement of the
6th and 8th nerves.

A great flow of saliva follows on the injection of morphine,
curare, or quinine, which is independent of the epileptic attacks,
being due to stimulation of the chorda tympani. A transitory flow
is caused by cocaine.

Many animals alter injury to the pons or corpora quadrigemina
exhibit alteration of the voice. This supports the view that a
centre for voice production is present in this region. In opposition
to Pussep, erection of the penis has not been observed.

ABSTRACTS

587

The experiments show that there exist two motor centres, one
situated in the mid-brain, in relation with visual and auditory
impressions, and the other in the pons, in relation with acoustic-
facial reception, with perception of equilibrium, etc. After injury
to the pons, pendulum-like movements of the head and a character¬
istic position of the neck are seen, very similar to appearances
presented after lesions of the semi-circular canals or cerebellum.

The movements caused by stimulation of those parts of the
brain are produced by direct excitation of motor elements which
have their origin there.

After injection of cocaine in the pons or corpora quadrigemina,
movements are carried out after a certain period, but co-ordination
and regularity are wanting until the action of the drug passes off—
that is to say, until these centres resume their normal function.
The cortical centres are not able to produce harmonised move¬
ments without the aid of these lower motor centres.

W. A. Jolly.

ON THE FUNCTIONS OF THE NEUROGLIA. Lugaro, Arch.
(506) Ital. de Biol., T. 48, f. 3, 1908, p. 357.

This paper is based in part on the work of Cajal. The conclusions
Lugaro arrives at may be stated as follows:—

1. The fibres of the neuroglia support and add elasticity to the
nerve tissue.

2. The protoplasm of the neuroglial cells acts as an insulating
medium, confining nerve stimuli to their proper line of neurones
and preventing leakage of energy.

3. The protoplasm of the neuroglial cells acts as a filter for
toxic products of normal metabolism and renders them innocuous.
The toxic products may be iu part in the blood and in part in the
nerve elements, and possibly the neuroglial cells prevent toxic
agents in the blood from damaging the neurones. It is probable
that nervous excitations at articulations of neighbouring neurones
may be of a chemical nature, and it is possible that here also the
neuroglial cells may take some part in the process, perhaps by
eliminating waste products which may be formed.

4. In pathological conditions the neuroglial cells acquire
perverted activity, and may become the source of toxic substances.
The importance of this in many affections of the nervous system
is obvious, if somewhat theoretical.

5. The neuroglia may exercise nutritive or chemical influences

in the process of development, although the part played is difficult
to define. Robert A. Fleming.

588

ABSTRACTS

THE CENTRE FOR THE SUBMAXILLARY GLAND. (Vom

(507) Centrum der Submaxillar Druse.) Julian Solomowicz,
Neurol. Centralbl., Aug. 1, 1908, S. 724.

The researches of Grutzner and Schlapowski and Hermann have
demonstrated that the reflex centre for the secretion of saliva
exists in the medulla.

Beck, experimenting on dogs, using the method of cross section
of the medulla, came to the conclusion that the reflex centre for
the secretion of saliva remained intact when the facial nucleus was
uninjured, while when it was damaged the secretion was arrested.

Kohnstamm divided the chorda tympani, central to the sub¬
maxillary ganglion, in two dogs and examined the medulla. He
found the nucleii of nerves 5, 7 and 10 intact, but, on the contrary,
numerous degenerated cells over a wide area, especially on the
side opposite to that of operation, at the level of the facial nucleus.

The author has examined histologically the medulla of two dogs
in which twenty-one and twenty-six days previously the sub¬
maxillary gland had been excised. He arrives at the following
conclusions:—(a) The centre for the submaxillary gland is formed
of cells which are distributed in the region of Deiter’s nucleus;
only very few are found in the substantia reticularis; (b) the cells
which form the above-mentioned centre are found in both halves
of the medulla, with slight predominance on the side of the corre¬
sponding gland. Edwin Bramwell.

ON THE QUESTION OF INHIBITORY FIBRES IN PERIPHERAL

(508) NERVES. (Zur Frage der hemmenden Fasera in den Muskel-
nerven.) F. W. Frohlich, Arch. f. Anal. u. Physiol., Heft iii.
and iv., p. 392, 1908.

The author discusses the question as to whether inhibitory pro¬
cesses are conducted from the centre to the periphery, or whether
inhibitory fibres are present in the peripheral nerves, and concludes
that there is no proof of the presence of such fibres in peripheral
nerves.

Nikolaides and Dontas have published experiments which lead
them to the belief that inhibitory fibres to the gastrocnemius
muscle are contained in the ninth spinal nerve of the frog. Their
results have been subjected to criticism by Woolley and by Frbhlich,
who point out that the former authors have overlooked the spread
of current from stimulated to non-stimulated roots, and that the
inhibition obtained by them is a special case of the phenomena
described by Wedensky and others.

The author compares the curves of Nikolaides and Dontas with
those given by Hofmann and Amaya. W. A. Jolly.

ABSTRACTS

589

NOTE ON THE SUPPOSED EXISTENCE OF VASO-CONSTRICTOR
(509) FIBEES IN THE CHORDA TYMPANI NERVE. W. M.

Bayliss, Joum. of Physiol ., Vol. xxxvii., 1908, p. 256.

The chorda tympani is usually regarded as a typical vaso-dilator
nerve. Frohlich and Loewi state that, after the administration of
amyl nitrite or sodium nitrite, stimulation of the chorda is attended
with diminution of the blood-flow from the vein of the submaxillary
gland. They conclude from this that there are present in the
chorda vaso-constrictor fibres whose effects become more manifest
after the injection of nitrite. These results are not confirmed by
Bayliss, who fails to find evidence of such constriction after the
use of nitrite, or in the general excitation of asphyxia, where it
might be expected, were vaso-constrictor fibres present.

With regard to the effects of pilocarpine, if arterial constriction
is caused by this drug, it should be referred to the action of the
drug upon the terminations of the sympathetic constrictors in the
gland, or directly upon the muscular coat of the arterioles, rather
than to central excitation of constrictors contained in the
chorda.

The results obtained by Frohlich and Loewi are explained by
Bayliss as due to escape of the exciting current to surrounding
tissues, producing contraction of muscular structures under the
vein and thus causing its obstruction. Further, from experiments
upon the cervical sympathetic in the cat, it appears that the
method of investigation adopted by these observers—stimulation
after injection of nitrite—is not likely to reveal the presence of
vaso-constrictors in a nerve. W. A. Jolly.

THE EXCITATION OF VASO-DILATOR NERVE FIBRES IN
(510) DEPRESSOR REFLEXES. W. M. Bayliss, Joum. of Physiol .,
Vol. xxxvii., 1908, p. 264.

On stimulation of the central end of the vagus in the cat, there is
acceleration of blood-flow through the submaxillary gland of the
opposite side, on which the cervical sympathetic has been cut.
There is thus excitation of the vaso-dilator fibres of the chorda
tympani in a depressor reflex. When the chorda is cut and
the cervical sympathetic left intact, there is also increased flow
through the gland. This must be due to inhibition of constrictor
tone.

At first sight it appears that we have to do here with un¬
doubted reciprocal innervation in vaso-motor reflexes, but it may
be objected that the inhibition of constrictor tone represents the

590

ABSTRACTS

result of excitation of the true depressor fibres in the vagus, while
the excitation of dilators may be due to a special reflex following
on excitation of afferent fibres from the alimentary canal, and con¬
nected with the secretion of saliva.

Experiments are described which show that it is possible on
stimulating the central end of the vagus in the cat to obtain
excitation of dilators although no secretion is present. The
excitation of the central end of the anterior crural nerve produces
vaso-dilatation in the gland vessels, with a considerable flow of
saliva. The increased flow does not of itself necessarily imply
excitation of vaso-dilator nerves, since the effect might be due to
the production of metabolites from the secretory cells. Vaso¬
dilatation is not obtained in the gland on stimulation of the vagus
below the entrance of the fibres from the aorta.

Experiments were performed in which the depressor nerve
was excited in the rabbit. The effect of changes in the blood
pressure is diminished by the use of a mercury compensator con¬
nected with the abdominal aorta. This compensator consists of a
Voit’s flask and mercury reservoir, and by its action blood, rendered
non-coagulable by hirudin, is automatically removed or returned as
the blood-pressure rises or falls. On stimulation of the depressor
nerve there is a marked acceleration of blood-flow through the sub¬
maxillary gland, whose vaso-constrictor nerves have been cut, due
to excitation of the chorda dilator fibres.

The experiments show that the action of the depressor nerve
brings about not only inhibition of tone of the vaso-constrictor
centre, but also excitation of vaso-dilator nerves, and support the
view that there exists in vascular reflexes a process akin to
Sherrington’s reciprocal innervation in voluntary muscle reflexes.

W. A. Jolly.

OBSERVATIONS ON THE ACTION OF NITRITES AND ATROPIN
(511) ON THE AUTONOMIC NERVOUS SYSTEM. A. Frohlich
and 0. Loewi, Archiv fiir Exper. Pathol, und Pharmathol, Bd. 59,
H. 1, 1908, p. 34.

Frohlich and Loewi have, in the Pharmacological Institute of
Wien, conducted for some time a large series of observations with
various medicinal substances, attempting to isolate the precise and
particular portion of the nervous system on which they have a
specific action.

This has been done previously for several other drugs-^—ergotin,
adrenalin, and pilocarpin—and their observations were concerned
with nitrites and atropin.

They first of all discuss the innervation of the various organs,

ABSTRACTS

591

glands, etc., and distinguish broadly between autonomic and
sympathetic fibres to these parts. The former has a cranial and
a sacral portion, the former springing from the mid-brain and
medulla, and the latter from the sacral portion of the spinal cord.
The sympathetic fibres arise in sequence from the thoracic and
lumbar cords. From these two systems the various organs have a
four-fold innervation—two sets of fibres from each—autonomic
motor and autonomic inhibitory, sympathetic motor and sym¬
pathetic inhibitory.

Nitrites .—Their observations were made chiefly ou cats and
dogs. The autonomic and sympathetic fibres to various organs—
e.g. pupil of eye, tongue, penis, bladder, etc.—were dissected out.
The action of the nerve was ascertained by section and electrical
stimulation of the cut end. This was followed by the intravenous
injection of nitrite of soda in varying doses, and the result
watched.

They found that the nitrite has no effect on either group of
sympathetic fibres, nor on the autonomic motor fibres. A marked
and regular effect was obtained on the autonomic inhibiting fibres.
After the injection of the nitrite the impulses were prevented
passing and the action of the nerve fibres abolished. This they
found without exception in all the nerves to the various organs on
which they made observations.

Atropin .—Numerous and exact observations were made with
atropin in continuation of previous work of their own and of
others. The method of procedure was the same as with the
nitrites. The nerve was separated, then cut, and the injection of
atropin followed.

They came to the conclusion that atropin, like the nitrites,
has no effect on the two sets of sympathetic fibres. No effect was
observed on the autonomic inhibiting fibres. But following the
injection of atropin the autonomic motor fibres are put out of
action and no contraction obtained. In the case of atropin, how¬
ever, two exceptions were observed. The autonomic motor nerves
to the rectum and bladder continued to respond, and a contraction
was obtained after the injection of atropin. Atropin has no
paralytic action on the nerves to these organs. They consider
that atropin has exclusively and regularly an action on these
autonomic fibres.

Both atropin and the nitrites exercise an action only on
the autonomic and not on the sympathetic fibres, the one on the
motor and the other on the inhibitory fibres.

Edwin Matthew.

592

ABSTRACTS

PSYCHOLOGY.

AN EXPERIMENTAL STUDY OF SLEEP. Boris Sidis, Joum.
(512) of Abnorm. Psy., Aug.-Sept. 1908, p. 170.

The third and final instalment of Dr Sidis’s study of sleep deals
with the nature of reactions in sleep, the relation of cell energy to
sleep, and motor consciousness and sleep.

With respect to the nature of sleep, Dr Sidis agrees with
Clapar&de’s biological view that sleep is a function of defence, an
instinct which has for object the prevention of exhaustion. Sleep
is not a kind of narcosis of the system by the poison of fatigue
products; it is a state into which we fall at will, and out of
which we can awake at pleasure.

In common with most modem psychologists, the author lays
great stress on motor consciousness as being at the very heart of
personality. “ We are what we can accomplish.”

A useful bibliography is appended to the paper.

Margaret Drummond.

THE STATE OF THE BRAIN DURING HYPNOSIS. William
(513) M‘Dougall, Brain, Yol. xxxi., 1908, p. 242.

The aim of the paper is to render clearer and more definite the
“ theory of cerebral dissociation,” and to show how explanations
of many of the phenomena of hypnosis may be deduced from the
theory in the more definite form proposed. It is contended that
hypnosis is closely allied to the state of sleep, and that while the
state of the brain is very similar in these two conditions, its state
during hypnosis differs from that obtaining during sleep in the
possession of certain positive characteristics. The first step must
therefore be to obtain a satisfactory conception of the state of the
brain during sleep; this may be arrived at by denying it those
positive characters which constitute the waking state.

The principal difference between the sleeping and the waking
brain is that the latter is suffused with free or active energy which,
though constantly being used, is constantly renewed through the
stimulations of the sense-organs and the activity of the great
functional dispositions within the brain. The presence of this
charge of varying potential during the waking state maintains the
synapses of the brain, the principal seats of the resistances which
delimit the neural systems of which it is composed, in a condition
of lowered resistance, so that interplay between all parts is free

ABSTRACTS

593

and easy. All factors that tend to diminish the quantity of free
energy present in the brain ( e.g. withdrawal of sensory stimuli)
or directly to raise the resistances of the synapses {e.g. action on
them of products of metabolism), therefore tend to render less
easy the interplay between neural systems. Any considerable
degree of such general increase of synaptic resistances constitutes
a state of cerebral dissociation. Such a state obtains during sleep
and hypnosis. Hypnosis differs from sleep in that one group of
neural systems, all those concerned with the presentation of the
operator, are kept in a state of excitation, while the rest of the
brain falls into quiescence. The one active group then serves as a
channel through which other systems may be brought into isolated
activity; and each one then, functioning in the absence of the
partial inhibitions normally exerted during the waking state by
the dispositions of rival ideas, operates with abnormal intensity.

Author’s Abstract.

PATHOLOGY.

SOME POINTS IN THE HISTOLOGY OF LYMPHOGENOUS AND
(514) HEMATOGENOUS TOXIC LESIONS OF THE SPINAL
COED. Orr and Rows, Journ. of Merit. Sc., July 1908.

The following constitute the principal points of difference between
the above two types of lesion:—

When the spinal cord is infected by toxins via the lymph
current ascending in the perineural sheath, the posterior columns
show degeneration in the root entry zones. The fibres around the
median septum remain normal. With increased toxicity of the
lymph entering the cord there is a greater tendency to diffusion,
so that changes are found round the cord-margin and along the
septa. The morbid process spreads from below upwards. The
Marchi method gives a positive reaction. In general blood toxaemia
the cord lesions are very different. The degeneration is diffused.
In the posterior columns it affects the fibres round the median
septum first, leaving the root entry zone intact. The basis bundles,
the crossed pyramidal tract and the fibres in the grey matter are
attacked, as is also the cord margin to a slight extent. The lesion
is most marked in the cervical and upper dorsal cord, and spreads
downwards to the lumbar region. ^

Marchi’s method gives a negative reaction. The morbia change
consists in a slow atrophy of the myelin, but with increased toxicity
of the blood this may be swollen and varicose.

The system lesions in tabes dorsalis and those occurring in the

2 u

594

ABSTKACTS

cord and cranial nerves of general paralysis of the insane fall into
the lymphogenous group; the cord lesions in acute insanity,
leuka*mia, pernicious amemia, Addison’s disease, metallic poison¬
ings, etc., fall into the hjematogenous group.

Author’s Abstract.

CELLULAR LESIONS OF THE ANTERIOR HORNS IN NER-
(515) VOU8 ARTHROPATHIES. (Les lesions cellnlaires des comes
ant^rieures de la moelle dans les arthropathies nervenses.)

Etienne and Champy, L’Enctphale, May 1908, p. 369.

The authors examined carefully, with modern methods, the
anterior horn cells in a case of tabes, of syringomyelia, and of
Aran-1 Hichenne muscular atrophy respectively, each one of which
was associated with an arthropathy.

1. Arthropathy of the right shoulder in a tabetic. In this
case throughout the cord the anterior horn cells were affected to a
varying extent at different levels. Chromatolysis was found, its first
stage being some diffusion of the Nissl bodies, becoming complete
throughout the cell, with vacuolation, disappearance of the
nucleus, and eventually neuronophagia. In the cervical cord not
a single normal anterior horn cell was found. On the right side,
corresponding to the arthropathy, specially in the postero-extemal
groups, the cells were in an advanced state of degeneration; many
had entirely disappeared.

2. Arthropathy of the left shoulder in a case of syringomyelia.
In this case there was a glioma of the cervical cord, with cavity
formation, and the anterior horn cells were much affected, all,
more or less, being in a state of chromatolysis. The cellular
lesions were bilateral, but much more intense on the left side than
on the right, and again the chief area affected was the postero¬
external group.

3. In a rare case of arthropathy of the shoulders in progressive
muscular atrophy, the authors found all the cells of the cervical
cord affected, in particular those belonging to the postero-extemal
groups: the latter showed intense chromatolysis, with complete
“ pulverisation ” of the Nissl bodies, but without vacuolisation or
neuronophagia.

Nervous arthropathies are caused by a disturbance of reflex
trophic equilibrium, as a result of lesions of the anterior horn
cells. These lesions may be determined by alteration of the
sensory influx from disease of the centripetal protoneurons, or by
disease of the sensorimotor branches of these protoneurons which
pass to the anterior horns ; or, again, the anterior horn cell lesion
may be primary, as in progressive muscular atrophy, and may of

ABSTRACTS

595

itself determine the arthropathy. It is conceivable, further, that
these changes may be induced by alteration in the trophic
influence coming to the cells from levels higher up.

S. A. K. Wilson.

CLINICAL NEUROLOGY.

THE RELATIONSHIP OF THE SO CALLED FAMILY DISEASE
(516) TO A PREMATURE PHYSIOLOGICAL SENESCENCE
LOCALIZED TO CERTAIN ORGANIC SYSTEMS,
CONSIDERED WITH SPECIAL REFERENCE TO THE
NERVOUS SYSTEM. F. Raymond, Lancet , June 27, 1908,
p. 1859.

The so-called family diseases form a group which, whether
considered from their anatomy or pathological physiology, cannot
be mistaken for any other disease. They are the consequence of
the original constitution of certain nerve tracts or cells, and so they
have sometimes been called Evolution Diseases. They can hardly
be termed “ Diseases,” for they are organic types abnormal from
their very origin.

Family diseases are exclusively created by the parents, and
they develop quite apart from any external influence. These
“ family diseases ” are often met with as isolated cases, and it is by
their own symptoms that they can be recognised.

The clinical types which constitute the family diseases are not
found to be identically the same in all cases. Each family tends
to work out its own disease. The following classification is
proposed for the group “ Hereditary Ataxias ”:—

a. A spinal form with loss of reflexes, scoliosis and club-foot

added to the common syndrome. This would be the

Friedreich type.

b. A cerebellar form with atrophy of the optic nerve, vertigo,

mental disturbances, added to the common syndrome

forming the Marie type.

c. A bulbar form with vomiting dyspnoea, and cardiac

arrhythmia.

d. A bulbo-pontine form characterised by auditory

disturbances.

e. A generalised form as in Menzel’s case.

These are all different types, but linked up together by the
common cerebellar syndrome.

The essential characters of family disease are: (1) they affect in

596

ABSTRACTS

an identical form several children in the same generation; (2) they
make their appearance at the same age in all of them; (3) and they
originate without the intervention of any morbific agent whether
extrinsic or intrinsic.

Of these three fundamental characters the first two may be
wanting.

The absence of all known efficient cause is therefore the
principal character of family diseases.

The morbid anatomy is characterised by a lesion which consists
simply in the disappearance of a system of cells or fibres which
dissolve without leaving a trace.

There is a complete absence of any inflammatory reaction.

The course of the disease is always progressive. There is
never any retrogression, never does a symptom fade or disappear.

The patient is doomed from the very instant of his conception,
as soon as the spermatozoon and ovum have united.

The mechanism by which this premature change takes place
is obscure. Is there in each cell a certain dose of energy which
gradually gets exhausted till it entirely disappears ? Is there a
poisoning of the nerve cells through the formation of a special
cytolysin? or are the sclerotic changes brought about by an
accumulation of waste products, the result of cell activity ?

The last hypothesis is rather tempting, for it enables us to
understand why it is that the onset of the disease takes place at
about the same age in several members of the same family—that
is to say, in individuals whose cells have the same chemical
characters and the same medium. In the course of development
there are thrown into the circulation of the individual at certain
periods of his life substances that are very toxic to his nerve
cells. The influence of these internal secretions is such that
puberty or castration bring about a veritable revolution in the
system. Now, is it not chiefly at the time of puberty that the
family diseases of the nervous system become manifest ? Whether
they be brought about in this way or by other means, heredity
governs their etiology. Family diseases represent veritable
degenerative stigmata in the race. For the purpose of general
classification these diseases should be grouped under the following
heading:—“ Premature physiological senescence of certain organic
systems.” This physiological senescence is quite independent of
any external factor. F. R Batten.

ABSTRACTS

597

TYPHOID BACILLI IN THE CEREBRO SPINAL FLUID IN

(517) TYPHOID FEVER. (Ueber die Auffindun* der Eberth-
Gaffky’schen Bacillen in der Gerebrospinalfliissigkeit bei
Typhus abdominalis.) L .Silberberg, Berl. klin. Woch., 1908,
p. 1354.

Silberberg examined the cerebro-spinal fluid of nine typhoid
patients. Of these one had a severe attack, five were moderately
severe, and three were mild cases. Although seven showed
organisms resembling typhoid bacilli, in only the severe case did
the culture tests give a positive result. In its physical and
clinical characters the cerebro-spinal fluid of these patients did not
differ from the normal. Its agglutinative action was very slight,
whereas its bactericidal power was much more marked. The
removal of the fluid was found to have a beneficial action. The
headache in most cases disappeared, and the patients generally
appeared brighter. J. D. Rolleston.

TYPHOID MENINGITIS WITHOUT OTHER LESIONS. R. S.

(518) Lavenson, Univ. of Pennsylvania Med. Bull ., 1908, p. 55.

A woman, aged 26 years, who was stated to have had typhoid
fever several years ago, and had recently been nursing a case
of that disease, was admitted to hospital with the symptoms of
typhoid fever on April 22nd. Widal’s reaction on the 23rd
was negative, but on the 26th, the eighth day of disease, was
positive. On the 27th lumbar puncture was performed, and a
pure culture of typhoid bacilli obtained. Death took place on
May 4th. Post mortem no intestinal lesions were found, nor was
the spleen enlarged. There was thick pus in the pia-arachnoid
covering the convexity of the right hemisphere, and the frontal
region of the left convexity showed a similar small focus. In the
meningeal exudation organisms were found which resembled
morphologically typhoid bacilli. J. D. Rolleston.

PURULENT CEREBRO-SPINAL MENINGITIS CAUSED BY THE
(519) TYPHOID BACILLUS WITHOUT THE USUAL IN.
TESTINAL LESIONS OF TYPHOID FEVER. J. Norman
Henry and Randle C. Rosenberger, Proc. Path. Soc.
Philadelphia , 1908, p. 52.

A man, aged 34 years, who had been ill six days, was admitted to
hospital with headache, dizziness, constipation and fever. Death
took place three days later. Lumbar puncture during life showed
a turbid fluid from which typhoid bacilli were isolated. No

598

ABSTRACTS

meningococci were found. The autopsy revealed purulent cerebro¬
spinal meningitis, very slight enlargement of the mesenteric
glands, and a slight change in Beyer’s patches, but no typical
typhoid lesions. Sections of the cord and cerebellum showed
typhoid bacilli. J. D. Rolleston.

TUBERCULOUS MENINGITIS IN INFANTS. (La mfcringite

(520) tuberculeuse du nourrison.) Willerval, Theses de Paris,
1907-08, No. 452.

This thesis, which should be compared with that on the same
subject by Clot (v. Rev. of Neurol, and Psych., 1908, p. 291), contains
forty-seven observations, six of which have been hitherto un¬
published, of tuberculous meningitis in children, whose ages
ranged from six and a half months to seven and a half years.
The disease is much less rare in infants than is supposed. Four
clinical forms are described—eclamptic, hemiplegic, somnolent,
and hydrocephalic. The diagnosis is often impossible, and should
always rest on the findings of lumbar puncture. The disease
may sometimes resemble tetany. In the diagnosis one must
also exclude acute non-tuberculous meningitis, which is far from
rare in nurslings, and may be due to Pfeiffer’s or Weichselbaum’s
bacilli or B. coli. J. D. Rolleston.

A CASE OF GONORRHCEAL MENINGITIS. (Em Fall von

(521) Meningites gonorrhoica.) R. de Josselin de Jong, Centralbl.
f. Bakt. Originate, Bd. xlv., 1908, p. 501.

A male, aged 19 years, a few weeks after becoming infected with
gonorrhoea, presented signs of cerebro-spiual meningitis. There
were no symptoms of myelitis or neuritis. The fever was inter¬
mittent. The heart and other organs were not affected. The first
lumbar puncture showed a slightly turbid fluid in which were
many pus corpuscles, but no meningo- nor gonococci. Eight days
later the fluid showed, in addition to a number of poly morph o-
nuclears, numerous intra- and extra-cellular diplococci, which their
morphological characters and cultural reactions proved to be
gonococci. The third puncture, made eight days later, showed a
clearer fluid with fewer pus cells and fewer gonococci. Complete
recovery took place. The present case, according to De Jong, is
the first in which gonococci have been found in the cerebro-spinal
fluid, and is an excellent example of a hsematogenous metastasis
of gonococci to the meninges within a few weeks of the primary
infection. The therapeutic success of lumbar puncture was
striking. J. D. ROLLESTON.

ABSTRACTS

599

ACUTE SYPHILITIC MENINGITIS. AN ATTEMPT AT OLASSI-
(522) FIOATION. (M6ningites sypMlitiques aigues. Essai do classi¬
fication.) R. de Coux, Thhes de Paris, 1907-08, No. 445.

This thesis, inspired by Boidin, contains twelve cases, four of which
have been abstracted in this Review (1907, p. 901, and 1908, pp.
174, 290, and 419). De Coux distinguishes meningitis of the
secondary period from that of the tertiary. The former develops
early, usually co-exists with the cutaneous eruption, and may,
therefore, be regarded as a meningeal enanthem. Its symptoms
are those of a diffuse meningitis without localisation phenomena,
and resemble those of the ordinary tuberculous meningitis of
children. Lymphocytosis is constant, and often considerable.
Recovery without sequehe is the rule. Acute tertiary meningitis
is only an episode in the course of a more or less latent chronic
syphilitic meningitis, and is due to congestion surrounding the
sclero-gummatous lesions. Its phenomena are much more
obtrusive than those of secondary meningitis, and consist of
violent delirium, convulsions and localisation phenomena, such as
epileptiform attacks and palsies of the face and limbs. Death
may occur, but more frequently the acute symptoms subside, and
a chronic localised meningitis persists. Tertiary meningitis must
be distinguished from seizures in general paralysis and from
tuberculous meningitis in the adult, ursemia and cerebral tumour.
The lymphocytosis which is the rule in chronic syphilitic meningitis
may be replaced by an excess of the polymorphonuclears, as in the
case of Glaisse and Joltrain (v. Rev. of Neurol., 1908, p. 290). The
cerebro-spinal fluid may then appear turbid or puriform, but the
polymorphonuclears still preserve their morphological integrity.
The spirochseta pallida has not been found in either form of
meningitis. J. D. Rolleston.

CEREBRAL AND OEREBRO - SPINAL MENINGITIS IN THE
(523) COURSE OF THE PUERPERIUM. (Mlningites Clrlbrales
et 0£r6bro-Spinales Suppur4es au Corns de la Puerp&alitd.)

F. Commandeur, VObsUtriqae, June 1908.

Commandeur has collected from the literature fifteen cases of sup¬
purative cerebro-spinal meningitis occurring during pregnancy and
in the puerperium ; cases of tuberculous meningitis are excluded.
The association of meningitis and pregnancy is thus extremely
rare, but the author has been able to formulate certain generalisa¬
tions from the material at his disposal. It is more common in
multiparse than in primiparse, in the proportion of nine of the

600

ABSTRACTS

former to three of the latter, the parity not being mentioned in
three of the cases. It is more common during pregnancy than in
the puerperium. Of the nine affected during pregnancy, five were
at full time, one at 8|, one at 8, one at 7£, and one at 7 months.
Of the six in which the symptoms were first noticed in the puer¬
perium, two were attacked on the day following confinement, one
on the second day, one on the third, one on the sixth, and one not
till four weeks after delivery. In only one case was the meningitis
secondary to a puerperal infection, and in it the organism present
was a staphylococcus. Two cases were secondary to pneumonia,
one to pneumococcal pleurisy, and one to suppurative otitis. In
the remaining ten the condition was apparently primary, and in
them the organism was usually the pneumococcus—in fact, the
bacteriological findings did not differ from those obtaining in
cerebro-spinal meningitis apart from pregnancy. The chief interest
of the condition when occurring in the pregnant or puerperal woman
lies in the possibility of mistaking it for eclampsia, a diagnosis
which was made in several of the recorded cases, and only rectified
on post-mortem examination. The two conditions ought never to
be confounded if a thorough examination is made. The headache
in cases of meningitis is more severe and continuous than in
eclampsia, the convulsions more localised, and the coma deeper
and occurring only as a terminal phenomenon. Kernig’s sign may
or may not be present. Albuminuria is usually present in both
conditions. All doubt is removed if the spinal fluid is examined
by means of spinal puncture. Treatment resolves itself into an
attempt to save the child. All the mothers died, but in all but
one case the child remained alive till the death of the mother.
Two of the nine cases died undelivered, but in one a post-mortem
Caesarean section was unsuccessful in saving the child. In four
labour occurred spontaneously during the illness, aud living
children were born. In three delivery was effected instrumental^,
in two the mother being in e.ctremi$ at the time of interference;
all the children survived. In all cases of cerebro-spinal meningitis
in pregnant women an attempt ought to be made to save the
child. B. P. Watson.

ANALYSIS OF 400 OASES OF EPIDEMIC MENINGITIS TREATED
(524) WITH ANTIMENINGITIS SERUM. Flexner and Jobling,
Joum. of Am. Med. Assoc., July 25, 1908.

Drs Flexner and Jobling have already published elsewhere
(Journal of Experimental Medicine , Jan. 1908) the first series of
cases treated with their serum. They now give statistics of the
393 cases treated up to date. These have been collected from the

ABSTRACTS

601

different centres in Great Britain and America in which the serum
has been tried. They exclude cases which terminated fatally
within twenty-four hours of the first injection, on the ground that
such a period is too short for any influence to have been exerted
by the treatment. In such a disease as epidemic cerebro-spinal
fever, however, these cases might with advantage have been
included, as in every outbreak a certain number of fulminant
cases are almost sure to occur, and this type of the disease may
run its whole course in twelve hours. To omit such cases, then,
destroys to some extent the value of the comparison of the serum
death-rate with that of the disease treated on ordinary lines. Of
the 393 patients included in their tabulation, 98, or only 25 per
cent., died. We may remark here that, without deductions, the
mortality is only 30 per cent., a most remarkable figure.

The disease was most fatal in infants of under one year, of
whom 50 per cent, succumbed, and in adults of over twenty years
of age. In 328 of the cases it was possible to determine with
reasonable accuracy the exact day of the onset of the illness.
From these it was found that the mortality of patients who came
under treatment from the first to the third day after the first
symptom was only 14'9 per cent Of the patients who received
their first injection from the fourth to the seventh day, 22 per
cent, died, and thereafter the mortality rose to 36 4 per cent.
These figures show very strikingly the advantages of early injec¬
tion, and also emphasise the value of the serum itself. Not a few
patients in the third group were chronic when first injected, and
the outlook for cases of this type is not wholly discouraging.
Indeed, so long as diplococci are present in the exudate, and
mechanical damage to structure is not irreparable, it is well worth
while to administer serum injections. From 25 to 30 per cent,
of the cases terminated by what might be fairly termed a crisis.

As regards the result of the injections on the diplococci them¬
selves, they are rapidly reduced in numbers, become wholly intra¬
cellular, and show swelling and fragmentation. Coincidently
they lose viability in cultures. As to the spinal fluid, turbidity
soon disappears, and even purulent exudates occasionally clear up
quickly. After injection a very rapid or even critical fall of leuco¬
cytes often takes place. Progressive increase of turbidity, rise of
leucocytosis, and persistence of diplococci in the fluid are bad signs.
Relapses are infrequent, and, if vigorously treated with serum,
seldom fatal. Generally speaking the number of complications
has been small. The only persistent defect noted in the series of
cases was deafness, and this was not common, and, when observed,
had often been present to some degree before the treatment was
commenced. Claude B. Ker.

€02

ABSTRACTS

THE EPIDEMIOLOGY OF ACUTE POLIOMYELITIS. L. Emmett
(525) Holt and Frederic H. Bartlett, Amer. Journ. of the Med. Sci.,
May 1908.

This is a very interesting analysis of thirty-five epidemics of acute
poliomyelitis collected from the literature. The original references
have been consulted in all but one instance. The most important
epidemics are those which occurred in Norway and Sweden in
1893, and in New York during the past year. No less than five
epidemics have been reported in Norway during the last ten years.

All but two of the thirty-five epidemics above referred to were
confined to the hot season only. The most frequent months were
July, August and September, the epidemic terminating iu almost
every case with the month of October.

Contrary to what is so often seen after epidemics of cerebral
spinal meningitis, in but one instance is it stated that there was an
increase in the number of sporadic cases in succeeding seasons
after an outbreak of poliomyelitis. The epidemics have been fairly
equally divided between city and country. In the majority of
instances the hygienic surroundings were good. Only one example
of the occurrence of an epidemic in a crowded community has been
reported.

No association with other diseases can be said to have been
established. On the contrary the great majority of patients are
stated to have been well at the time of onset. Severe cholera
infantum prevailed concurrently with the Stockholm epidemic of
1895. While both cerebro-spinal meningitis and gastro-enteritis
prevailed in Vienna in 1897, during the epidemic of poliomyelitis
of 1898 these diseases were not common. Landry’s paralysis, acute
encephalitis and multiple neuritis had been described in a few
epidemics. In all probability these were cases of poliomyelitis
erroneously diagnosed.

The mortality in 1659 cases collected from different records of
epidemics in which this point is specially referred to was 12’1.

Observations bearing upon the communicability of the disease
may be considered under three heads: (a) the general distribution;
(6) the occurrence of more than one case in a family or household,
and the interval between the onset in the different cases; (c) the
development of poliomyelitis after contact with a person suffering
from the disease in an acute stage, or after moving into a district
where the disease is prevailing.

In the majority of epidemics there have been a comparatively
small number of cases, and these have been widely distributed.
The authors have collated and tabulated forty instances of more
than one case in a household. Among these there were thirty-
seven in which the second case developed within ten days and

ABSTKACTS

603

thirty-three in less than a week, while in thirteen the interval was
less than twenty-four hours. Pasteur reports seven cases in one
family. In another family four cases occurred. Two sisters were
taken ill within six days of each other, the father seven days
later, a son two days after the father’s death. There are five
groups of three cases in a family, while instances of two are com¬
paratively common. Dr Holt has met with three examples which
he describes as follows:—

“ A boy aged 14 months was taken ill on the 23rd of the
month and died on the 27th with bulbar symptoms. A sister aged
5 years was taken ill on the 26th, and recovered with paralysis
of both lower extremities. No other cases are known to have
occurred in the town at the time.”

“ During the epidemic of 1907, in a family living in a village
near New York, a boy aged 8 years was taken ill on Sunday
and died on the following Sunday morning. His brother, aged
5 years, was attacked the day before the death of the older boy,
and recovered with paralysis. No other children in the family.
Only one other case in the village, living more than a mile away.”

“There were admitted to the Babies’ Hospital in October 1907
two children aged about 2\ years from a country home containing
twenty young children. The children attacked with poliomyelitis
occupied adjoining beds in the institution. The second child was
taken ill seven days after the first one. There were no other cases
in the house.”

In one epidemic of seventeen cases referred to by the authors
a group of ten occurred in the same neighbourhood; two cases
were in the same house ; two others were sisters ; two others
were brothers; the other four children attacked lived near by.
In the second group there were seven cases in the same neigh¬
bourhood ; three occurred in the same family; a fourth lived in
an adjoining house and was attacked just ten days after he came
there to reside; the other three children lived close by.

Among instances of cases occurring after moving into a district
where the disease is prevalent were the following:—Two children
(observed by Dr Holt) were taken ill simultaneously ten days
after their return to New York during the epidemic of 1907.
Another case was that of an infant aged nine months who was put
into the same crib with a child suffering from poliomyelitis.
Within eight days (the exact time was not determined) the child
was affected with fever followed by paralysis. Again, three servant
girls living in different houses returned together to their home.
While there and shortly after their arrival all three became ill
with acute poliomyelitis.

The following are the conclusions arrived at by the authors:—
“ The occurrence of epidemics and the relation of certain groups of

604

ABSTRACTS

cases to one another in these epidemics place beyond question the
statement that acute poliomyelitis is an infectious disease.
Whether we can go farther and state that the disease is com¬
municable is an open question. After carefully considering all
the evidence brought together in these papers, we cannot resist
the conclusion that the disease is communicable, although only to
a very slight degree, one of the most striking facts being the
development of the second cases within ten days after possible
exposure. Positive statements, however, must be deferred until
the discovery of the infectious agent.”

A table is appended which gives the principal facts regarding
the epidemics collected, together with the references to the
literature. Edwin Bramwkll

THE OCCURRENCE OF INFANTILE PARALYSIS IN MASSA
(626) 0HUSETT8 IN 1907. R. W. Lovett, Boston Med. and Stirg .

Jowm., July 30, 1908, p. 131.

This is a report prepared for the Massachusetts State Board of
Health, with special reference to the etiology of the disease.
It deals with some 234 cases, and the evidence as to the etiology
is summed up as follows:—The character of the onset suggests
infection, but the case is not proven bacteriologically. But
negative evidence does not disprove the theory of infection, for the
organism present, if one exists, may liberate a toxin and disappear.
The seasonal occurrence, the age incidence, and the frequent
association of intestinal disturbance with the onset suggest some
intestinal infection. It seems reasonable to suspect that some
bacillus, probably an anaerobic one, reaches the intestines in milk,
and there liberates a toxina which is absorbed and is carried to
the spinal cells in the blood current. But it cannot be asserted
that the disease is always due to the same organism, or even that
it is a pathological entity. It may be simply the clinical expres¬
sion of the reaction of the spinal cord to one of several causes, of
which infection may well be one. The data are not sufficient to
establish the idea of contagion, but the distribution, spread, etc.,
warrant us suspecting it, and isolation of children during the acute
attack is recommended. J. H. Harvey Pirie.

EPIDEMIC INFANTILE PARALYSIS. M. Allen Starr, Joan.
(527) Amer. Med. Assoc., July 11, 1908, p. 112.

This is an account of an epidemic occurring in New York and
neighbourhood in the summer of 1907, affecting about 2000 cases.
Lasting from May to December, it was at its height in August

ABSTRACTS

605

and September. In few of the cases was there any preceding
infectious disease. Excessive sweating was found a common
symptom in the early stages. Paralysis was generally noticed on
the third or fourth day. The type was sometimes the ordinary polio¬
myelitis, in others with accompanying bulbar paralysis, in others,
again, with polioencephalitis. Pain was a usual symptom.
Anaesthesias were not observed. Complete recovery occurred in
many cases, but there was a mortality of about 7 per cent. No
definite causal agent was detected. Urotropin was found useful in
the early stages, the liberated formaldehyde being found in the
cerebro spinal fluid. When the pain has subsided the use of
strychnine is recommended—to be pushed as far as is consistent
with safety. Orthopedic treatment for the prevention of de¬
formities is of the utmost importance. A short account of forty-
four other epidemics is included in the article.

J. H. Harvey Pirie.

ACUTE ANTERIOR POLIOMYELITIS IN THE ADULT, WITH

(528) EXHIBITION OF A CASE. La Salle Archambault, N.Y.

Med. Joum., Aug. 8, 1908, p. 255.

The case was that of a man of forty, who, after four days of fever,
headache, and vomiting, became paralysed in the left arm. In
three days all four extremities were involved, especially the left
arm and right leg. The trunk and neck muscles were affected,
but not those of the face. At the onset pain was a marked
feature along the spine and in the lower limbs. There was slight
temporary retention of urine. There were no sensory disturbances
save slight generalised hyperalgesia, and there was both subjective
and objective coldness, affecting especially the right lower limb.
The case would appear to be one of anterior poliomyelitis asso¬
ciated with some degree of meningitis. Lumbar puncture had not
been done at the time of exhibition of the patient.

J. H. Harvey Pirie.

THE OCULAR MANIFESTATIONS OF TABES DORSALIS.

(529) (L’ceil taWtiare.) Massia and Delachanal, Gaz. des Hop.,
Jan. 1908, p. 3.

This is the first instalment of a paper upon the ocular troubles in
tabes. The motor troubles are discussed fully, special emphasis
being laid on the frequency of the external ocular paralyses, and
upon their occurrence with different clinical features in the prse-
taxic and in the fully-developed stages of the disease. The
prsetaxic palsies are distinguished by being monocular, isolated,

006

ABSTKACTS

rapid in their onset, by affecting branches of different nerves, and
by being fleeting and benign in their course. They give a valuable
clue to the diagnosis, especially in luetic subjects with few other
signs. The later paralyses are less frequent, often bilateral, affect
the third and sixth nerves too, and often all the branches of the
former. Their onset is slow, they gradually get worse, they
persist.

Diplopia is fully discussed, as regards signs, symptoms, and
diagnosis, also ptosis and strabismus. Under the pathogenesis of
the transitory palsies, the reflex, vascular, and neuritic theories
are noted, and Brissaud’s idea of their being, like the later ones,
due to central lesions. The relationship between tabes and ex¬
ophthalmic goitre is emphasised. Inco-ordination of the eye
muscles, comparable to that of the limbs, seems to be not so
uncommon, although nystagmus is almost limited to the ataxia of
Friedreich.

Myosis, estimated as present in 50 per cent, of cases, is very
rarely accompanied by external ocular paralysis, while accommo¬
dative paralysis and papillary atrophy seldom accompany myosis.
The Argvll-Kobertson pupil is its only concomitant. Mydriasis,
less frequent, usually goes with optic atrophy with defective
vision, although rarely myosis is then present. Convergence and
accommodative pupillary contraction seem variously influenced,
but they are usually absent in mydriasis. Mydriasis is possible
without ophthalmoplegia, presumably from stimulation of the
sympathetic. An average of 30 per cent, have neither myosis
nor mydriasis.

In anisocoria the abnormal pupil is the one which reacts less
well to light. Both eyes must be equally illuminated. In
physiological anisocoria (which, by the way, Fuchs does not
acknowledge) both pupils react equally well to light. The various
causes of dilatation and contraction are given fully, and the
differential diagnosis.

Pupillary irregularity, usually in mydriasis, unilateral at first
but bilateral later, is often a very early sign. Joffroy says that
all Argyll-Robertson pupils show irregularity. The pupils may
undergo transitory alterations in size and shape before the gastric
crises and during the lightning pains.

Atrophy of the iris, evidenced by the loss of the markings and
ridges—radial in the pupillary zone and concentric in the peripheral
zone—is often seen. It may be local or general, and depends
upon the state of the ciliary ganglion.

Accommodation is frequently affected, either by spasm—with
its accompanying photophobia, lacrymation, and even dissociation
between convergence and accommodation—or by partial or com¬
plete paralysis, due to third or ciliary nerve lesions.

ABSTEACTS

607

The pupil reflexes and the sensory and trophic affections are
to be dealt with in the subsequent instalments of their review.

W. Clakk Souter.

TABES ASSOCIATED WITH TROPHIC CHANGES SUGGESTING

(530) ACROMEGALY. F. X. Dercum, Journ. of New. and Ment.
Dis., Aug. 1908, p. 507.

This is a typical case of tabes, but the patient presented in
addition certain trophic changes suggestive of acromegaly. Six
years after the commencement of the tabes, and two months before
the patient’s death, it was noticed that his face had become
lengthened, that his chin was protruding, that his nose was
prominent, as were also the zygomatic arches and the occipital
protuberance. The hands and wrists were also large, the heels
were much enlarged, as were the internal condyles of the knees.
The joints were apparently normal. The acromial ends of the
clavicle were enlarged, the ribs were broad and thickened, and
there was some spinal curvature in the dorsal region.

At the autopsy tuberculosis of the lungs, chronic myocarditis
and interstitial nephritis were present. The hypophysis was
twice as large as normal. Its capillaries were engorged with
blood. Some of the cells were fragmented and apparently de¬
generated. The suprarenal glands were somewhat enlarged, but
no marked changes were noticed save that the cells of the zona
fasciculata seemed to have undergone an unusual degree of fatty
change. There was a marked sclerosis in the posterior column of
the cord.

The author concludes by remarking, “ It is not improbable that
the changes in the pituitary body bear some relation to the bony
changes. The thought suggests itself that perhaps in cases of
tabes generally, where there are marked trophic changes in the
bones there are also changes of the pituitary body, and it may be
wise to examine the pituitary body and the other ductless glands
in such cases.” Edwin Bramwell.

PRURITUS IN TABES. (Du prurit taMtique avec ou sans lichlnifl-

(531) cation.) J. Rebaud, Theses de Paris, 1907-08, No. 287.

This thesis, inspired by Milian, who first described this symptom
(v. Rev. of Neurol, and Psych., 1907, p. 909), contains thirty-nine
cases. Of twenty-seven personal cases of tabes eight gave a
history of pruritus. Among these, thoracic pruritus was most
frequent. There was only one case of pruritus ani and not a
single case of lichenification. J. D. Rolleston.

608

ABSTRACTS

CLINICAL AND ANATOMICAL OBSERVATIONS UPON SIX
(532) OASES OF PSEUDOSYSTEMIO DISEASE OF THE SPINAL
CORD, etc. (Klinische and anatomische Untersuchongen von
sechs F&lle von Pseudosystemerkrankung dee Rdckenmarks:
Eritik der Leben von den Systemerkrankongen dee Riicken-
marks.) Nonne und Frond, Deutsche Zeitsch. f. Nervenheilk .,
Bd. 36, S. 102, 1908.

System diseases of the cord may be divided into two main classes,
hereditary and acquired. The hereditary group comprises
Friedreich’s ataxia and the hereditary spastic spinal paralysis of
Striimpell, Bernhardt, and others. The acquired forms are much
more varied and numerous, including tabes and tabes-paralysis,
pellagra, and the degenerations occurring in such diseases as per¬
nicious anaemia, carcinoma, and chronic alcoholism. These again
may be subdivided into the true system diseases, spastic or ataxic,
or a combination of spastic and ataxic; and lastly, the pseudo¬
system diseases of several regions of the cord. Nonne and Friind
here discuss the question whether any sharp distinction can really
be drawn between the true system diseases and the pseudo-system
diseases, ultimately answering this question in the negative. Tabes,
which is a disease sui generis, is expressly excluded from the group
of diseases here discussed.

Case 1.—The clinical notes have been lost. The following
conditions were present in the spinal cord:—In the posterior
columns, symmetrical degeneration of Goll’s and Burdach’s tracts
in the lumbar region, with normal fibres in the septo-marginal
area. In the dorsal region, total degeneration of the posterior
columns, except a small area close to the posterior cornua and at
the periphery of Goll’s tract. A similar condition extended up to
the upper cervical region. In the lateral columns, symmetrical
degeneration of the lateral pyramidal tracts in the lumbar region;
in the dorsal and cervical regions, degeneration of the lateral
pyramidal and dorsal cerebellar tracts; in the anterior columns,
unilateral degeneration of the ventral pyramidal column in the
lower dorsal region, bilateral degeneration in the upper dorsal
region, normal appearance in the cervical region.

Case 2. —A male patient of 56 years, free from hereditary taint,
who had severe gastro-intestinal disorder three years before the
onset of his illness. No syphilis, but alcoholic excess for three
years. No pains or parasthesia. Flaccid paresis of the legs, with
loss of the deep reflexes and extensor plantar reflexes. Towards
the end, weakness and ataxy of the arms, and distinct sensory
disturbances. Bladder and rectum early affected. Pupils normal.
Febrile enteritis with recurring exacerbations. Severe ansemia.

ABSTRACTS

609

Microscopically the cord showed foci of sclerosis in the posterior
columns in the lumbar region; systematic degeneration of Goll’s
tracts in the dorsal and cervical region; in addition, sclerotic foci
in Burdach’s columns in the cervical region. The lateral pyramidal
tracts showed sclerosis, increasing in intensity from the lumbar
region upwards. The dorsal cerebellar tracts were sclerosed in
their whole extent. Degeneration of the ventral pyramidal tracts
began below in the mid-dorsal region, overlapping the ventral
pyramidal tract in the upper dorsal region, and could no longer be
recognised in the upper cervical region. The anterior and posterior
cornua were normal, save for the cells of Clarke’s column, which
were atrophic. Anterior and posterior roots normal.

The disease lasted ten months, with a probable earlier attack
three years previously.

Case 3.—Two years before the beginning of the disease the
patient, a man of 36, had severe anaemia with general glandular
enlargement, followed by iritis. For a year and a half the patient
felt well, then began to have weakness and spasticity of the legs.
Syphilis and alcohol were denied. The pupils were normal. The
gait was spastic-ataxic, with increased deep reflexes. No sensory
changes at first. Bladder normal; later, the bladder became
paralysed, and there were severe pains and girdle sensations.
Moderate anaemia. Duration of disease, eight months.

Anatomically: in the posterior column commencing degenera¬
tion in the lumbar region of focal character, nearly symmetrical.
In the dorsal region, symmetrical degeneration of the greater part
of Burdach’s and Goll’s tracts. In the cervical region, symmetrical
degeneration of Goll’s tracts; new foci in Burdach’s tracts. The
lateral pyramidal tracts showed symmetrical degeneration begin¬
ning in the lumbar region, extending to the upper dorsal region,
where it was more diffuse. In the cervical region marked restitu¬
tion took place around the grey substance. Isolated empty areas
in the medulla oblongata. The ventral pyramidal tracts were
diseased, commencing with empty areas in the lumbar region. In
the dorsal region both ventral pyramidal tracts were totally
degenerated, overflowing to the periphery of the cord anteriorly.
In the cervical region there was a distinct lessening of degenera¬
tion. The dorsal cerebellar tracts were sharply and systematically
diseased from the dorsal region upwards, and this could be traced
into the medulla. The cells of Clarke’s column were rarified. In
the diseased areas marked vascular changes were present.

Case 4. —Forty-one year man, with negative family and personal
history. No venereal disease, but moderate alcoholism. Began
with pains and weakness of the legs. At first the paresis was
spastic-ataxic, with increased deep reflexes and extensor plantar
response. Sensory losses were well marked. Microscopically
2 x

610

ABSTEACTS

there were focal degenerations in the posterior column in the
lumbar region, which degeneration in the dorsal region included
the whole space between the posterior horns. In the cervical
region there was systematic degeneration of Goll’s column and
new sclerotic foci in Burdach’s column. In the lumbar region
there was marginal degeneration and thickening all round the
periphery. The degeneration of the lateral pyramidal tracts
began in the lower lumbar region, and in the dorsal region over¬
spread beyond the boundary of the pyramidal system. In the
cervical region healthy fibres entered the tract from the grey
matter. Total degeneration of the dorsal cerebellar tracts, forming
sclerotic areas in the lower part; in the upper part showing
empty fibres. The cells of Clarke’s column were diminished.
Diffuse degeneration of both ventral pyramidal tracts in the whole
of the dorsal and cervical regions.

Case 5.—A man of 50 years, whose mother died of some
nervous malady, but who himself had an excellent previous
history, free from alcoholic or venereal taint. The illness began
with gastro-intestinal symptoms. Then he developed feeling of
weakness and stiffness in the legs. The upper extremities had
spasms and intention-tremors, the legs were paretic and spastic,
the deep reflexes were increased, with extensor plantar reflexes.
Sensory blunting was also present in the legs. The spastic
paresis ultimately became flaccid. Post-mortem, there were focal
degenerations in the posterior column of the lumbar region, with
a pure sclerosis of Goll’s column in the dorsal and cervical regions.
Focal degeneration also in Burdach’s colximn in the dorsal and
lower cervical regions. In the lumbar region there was com¬
mencing degeneration of the lateral pyramidal tracts, overstepping
the limits of the tract itself, but less intense in the cervical
region. The central parts of the cord were also sclerosed. The
dorsal cerebellar tracts were completely degenerated. There was
irregular degeneration of the ventral pyramidal tracts in the
dorsal and cervical regions. The anterior and posterior grey
matter were normal, but the cells of Clarke’s column were
atrophied. The total duration of the illness was eight montha
There was moderate anaemia of simple type.

Case 6.—A man of 47 years, without hereditary taint, had
severe anamia two years before the onset of his later symptoms,
together with transient paraesthesias, sensory change, and absent
knee-jerk. A second attack occurred, without anaemia, beginning
with flaccid paresis and ataxia, without sensory loss. Later the
paresis became spastic, sensory change reappeared, also loss of
control of the sphincters.

In the posterior column there were foci of sclerosis in the
lumbar region. In the lower dorsal region the whole of the

ABSTRACTS

611

posterior columns were degenerated. In the upper dorsal and in
the cervical region there was symmetrical degeneration of Goll’s
and partly of Burdach’s tracts, with isolated small foci in addition.
The pyramidal tracts and the whole anterior columns were
sclerosed from the upper lumbar region upwards, diminishing in
intensity in the cervical region. Anterior and posterior cornua
and roots were normal.

All the above cases are examples of combined system-disease
of the cord. In three out of the six the spinal affection was
preceded by a severe febrile malady, at periods varying from one
and a half to two and a half years before. Two cases had severe
anaemia. It was noticeable that no two cases were exactly
similar, either clinically or anatomically. But, on the whole, it
was evident that the posterior columns were most severely
affected. The pyramidal system was also constantly degenerated,
the other parts of the lateral column being only sclerosed when
the marginal zone was diseased. The affection of the anterior
column was most irregular in form and extent, though the ventral
pyramidal tracts were often systematically affected. The grey
substance and its surrounding white matter seemed to be relatively
less affected. This was apparently associated with the normal
condition of the vessels of the grey matter.

To sum up, the authors conclude that there is no real combined
“ system ” disease, in the strict meaning of the term; moreover,
the slightness of the clinical symptoms is often in marked contrast
to the severity of the anatomical change. The degeneration is
not limited to strict systems or tracts; there are present, in
addition, diffuse non-systematic degeneration. In acute cases this
marked process appears to commence as small-cell infiltration
around the blood vessels.

Finally, the authors point out that true system degenerations
are best exemplified, not by cases such as are above described, but
by cases of family and hereditary spinal diseases, amyotrophic
lateral sclerosis, and tabes dorsalis, with its various combinations.

Purves Stewart.

UNILATERAL CAUDA EQUINA SYNDROME. (Syndrome de
(533) T “h&ni-queue de clieval ” par meningo-radiculite syphilitique.)

Laignel-Lavastine, Nouv. Icon, do la Salpitri&re, Marcb-April
1908, p. 117.

This is an interesting case of involvement of the right fifth lumbar
and all the right sacral roots in a mass of syphilitic meningitis or
“ meningo-radiculitis ” at the level of the exit of the third lumbar

612

ABSTRACTS

root, with a typical clinical picture. The case is of value inas¬
much as the pathological examination demonstrates accurately
the difference between the exogenous and the endogenous fibres
at these levels. According to Laignel-Lavastine, his case supports
Nageotte’s contention that Lissauer’s zone is composed of fine
vertical endogenous fibres. S. A. K. Wilson.

▲ CASE OF BULBO PONTINE SOFTENING. (Etude Anatomo-

(534) clinique d’un cas de ramollissement bulbo-protubdrantiel.)

Fran^ais and Jacques, Rev. Neurol., June 15, 1908, p. 521.

Clinically : inability to swallow, absence of the pharyngeal reflex,
paralysis of the left side of the palate, weakness of the left limbs,
inability to stand alone, tendency to fall to the left, slight general
ataxia, dissociated anaesthesia on the right side, including the face,
myosis and narrowing of the palpebral fissure on the left side, a
little nystagmus to both sides, double flexor response. Patho¬
logically : three limited areas of softening, one dorsal to the left
inferior olive, destroying the ventral cerebellar tract, the nucleus
ambiguus, the greater part of the grey reticular formation, the
upper part of the sensory decussation, some of the fibres of the
bulbar part of the spinal accessory, the descending sensory root of
the fifth, the ventral part of the corpus restiforma, the superficial
arcuate fibres and many cerebello-olivary fibres; a second towards
the middle part of the pons on the right side, involving the right
pyramidal tract, and some of the transverse fibres of the middle
cerebellar peduncle; and a small third area at the same level, in¬
vading the outer end of the left fillet. S. A. K. Wilson.

CONTRIBUTION TO THE DIAGNOSIS AND TREATMENT OF

(535) TUMOURS OF THE CENTRAL NERVOUS SYSTEM.
(Beitr&ge zur Diagnostic und Therapie der Geschwulste im
Bereich des Zentralen Nervensys terns.) H. Oppenheim.
Sn. 193. Mit 20 Abbildungen im Text und 6 Tafeln. Verlag
von S. Karger, Berlin, 1907.

Statistics collected from the literature must give, it is obvious,
a quite erroneous impression of the results obtained in operations
for the removal of intracranial tumours. We have in the present
monograph a most important contribution to the surgery of
tumours of the central nervous system, for the work embodies
the personal experience of one man, and he one of the greatest
authorities of the day, working in conjunction with surgeons who
have had a special experience in this department of surgery.

ABSTRACTS

613

Oppenheim, in the second edition of his monograph on intra¬
cranial tumours (published in 1902), recorded his experience of
the results of operation up to that date. At that time, of twenty-
four cases which he had submitted to operation, in only one was
a cure effected. In 20 to 21 per cent, there was improvement,
while in 37 to 38 per cent, death followed as the result of the
operation. Of these twenty-four cases, in four a palliative opera¬
tion only was undertaken.

The present communication embodies the author’s experience
since 1903. Among twenty-seven cases operated upon, in twenty-
four the operation was undertaken in the hope of being able to
remove the growth. Three cases (11*1 per cent.) were cured, six
(22’2 per cent.) improved, a part of the tumour or a cyst in its
substance being evacuated, while in 55 per cent, death occurred
immediately, or soon after the operation. This large mortality
Oppenheim accounts for by the circumstance that in twelve cases
the tumour was situated in the posterior fossa. The conclusion he
arrives at from his own material is, that of every nine or ten cases
carefully selected and for the most part (grosstenteils) correctly
diagnosed, in only one is complete removal and recovery to be
expected. All these cases above referred to are recorded in
detail.

The paper also includes the records of the cases of tumour of
the spinal cord which the author has submitted to operation.
These are fifteen in number.

Oppenheim holds that surgical treatment is urgently indicated
in any case which presents the typical symptomatology of a tumour
of the spinal membranes. According to his experience, in about
50 per cent, of these cases a cure is to be anticipated, and it will
be the more complete the earlier the interference is undertaken.
More extended surgical experience will doubtless reduce the
mortality from shock, and especially from meningitis, which is at
present considerable. The typical symptoms of an extra-medullary
tumour may be simulated by disease of the vertebra;, by a localised
meningeal process, or by a new formation within the spinal cord.
As Nonne’s material demonstrates, the differential diagnosis
between an extra medullary tumour on the one hand, and a
tumour of the vertebral column on the other, is not always
possible. Again, the symptomatology of tumours of the spinal
membranes is very often atypical, and if we are to reserve opera¬
tion only for those cases in which the symptoms are practically
certain, a considerable proportion of tumours will be missed. If
after consideration in a doubtful case the disease is observed to
be distinctly progressive and the existence of an extra-medullary
tumour appears to be at all probable, an exploratory laminectomy
should be undertaken. Where the general diagnosis is uncertain

614

ABSTRACTS

the diagnosis of the level of the lesion should be as absolute as
possible. The operator should not stop on exposing the dura if no
tumour is met with, for in only some of Oppenheim’s cases of
intradural tumour was the new growth visible or palpable before
the membrane was opened. That an exploratory laminectomy
leads to no harmful result when an intramedullary lesion exists
is demonstrated by several cases here recorded, as well as by the
observations of others. Edwin Bramwell.

A BBAIN TUMOUR LOCALISED AND COMPLETELY REMOVED,
(536) WITH SOME DISCUSSION OF THE SYMPTOMATOLOGY
OF LESIONS VARIOUSLY DISTRIBUTED IN THE
PARIETAL LOBE. C. K. Mills and C. H. Frazier, Joum.
of Nerv. and Ment. Dis., Aug. 1908, p. 481.

The case is that of a female aged 45, who suffered from attacks of
vomiting, dizziness and headache. When seen by Dr Mills on
December 30, 1907, in addition to optic neuritis and left lateral
hemianopia, previously detected by Dr de Schweinitz, there was
a moderate degree of hypsesthesia of the left extremities together
with hypastereognosis, some loss of sense of position, and some
ataxia and atactic tremor of the left arm. There was also some
impairment of the ability to use her left leg and arm, “ this being
due to inco-ordination rather than to loss of strength." There was
no aphasia. The tendon jerks were normal and the Babinski sign
was not present. On February 1st the left pupil was slightly
greater than the right, and the associated upward movement of
the eyes seemed to be limited but was not lost. Ever since her
first symptoms were noticed in October the patient had had a
peculiar puffing sound in the left ear and a singing or buzzing
sound in the right, although her hearing had not changed. Memory
and attention were good. Slight left facial weakness. A little
awkwardness in some of the finer movements with the left hand.
Sense of location impaired over left upper extremity. Distinct
ataxia in finger nose test on left side. Slight hypastereognosis
on left side.

On February 3rd it was noted that the swelling of the optic
discs had increased from 2£ to 5 dioptres. Wernicke’s symptom
was not present.

Dr Frazier operated on February 5th. The incision was made
so as to expose portions of the occipital, parietal and temporal
lobes. A cyst was removed which was found subsequently to
measure 8 by 4 centimetres. The cyst came to the surface
over an area which did not exceed that of a 25 cent piece in
the superior posterior angle of the opening. The operation, which

ABSTRACTS

615

was performed in one stage, the bone flap being replaced, occupied
thirty minutes exclusive of the time taken in closing the wound
in the dura and scalp. The cyst proved to be a simple serous
cyst.

On February 12 the ataxia had disappeared and all the functions
of the arm and leg were restored. There was still five dioptres
of swelling of the optic discs. On March 9 the hemianopsia was
improving, and on May 8 she had a practically full field on the
right side with partial hemianopsia on the left.

The authors remark that the autopsy method of determining
the operability of tumours is open to serious objection, and the
percentage of tumours suitable for radical operation should be
made from the statistics of the surgical clinic and not of the
pathological laboratory.

They have studied four different symptom complexes accord¬
ing to the degree of implication of the various portions of the
parietal lobe, and they give directions for exposure of the implicated
region in each case. The symptom complexes are (1) pronounced
hemianopsia and ataxia, combined with pressure symptoms vary¬
ing in intensity, such as hypsesthesia, hypastereognosis and slight
paresis of the face and limbs; (2) astereognosis and ataxia, com¬
bined with symptoms showing various degrees of involvement
of cutaneous, muscular and arthridal sensibility, but without
hemianopsia and with no, or only slight, paresis ; (3) hemianopsia
and hemiataxia, with hypsesthesia and hypastereognosis and pro¬
nounced paresis, specially of the face and upper extremity;
(4) astereognosis and ataxia, with hypaesthesia and pronounced
paralysis, specially in the lower and upper extremities.

Edwin Bramwell.

A CONTRIBUTION TO THE SYMPTOMATOLOGY OF PARALYSIS
(537) AGITANS. (Ein Beitrag zur Symptomatology der Paralysis
Agitans.) A. Pelz, Neurol. Centralbl., Aug. 1, 1908, S. 27.

The case is that of a man aged 59, who presented the char¬
acteristic postures of paralysis agitans. While the patient was at
rest there was no tremor. Upon movement, however, a tremor
was present. The author, after referring to paralysis agitans
without tremor, alludes to cases in the literature in which tremor
was present only during voluntary movement.

Edwin Bramwell.

616

ABSTRACTS

THE REVISION OF HYSTERIA. (La revision de lliystfrie.)

(538) Henry Meige, Pressi mid., juillet 4, 1908.

This paper formed the basis of a discussion on the subject of
hysteria at the meeting of the Neurological Society of Paris.

M. Meige commences by pointing out the necessity of having
instituted a discussion for the revision and elucidation of a condi¬
tion so variable and ambiguous.

He gives us a clear insight into the resultant opinion arrived
at by numerous trustworthy observers.

The elusive manifestations of hysteria which have heretofore
been regarded as more or less pathognomonic of the condition, and
upon which so much stress has been laid, have now been inter¬
preted in such a manner as to lose their significance and prestige.

Among the characteristic and formerly accepted signs of
hysteria the following are discussed :—

Hemi-anaesthesia, anaesthesia of the pharynx (or, as he terms it,
abolition of the pharyngeal reflex”), retraction of the visual field,
monocular polyopia and dyschromatopsia.

These have been termed the “ feigned ” stigmata of hysteria.
He quotes the opinion formulated by Babinski, Ballet, Brissaud,
Dupre, and Souques as being that “the feigned stigmata of
hysteria result only from an unconscious suggestion which is
usually of medical origin.”

Each of these observers cites cases in which one or other
stigma was unnoticed by patient or physician on admission or
at the onset of the condition, but developed subsequently after
examination.

Babinski asserts that the anaesthesia arises from faulty or
indiscreet methods of examination, and is the result of suggestion.
On these grounds one should never ask the hysterical patient
questions like the following:—

“ Do you feel that ? ” “ Do you feel as well on one side as the
other ? ” as they suggest to the patient an impairment or absence
of cutaneous sensations.

Babinski, after personally examining a hundred cases of
hysteria with care, was unable to find hemi-ansesthesia in a single
case.

Dejerine, Raymond, and Pitres, recognising that anaesthesia is
often of medical origin, maintain that they appear spontaneously
in some cases, suggestion taking no part in their genesis.

M. Thomas contends rightly that it is so difficult to prove
whether or not any previous or anterior suggestion has been put
forward that he finds it impossible to maintain that it has not
existed.

ABSTRACTS

617

With regard to contraction of the visual fields, Rochon-
Duvigne and Brissaud, like Babinski, arrive at the conclusion that
this disturbance is due to errors in examination.

Dyschromatopsia has also been proved to be absent by Brissaud
hy adopting the*use of the Remy’s diploscope, which renders de¬
ception impossible on the part of the patient.

Babinski also maintains that abolition of the pharyngeal
reflex varies according to the subject, and may be suppressed by
patients owing to some suggestion.

The above signs are discussed under the title of “ Stigmata of
Hysteria.”

Next “Les troubles pithiatiques ” (disorders curable by per¬
suasion) and so-called hysterical dystrophies are discussed.

Babinski suggests that this group, in which we find convulsive
attacks, paralyses, contractures, anaesthesia, hyper-aesthesiae, dis¬
turbance of the senses and speech, etc., ought to be recognisable
from the fact that they can be produced by suggestion and dis¬
appear under the influence of suggestion or persuasion alone.

Raymond, Pitres, and Dejerine think that one ought to regard
as hysterical certain circulatory and trophic disturbances, e.g.
dermographia, oedema, eruptions, haemorrhages, ulcerations, etc.

Brissaud is convinced that oedema and ulceration of a hysteri¬
cal nature do not exist. He cites the case of a young girl who
developed a series of abscesses which were considered hysterical
but were found each to contain a fragment of needle, presumably
introduced by the patient herself.

As regards the bullae of pemphigus, M. Raymond clearly recog¬
nises that such symptoms cannot, be produced by suggestive
influence, and states that the time is not far distant when another
“ vaso-motor neurosis ” will be proved responsible for these circula¬
tory disturbances; and it is from future investigation that we
must learn what the link is which unites this neurosis to the
4 ‘ pithiatique ” symptoms, the only indisputable phenomena of
hysteria. Thus we see that the vaso-motor or trophic disturb¬
ances formerly attributed to hysteria do not appear in the same
way as those of the “ pithiatique ” group (paralyses, contractures,
etc.), which one is unable to reproduce by suggestion.

It is pointed out that reserve should be exercised with respect
to visceral haemorrhages and secretory disturbances as being
symptoms of hysteria.

M. Cestan quotes a case of anuria present in a hysterical
patient, but he adds that he could not affirm its hysterical nature.

Babinski and Dupr4 Btate that they have never been able to
produce “ hysterical fever ” by suggestion, and so far do not accept
the observations made under this heading.

J. George Phillips.

618

ABSTRACTS

FURTHER CONTRIBUTIONS TO OUR KNOWLEDGE OF TOR-

(539) TIOOLLI8 MENTALIS (HYSTERICUS.) Sectio. (Weitere
Beitr&ge zur Kenntnis dea Torticollis mentalis (hystericus),
mit einem Sektionsbefund. ) Jkno Kollarits, Zeilschrifi. /.
NervenheiUc., Bd. 35, Hft. 1 und 2, S. 141.

This paper gives a summary of the points in favour of the
psychical origin of spasmodic torticollis. Three new cases are
described, one of which appeared to be a pure traumatic neurosis.
In none was there any sign of labyrinthine disease, which Curschman
has put forward as a cause of torticollis. There is also the account
of a sectio on a case previously reported. The only change found
in the nervous system was a very distinct degeneration in the
column of Goll, which it is very difficult to connect with the
disease in question. J. H. Harvey Pibie.

MIGRAINE, AN OCCUPATION NEUROSIS. George L. Walton,

(540) Joum. of Am, Med. Assoc., July 18,1908, p. 200.

Defining an occupation neurosis as “ a condition resulting from
overuse of certain parts,” the author considers that migraine is an
occupation neurosis, and involves—(1) the visual centres; (2) the
centres of accommodation ; (3) the intrinsic and extrinsic muscles-
of the globe; and (4) the muscles outside the orbit which are
called into play in the effort required for accurate vision, princi¬
pally the corrugator supercilii and occipito-frontalis, and also the
muscles inserted in the occipital region, which serve to steady the
head. Migraine results, in individuals of neurotic inheritance,,
from overuse, or use under the handicap of refractive error, of the
parts concerned in vision. In cases of extreme susceptibility
migraine may even appear without error of refraction from
moderate use of the eyes. He believes that the vasomotor
phenomena are secondary, and that the vomiting “ represents a
protective effort on the part of nature.” J. A. Gunn.

DOUBLE OPTIC NEURITIS FOLLOWING VARICELLA. (NfSvrite

(541) optique double suite de varicelle.) P. Chavernac, Ann.
cToculistique, 1908, p. 52.

A boy, aged 11 years, had an attack of varicella in February 1905,
for which he was kept in bed a few days. As soon as he was
convalescent he noticed that his sight was impaired. Within forty
days he was unable to read, and by June he could not count
fingers at a metre’s distance. Optic neuritis was diagnosed by

ABSTKACTS

619

several eminent ophthalmologists, and he was subjected to intense
mercurial treatment from March to November. In November
the mercury was omitted. Fifteen subconjunctival injections of
hetol were then given at two to three days’ interval, and considerable
improvement resulted. Chavernac thinks that mercury should be
used with great care in optic neuritis of infectious nature. In the
present case it was inactive and perhaps harmful, since mercurial
intoxication was superadded to the varicella poison.

J. D. Kolleston.

THE PHENOMENON OF CHARLES BELL. Fumarola, L'Enctphale ,

(542) May 1908, p. 385.

The author examined thirty-two cases of facial paralysis. In
thirteen cases the eye rotated upwards and outwards—eight times
upwards, six times upwards and inwards; in five cases the eye
remained immobile; once it rotated downwards and inwards, and
once directly inwards. He considers the phenomenon to be
purely normal, rendered visible by the paralysis, and of no
prognostic significance whatsoever. S. A. K. Wilson.

HERPES OF THE MEMBRANA TYMPANI DOE TO ZOSTEROm

(543) AFFECTION OF THE PETROSAL GANGLION. T. J.

Orbison, Joum. of Nerv. and Ment. Dis., Aug. 1908, p. 500.

Earache, tinnitus and deafness in the left ear. An herpetic
vesicle on the posterior surface of the membrana tympani together
with similar vesicles in the palatine and alveolar regions.

The author refers to the sixty cases collected by J. Eamsay Hunt,
in which peripheral facial paralysis and zoster co-existed and
were attributed by that writer to inflammation of the geniculate
ganglion. He remarks that the petrosal ganglion of the glosso¬
pharyngeal nerve plays the same role as the geniculate on the
7th, and argues on anatomical grounds that it is the former
ganglion which is the seat of the lesion in the case he reports.

Edwin Bramwell.

THE SYMPTOMS AND BASIS OF WORD-DEAFNESS. (Ueber

(544) Enchemungen und Gnmdlagen der Worttaubheit.) Quensel,
Deutsche Zeitschr. f. N’ervenheilk., 1908, Bd. 35, S. 25.

The author describes three cases of word-deafness, two of them
with autopsy, and after a long discussion of the phenomena sums
up his chief conclusions as follows:—

(1) The cortical area, whose destruction produces word-

620

ABSTRACTS

deafness, includes the posterior half of the first temporal gyrus,
together with the transverse temporal gyrus, on the left side in
right-handed individuals. The transverse temporal gyrus must
be completely destroyed to produce total word-deafness.

2. Total word-deafness can occur—( a ) In cases of subcortical
lesion with complete interruption of the auditory radiation and of
the corpus callosum in the region of the word-hearing area.
Partial interruption of the auditory radiation, with total interrup¬
tion of the corpus callosum, leaves the hearing and comprehension
of words intact, provided the cortex of the transverse temporal
and first temporal gyrus be undamaged. ( b ) Total word-deafness
occurs in a lesion entirely or partially cortical, if the left transverse
temporal gyrus is isolated or included in a larger lesion. This
result will also occur in a right-sided lesion, even though the
process of hearing is not completely lost.

3. Cases of partial lesion of the transverse temporal gyrus
show partial word-deafness, with the power of repeating cor¬
rectly words of one or two syllables, but failure with other
words.

4. The power of repeating words heard in partial word-
deafness occurs only when lesions are also present in Broca’s
convolution or in the motor area.

5. Intact power of repeating words heard in certain cases of
word-deafness shows that besides parts of the transverse gyrus,
other parts of the first temporal gyrus have survived. The con¬
verse, however (preservation of function when these areas are
spared), does not necessarily occur.

6. Disorders of reading are not necessarily associated with
destruction of the above area for word-deafness, although loss of
comprehension of what is read, with preservation of the power of
reading aloud, may be expected.

7. Alexia, complete or partial (except the variety included under
paragraph 6), is observed almost exclusively in cases where the
lower parietal region, especially the angular gyrus, has been
destroyed, at least partially.

8. The loss of power of repeating words heard and of reading
are not necessarily proportional to the word-deafness.

9. Anamnestic and paraphasic faults of spontaneous speech are
hardly ever absent in word-deafness, though their intensity is
variable.

10. The power of spontaneous expression by writing in cases
of word-deafness is dependent on (a) impairment of spontaneous
speech, and ( b ) impairment of reading. The loss of power of
writing to dictation is dependent on (a) the condition of spon¬
taneous speech, and (b) the degree of word-deafness.

11. When the power of copying is lost in cases of word-deafness,

ABSTRACTS

621

this corresponds either to a total alexia or to a concomitant motor
aphasia or apraxia.

12. Cases of word-deafness with marked apraxic phenomena
are associated with implication of the supra-marginal gyrus.

13. The following points are in favour of the existence of a
well-defined form of word-deafness :— (a) The occurrence of word-
deafness as a clinical syndrome. Hitherto only one case has been
shown to be due to a subcortical focus of disease. ( b ) The so-
called transcortical sensory aphasia of Wernicke is a clinical syn¬
drome, mostly transitory, and due to a diffuse morbid process.
As a direct stabile focal symptom it is not firmly established.

Against its existence is the fact that so-called cortical sensory
aphasia may be of most varied clinical forms, whose phenomena
vary according to the variation in the positions of the anatomical
lesions.

14. As to the division of cases of word-deafness according
to their underlying anatomical lesions, it is best to start
from the proposition that we have in the brain cortex a
relatively widespread area which has to do with the asso¬
ciation of the auditory speech function, into which area the
auditory projection-fibres enter. This area — the transverse
temporal gyrus—forms a defined centre together with a transi¬
tion area. Every case of word-deafness caused by a deep
peripheral focus may be called “pure perceptive,” a variety
which is total, pure, and stabile. On the contrary, every case of
word-deafness caused by a central focus is necessarily incomplete,
complicated, and generally capable of improvement—the “pure
associative” variety. The cases where the transverse gyrus is
more or less implicated produce the mixed form of perceptive-
associative word-deafness, which may be partial or complete,
permanent or curable.

15. The conditions under which word-deafness may improve,

though it seldom passes off completely, cannot yet be formulated
with certainty. Stabile cases are often associated with bilateral
lesions of the word-hearing centres, but sometimes with unilateral
destruction of the transverse gyrus as part of a more extensive
lesion. Probably the implication of the corpus callosum is of
great importance. In cured cases the word-hearing area has never
been bilaterally destroyed. Purves Stewart.

▲ CASE OP PARAPHASIA. Grasset and Rimbaud, Rev. Neurol .,
(545) June 30, 1908, p. 577.

In this case the patient exhibited typical paraphasia, and while he
read and wrote with difficult* there was neither agraphia nor
word-blindness. There was not the slightest indication of word-

622

ABSTRACTS

deafness. Nevertheless at the autopsy a softening of the first left
temporal convolution was found, towards its posterior end. This
lesion is perhaps rather further back than the middle part of the
convolution, destruction of which is supposed to produce word-
deafness. Minute examination of the brain revealed arterial
disease and microscopical cortical changes in various areas, which
to the naked eye appeared quite normal. The importance of this
cannot be overlooked in any discussion of the relation of the
clinical symptoms to the pathological facts.

S. A. K. Wilson.

RELATIVE EUPRAXIA IN RIGHT HEMIPLEGIA. (Relative
(546) Eupnude bei Rechtsgel&hmten.) Meter, Deutsche Med. IVoch.,
June 25, p. 1143.

The first patient was a man with slight right hemiplegia, probably
of syphilitic origin. In proportion to the degree of paralysis of
the right arm, his capacity for performing various movements with
it was astonishingly good. While he could not lift his arm, on
request, much higher than his shoulder, he was able to lift it
higher, sometimes by as much as 10 centimetres, if an object was
held up for him to grasp. His caligraphy with the right hand
was quite good.

On the other hand, a second patient showed exactly the reverse
conditions. With considerable conservation of strength in the
paresed right arm he was unable to perform many movements,
nor could he reach as high for an object as without one. The first
case was probably due to a lesion of the basilar artery, whereas
other signs in the second case pointed to a lesion of the cortex.
The author sums up with the loose statement that the further
away the lesion is from the cortex, the less the degree of apraxia.

S. A. K. Wilson.

THE ABDOMINAL REFLEX. (Contributo alio studio del riflesso
(547) addominale.) A. Baldi, H Policlinico, Aug. 2, 1908, Fasc. 31,
p. 965.

Baldi investigated the abdominal reflex in the various conditions
in which the physiological integrity of the skin had been impaired,
viz., by pregnancy, new growths, laparotomy, or such diseases as
tuberculous peritonitis or small-pox. In twenty-seven primiparae
in whom delivery had taken place not more than six months
previously the reflex was absent. In forty-one primiparae who
had been delivered from two to five years previously the reflex

ABSTRACTS

623

was easily obtained. Multiparse, on the other hand, were found
to have lost their reflex after the birth of their third child. The
reflex was also absent in all the cases in which the sensory
conductivity of the skin had been interfered with by tumours,
operation wounds, tuberculous peritonitis or small-pox.

J. D. Rolleston.

HEREDITARY TREMOR (Tremblement h6r6ditaire, rappelant
(548) celui de la sclerose en plaques.) Dromard, L’Endphale, July
1908, p. 45.

The patient is an old man of 73, who has been an inmate of the
asylum of Clermont since 1862. Tremor of the arms and head,
resembling the intention tremor of disseminated sclerosis, was
noted in his case at least as early as 1887. At the present time
his mental powers, in spite of his age, do not appear enfeebled.
He presents a highly advanced intention tremor of the arms, of
wide amplitude, increasing with the progression of the movement,
a certain spasmodicity of the lower extremities, staccato speech, and
nystagmus. The superficial resemblance to disseminated sclerosis
which the case shows cannot obscure the significance of various
points which make that diagnosis impossible.

The real import of the case will be grasped at once when we
learn that the patient’s father and mother both suffered from an
identical tremor, and died at an advanced age. The patient is
the second of three children, of whom the youngest was similarly
affected.

The author is able to supply illustrations of the handwriting
of father, mother, and patient. S. A. K. Wilson.

RECKLINGHAUSEN’S DISEASE. Raymond and Alquier,
(549) L’Enctphale, July 1908, p. 6.

In all probability Recklinghausen’s disease is a congenital affec¬
tion, either from malformation or defective development, whose
clinical evolution is in many ways comparable to that of dermoid
cysts. It may remain latent for a variable time, or may progress
slowly, or may develop with great rapidity—facts which render
an accurate prognosis difficult.

Only rarely are the tumours true neuromata; they are com¬
monly akin to the “ false neuromata ” of Virchow, that is to say,
they are formed of connective tissue. Their structure is fibro-
matous, fibro-lipomatous, or sarcomatous. The fact of their struc¬
ture being sarcomatous does not necessarily indicate a rapid
development. The sites of the tumours are likewise variable; we

624

ABSTRACTS

meet with neuro-fibromata, also with perivascular fibromata, and
also periglandular fibromata.

The authors have met with fibromata of the skin, in which the
vessels and nerves running through the fibrous tissue are perfectly
normal; such cases may justifiably be described as “ pigmentary
dermato-fibrosis.” S. A. K. Wilson.

COMPLETE RADICULAR PARALYSIS OF THE BRACHIAL

(550) PLEXUS WITH OCULO-PUPILLARY PHENOMENA, FOL¬
LOWED BY AUTOPSY. (Paralysie radiculaire totale du
plexus brachial avec phlnom&nes oculo-pupillaires autopsi6e
trente-six jours aprbs l’accident.) Madame D£j£rine-
Klumpke, Rev. Neurol., July 15, 1908, p. 637.

The patient was a young man who in a bicycle accident sustained
a complete paralysis of his right arm. When he was seen, it was
cold, cyanotic, and cedematous, with absence of the radial pulse.
There was complete loss to all forms of sensation as far as the
shoulder, with the exception of a strip running from the axilla
down the inside of the upper arm almost as far as the elbow. All
the right arm deep reflexes were lost. There was a cervical sym¬
pathetic lesion as well, on the same side. The patient died during
an operation undertaken to relieve the symptoms, and the parts
were subsequently dissected with care. The axillary and sub-
clavicular arteries were found to be thrombosed. Behind the first
rib the trunk common to the fifth and sixth cervical roots was
found to be elongated; the seventh and eighth cervical and the
first dorsal roots were completely torn across; the ganglia corre¬
sponding were wrenched out of their bed. Vessels and nerves
alike were embedded in a mass of fibrous tissue (the operation was
thirty-six days after the injury). The only part of the sympa¬
thetic involved was the communicating branches of the roots just
mentioned.

It is unusual to have the lower roots destroyed by accident
while the upper are more or less intact. Oculo-pupillary pheno¬
mena are encountered only when the ramus communicans of the
first dorsal is involved. S. A. K. Wilson.

XVin. OONGRES DES MBDE0IN8 ALIENISTE8 ET NEURO-

(551) LOGISTE8 DE FRANCE. Dijon, August 3-8, 1908, Rev.
Neurologique, August 30, 1908.

Among many interesting communications the following are worthy
of notice:—

L^ri has noted aplasia of the suprarenals as a constant accom-

ABSTRACTS

625

paniment of anencephaly. Anencephaly is not an arrest of develop¬
ment, but the consequence of an inflammatory disease of the
central nervous system. The suprarenal aplasia is elective, since
the other organs are intact. It is conceivable that the further
production of lecithin by the gland becomes unnecessary when
the brain is destroyed, and that therefore the gland undergoes
atrophy.

In seventeen cases of epilepsy, Claude and Schmiergeld found
alterations in the thyroid gland in all; in twelve the normal
glandular structure was entirely changed, there being areas of
atrophic sclerosis, with zones of compensatory hypertrophy.

Cases of psychasthenia and other mental troubles (phobias,
anguish, etc.) associated with glandular troubles (“instability
thyroidienne,” “ hyperthyroidie,” “ hypo-ovarie,” etc.), and treated,
in some instances, with considerable success by the appropriate
glandular extract, are reported by Sollier and Chartier, and L^vi
and Rothschild. Some of the cases are very convincing.

Parhon and Urechia observed catatonic phenomena in dogs
deprived of the “ thyro-parathyroid apparatus.” Muratow had
already found changes in the thyroid gland in catatoniacs, but
Kraepelin failed to register improvement by thyroid treatment.

In the treatment of writers’ cramp Meige recommends that the
patient’s caligraphy should be “ peu, lent, rond, gros, droit,” i.e. he
should write little and slowly, and his letters should be round,
large, and upright. In the following out these simple instructions
Meige has noted improvement in various cases.

S. A. K. Wilson.

PSYCHIATRY.

JUVENILE GENERAL PARALYSIS. (Paralysie glnlrale juvenile
(552) chez un sujet de 23 ans.) Joffroy, L’Enciphale, July 1908,

p. 1.

The patient was a case of physical infantilism, who, in spite of
his twenty-three years, had the appearance of a boy of thirteen or
fourteen. While under observation his memory began to fail ;
his hands, tongue, and facial muscles became tremulous, his
speech slurring and almost unintelligible; his pupils became un¬
equal and reacted sluggishly to light; a marked lymphocytosis was
found in the cerebro-spinal fluid. There was no history of pre¬
ceding syphilis.

The author remarks on the frequency of the pre-existence of
physical infantilism in cases of juvenile general paralysis.

S. A. K. Wilson.

2 Y

626

ABSTRACTS

ALCOHOL AND MENTAL DISEASE. W. R. Dawson, Dub. Jowm.

(653) of Med. Sd., June 1908.

Apart from personal bias, the uncertainty existing with reference
to the effects of alcohol is largely due to insufficient appreciation
of the influence of individual diathesis and of the varying effects
of different doses. On the whole, it appeared that for normal
persons, and under appropriate circumstances, small doses properly
diluted and taken with food not too frequently were physiologically
beneficial, but for neuropaths, and with larger or more frequent
doses, the case was otherwise. Alcohol taken occasionally in large
doses—the “ convivial drinking ” of Sullivan—produced less serious
effects than in moderate doses very frequently repeated, though in
highly neuropathic persons serious results might arise. The latter
mode of drinking, the “ industrial drinking ” of Sullivan, was due
to the influence of alcohol in facilitating for a time coarse muscular
exertion. It produced in the long run progressive mental and
bodily degradation, between which and technical insanity no hard
and fast line could be drawn. Moreover, of the technically insane
all did not enter asylums, and therefore a complete estimate of
the amount of mental disease due to alcohol was at present im¬
possible. Even as regarded the insane in asylums, much difficulty
existed in arriving at a correct conclusion, and for a variety of
reasons it was almost certain that the amount of mental disease
really chargeable to alcohol had been over-estimated. About 15 to 20
per cent, of cases seemed to be the proportion usually so attributed,
but probably 10 per cent, would be nearer the mark. (In Ireland
the average percentage of cases so caused in the previous five years
had been stated at 9'90.) The regional distribution of insanity did
not correspond with that of either alcoholism or drunkenness. On
the other hand, the cases in which alcohol acted as a contributory
cause must be numerous, owing to the susceptibility to its action
of persons with hereditary or acquired brain weakness. The
mental symptoms most characteristic of alcoholic insanity were
confusion with hallucination in the acute cases, a tendency to
impulsive action, suspicion passing into delusion, and loss of
recent memory with a tendency to supply its place by fabrica¬
tions. The most purely alcoholic forms of insanity were delirium
tremens, Korsakoff’s psychosis, hallucinatory-confusional insanity,
and some cases of alcoholic dementia. The other alcoholic psy¬
choses presupposed a greater or less degree of neuropathic
tendency, beginning at the top with mania a potu, trance states,
and dipsomania, and passing down through alcoholic paranoia,
mania and melancholia, to dementia. As regarded treatment, the
essential was total abstinence, which must be enforced for a time—

ABSTRACTS

627

a minimum of two years had been found neoessary at Ennis Re¬
formatory. It was therefore highly desirable that such cases on
recovery of their sanity should be transferable from the asylums
to inebriate reformatories, and legally detainable therein for a time.
For all neuropaths total abstinence afforded the only hope of con¬
tinued well-being. Author’s Abstract.

THE SENSE OF TIME IN KORSAKOFF’S PSTOHOSIS. (Zur
(554) Kenntniss des Zeitsinnes bei der Korsakoffschen Geistes-
storung.) Adalbert Gregor, Monatsschr. f. Psychiat. u. Neurol.,
June 1908.

In this paper the author describes a series of experiments he con¬
ducted in a case of Korsakoff’s psychosis. The patient presented
marked disturbance of time consciousness, and the object of the
investigation was to obtain an exact record of the sense of time he
possessed. As controls to the experiments, one normal and two
pathological individuals, who did not present the particular dis¬
turbances in question, were subjected to the same tests.

The results are given in tabular form.

A. Hill Buchan.

DISTURBANCES OF THE PSYCHIC FUNCTIONS IN CASES OF
(555) UNILATERAL NASAL OBSTRUCTION. (Ueber Storungen
der psychischen Funktionen bei einsitiger Behinderung der
Nasenahnung.) Wilh. Anton, Prague, Pray. Med. JPchnschr.,
June 1908.

The connection between disturbances of mentality and nasal
obstruction was recognised as early as 1868, and described under
various titles—“ mental work made difficult,” “ psychic depression,”
etc., while in 1888 Guye gave a definite picture of the condition,
the principal symptom of which was incapacity to direct one’s
attention to a given object, and bestowed upon it the name “ Apro-
sexia.” Mental impressions are made with difficulty and
are easily lost; there is a continuous or intermittent feeling
of pressure in the head; giddiness and signs of increased nasal
reflex excitability such as fits of sneezing or “ trigeminal ” cough
may be present. Guye’s cases referred to adenoid post-nasal
growths in children; but other causes of the condition are found
in nasal catarrh, crests or deviations of the nasal septum, and
turbinal hypertrophy. After removal of the cause of nasal obstruc-

628

ABSTRACTS

tion the symptoms rapidly disappear. Kafeman in his psycho¬
logical experiments used a nasal obturator, and found that
mathematics were made specially difficult; the perception of
visible things was only slightly influenced, but the memory of
these objects was not nearly so good as in normal conditions: in
all the above cases both nasal cavities were obstructed. Anton
now records two cases of unilateral nasal obstruction in which
there was disturbance of psychic function; removal of the obstruc¬
tion resulted in cure in both instances. The first case was that
of a schoolboy, aged 17, who suffered from nasal (choanal)
polypi on the left side: his mathematical studies were specially
difficult, and, as he could not understand his lessons, he often
went to sleep over his books. From the report of the nasal
examination it would seem that there must have been some
obstruction of both sides, as it is stated that the nasal cavities
were narrow, and that nasal catarrh was present along with
enlargement of the posterior ends of the turbinal bodies. After
removal of the polypi the nasal symptoms disappeared at once and
the mental condition slowly improved. In the second case—that
of a girl of 16 years—there was congenital bony occlusion of the
left choana: the patient suffered from left-sided headache and
had been a somnambulist since childhood: the right side of the
nose was normal in this case. After operation the sense of smell
at once returned in the left nostril, and some days later the sleep
became quiet.

Guye has called attention to the connection between the
subdural lymph space and the lymphatics of the nasal mucosa,
which has been proved by Axel, Key and Retzius. The theory is
that in cases of nasal obstruction there is not a sufficient loss of
fluid from the surface of the nasal mucous membrane: the cause
of the nasal obstruction (polypi, etc.) may also mechanically in¬
terfere with the lymph-flow. In these ways the elimination of
effete products is to some extent prevented and “retention-
exhaustion” of the cerebral cortex occurs.

Zarniko, on the other hand, considers that, in comparison with
the other methods of drainage, the lymph flow from the brain to the
nasal mucous membrane is of small importance, that “ aprosexia ”
occurs in only a small proportion of cases of nasal obstruction, and
finally that it is absent in conditions where the lymphatic streams
in the nose are greatly reduced, e.g. atrophy of the nasal mucous
membrane. For these reasons Zarniko thinks that aprosexia is
only a special form of neurasthenia which is produced by nasal
obstruction and its consequent disturbance of sleep. Anton is of
opinion that his two cases support Zarniko’s theory, and points out
that his first patient was worried and slept badly. The whole
discussion can be summed up in two questions:—(1) Does nasal

ABSTRACTS

629

obstruction directly cause psychic disturbance by interfering with
the lymph flow from the brain; or (2) does nasal obstruction act
by creating or increasing a condition of neurasthenia of wliich
“ aprosexia ” only forms a part ? J. S. Fraser.

THE PROTECTION OF SOCIETY FROM CRIMINAL LUNATICS.

(556) (La difesa sociale dagli alienati criminal!) Tamburini, Riv.
di Sper. Freniatr., Vo! xxxiv., Fasc. 1-2, p. 274.

An article dealing with questions of Italian law, in which the
author advocates the English system of dealing with criminal
lunatics, especially in regard to the question of their discharge.

Ernest Jones.

THE ABOLITION OF THE USE OF TOBACCO AMONGST THE

(557) INSANE AT THE LUCCA ASYLUM. (L’Abolizione dell’
Q 80 del tabacco per gli alienati nel manicomio di Lucca.)

Andrea Cristiani, Riv. Sper. di Freniatr., Vo! xxxiv., Fasc.

1-2, p. 286.

Assured by the success of his experience in abolishing the use of
alcohol in his asylum, Cristiani has done the same for the past
year or so with tobacco. The results, he claims, are good, and
there are no disadvantages. With each individual the quantity is
first gradually reduced before complete cessation is enforced.

Ernest Jones.

TREATMENT.

THE CLINICAL USE OF HYPNOIDIZATION IN THE TREAT-
(558) MENT OF SOME FUNCTIONAL PSYCHOSES. J. E.

Donley, Joum. of Abnorm. Psy., Aug-Sept. 1908, p. 148.

This paper contains an account of the treatment of certain psychic
disorders by the hypnoidization method of Dr Boris Sidis. The
desired state was induced in the patients by placing them on a
couch, the head of which was close to a faradic wall plate. They
were then requested to listen to the monotonous vibration of the
ribbon rheotome, and to concentrate their attention either upon
nothing or upon the ideas suggested by the physician. In a few
minutes they sank into the hypnoidal state, during which it was
possible to obtain information valuable for diagnosis and to give
therapeutic suggestions.

Descriptions are given of five cases in which the method was
used with marked success. Margaret Drummond.

630

ABSTRACTS

NERVE ANASTOMOSIS IN INFANTILE PARALYSIS. Karl
(669) Osterhaus, Med. Bee., July 11, 1908.

This paper consists of a review of the present methods in use for
the treatment of infantile paralysis and the report of one case in
which nerve anastomosis was performed. The case was one of
slight right talipes equiuo varus of four years’ standing in a boy
aged ten years. At the operation a bundle of nerve-fibres was
isolated from the internal popliteal nerve and a similar bundle
from the external popliteal nerve, the former being centrally, the
latter peripherally, attached; the two nerve bundles were then
united end to end with fine catgut. At the same time the Tibialis
anticus, the tendo Achilles, and the plantar fascia were divided
subcutaneously. The limb was enclosed in plaster for six weeks.

At the end of four months there was a very slight improvement
in the function of the limb.

Systematic massage, electricity, and baking were carried out in
the after-treatment. D. P. D. Wilkie.

BOOKS AND PAMPHLETS RECEIVED.

Max KaufTmann. “ Beitrlige zur Pathologie des Stoffwechsels bei Psy¬
chosen. Zweiter Teil: Die Epilepsie.” Fischer, Jena, 1908. M. 6.

Reports from the Pathological Laboratory of the Lunacy Department.
New South Wales, 1908. Yol. I., Part III.

De Fursac and Rosanoff. “ Manual of Psychiatry.” 2nd Ed. Wiley &
Sons, New York, 1908. $2.50.

A. F. Tredgold. “ Mental Deficiency.” Bailliere, Tindall & Co., London,
1908. 10s. 6d.

IReview

1ReuroloQ£ anb flb8\>cbiatn>

Original Hrticies

LEPTOTHRIX INFECTIONS. A CASE OF PYAEMIA
WITH MENINGITIS, AND NOTES OF TWO SIMILAR
CASES.

E. SCOTT CARMICHAEL, M.B., F.R.C.S.E.,

Assistant Surgeon, Royal Hospital for Sick Children.

With Pathological Report by
Dre James Ritchie and Stuart Macdonald.

The following case came under my notice two years ago. In
April 1906, in consultation with Dr Thyne, I saw an infant, set. 4
months, who had suffered from gastro-intestinal symptoms for a
fortnight. Two days previously the child began to suffer from
abdominal pain, which suggested to Dr Thyne the possibility of
peritonitis. The abdomen was swollen, tympanitic, and rigid,
the child presenting locally all the symptoms of general peri¬
tonitis. The general condition of the child, however, was not
such as one would associate with a general peritonitis due to the
more common pyogenic organisms.

The abdomen was opened, and general peritonitis, evidently
of some duration, was present. The pelvis was full of a some¬
what serous pus, and there were dense adhesions between the coils
of intestine. These were especially so around the csecal region,
so that no attempt was made to find the appendix. Multiple
drainage was used for pelvis and lumbar regions.

R. OF N. & P. VOL. VI. NO. 11.—2 Z

632

E. SCOTT CARMICHAEL

The child made an uninterrupted recovery, and was dismissed
weeks afterwards completely cured. An ischio-rectal abscess
developed a month later, but since then the child has been in
good health.

The pus from the abdominal cavity was submitted to
bacteriological examination. Mr Richard Muir reported that
the infection was a mixed one, but that the predominant organism
was a leptothrix, probably of intestinal origin.

The interest of this case lay in the fact that the child was
very young (four months), and recovered after an attack of
generalised acute peritonitis. The child was never so seriously
ill as might be expected in a case of generalised peritonitis.

It has since been in good health.

Recently it has been my good fortune to meet with a similar
case. I am indebted to Dr James Ritchie and Dr Stuart
Macdonald for the pathological-bacteriological investigation of
the case.

A child, cet. 18 months, was sent by Dr Dickie to Dr John
Thomson’s ward on May 6, 1908. It had been ailing for
about ten days with gastro-intestinal symptoms. Two days
before admission, swelling appeared in the right lower limb.
Dr Thomson asked me to see the case with him.

There was general oedema of the limb up to the lower third
of the thigh downwards. There was no redness or inflammation
except for a small area about the size of a shilling in front of
the external malleolus. The temperature was 104° F. The
diagnosis lay between an acute osteo-periostitis of the tibia or
fibula and a subcutaneous oedema of septic origin.

The child, though ill, was not so bad as to lead one to
suppose that there was disease of the bone, and the absence of
redness and the general appearance of the limb was not charac¬
teristic of acute osteo-myelitis. There was no localisation of the
swelling. The knee and ankle joints were freely movable
without pain, although they participated in the oedema.

Although the clinical symptoms were against osteo-myelitis,
one did not feel justified in not exploring the bones of the leg.

Incisions were made down to the bone over the tibia and
fibula, but except for a general oedema of the subcutaneous
tissues, there was no evidence of more deep-seated inflammation.
The reddened area was incised and a small pocket of pus was

LEPTOTHRIX INFECTIONS

633

found under the common extensor tendons, in front of, and
independent of, the ankle joint.

This was examined bacteriologically by Dr James Ritchie.

The child’s condition continued much the same for the next
three days, the temperature remaining persistently about 103° F.
The general condition, however, was well maintained. Bier’s
treatment with the Saug-Apparat was carried out during this
period.

Discharge from the right middle ear, with bilateral swelling
of both elbows, was then noticed. The joints were markedly
distended, but there was no redness or signs of inflammation or
marked local rise of temperature.

Both joints were drained, and contained a large quantity of
thin, odourless, and rather pale creamy-coloured pus.

These were again examined bacteriologically by Dr James
Ritchie.

The child’s condition became distinctly worse. There was
very little discharge from the joints, much less than is present in
streptococcal or pneumococcal affections. The child lived for a
week longer with continued high temperature. Two days before
death there was some swelling of the cervical glands.

Lumbar puncture was performed and a turbid fluid drawn
off, which was examined bacteriologically.

A point of interest in these cases was that the general
condition of the child in each case was not gravely affected
while the leptothrix infection was localised. In the case
of the first child, though young, the recovery was complete.
In the second child, though there was high temperature, the
general condition remained fairly good until there was general
systemic infection, as shown by the otitis media and the double
elbow-joint affection.

The corresponding infection by staphylococci gives rise as a
rule to much more systemic derangement.

The oedema of the leg was not associated with any redness;
there was no evident active inflammatory change; the condition
of the limb resembled much more that of an oedema of cardiac or
renal origin than due to an inflammatory condition. I have
seen from time to time in the out-patient department children
brought up with a similar oedema of the hand and forearm,
unassociated with inflammatory change. In one case I made an

634

E. SCOTT CARMICHAEL

incision and endeavoured to cultivate an organism, but with
negative result.

On looking back on these cases I cannot but think that they
may be of similar origin. The oedema often persists for a week
or two without affecting the general condition of the patient to
any marked degree, and then gradually subsides.

We have considered these often of a mild streptococcal
nature, without being able to grow such an organism.

The want of local inflammatory reaction was markedly seen
in the case of the elbow-joint swellings. It is unlikely that
these had been overlooked for more than a day or two, but the
appearance much more resembled that of a tuberculous affection.
It was not like an acute arthritis due to the more common
pyogenic organisms.

The pus was thin, odourless, and of a pale creamy colour.

In the abdominal case it was thin and more serous, odourless,
much more like the fluid of a pneumococcal condition.

The organism, if it is the cause of these conditions, does not
appear to be an acutely virulent one, but can lead to a general
pyaemia, as shown in the last case.

These cases, however, seem to show that the organism is
generally associated with other organisms, such as the
pneumococcus.

It is also of interest to note that both cases were ushered in
by gastro-intestinal symptoms.

Cases 3 and 4. —Drs John Thomson and Fowler have
kindly permitted me to refer to two cases under their charge,
the bacteriological findings in each case being similar to those
above recorded.

Without referring at any length to these cases, I may say
that they presented the symptoms and course of a post-basic
meningitis.

In Dr Fowler’s case head retraction appeared one week
after the onset of the illness, which was ushered in with vomiting.
Lumbar puncture on six occasions was performed, and indefinite
diplococci found. The child was treated with Flexner’s serum.
It died five weeks after admission to hospital.

The bacteriological examination in these cases, carried out

LEPTOTHRIX INFECTIONS 635

by Dr Stuart Macdonald, gave a similar finding to that described
fully in Case No. 2.

Post-mortem and Bacteriological Report. Case 2. By Dr
James Ritchie and Dr Stuart Macdonald.

There was a purulent sub-dural meningitis over left hemi¬
sphere, a purulent pia-arachnoiditis in patches over the surface of
the brain, and spinal meningitis about the lumbar cord.

From the abscess in front of the ankle joint, the elbow joints,
cerebro-spinal fluid and peripheral blood, a gram negative bacillus
was obtained in long filamentous forms.

It was mobile, grew on all media, did not liquefy gelatine,
and somewhat resembled the typhoid bacillus in its characters,
giving a slight acid reaction in mills and glucose. There was in
the case evidence of a terminal pneumococcal infection. The
bacillus was pathogenic to monkeys and mice, very slightly to
guinea-pigs, and apparently to rabbits. It appears to break
down the resistance of the animal to other pathogenic
organisms. The importance of the case seems to rest in the
production of the pysemic process by a probably hitherto
undescribed organism.

THE EXAMINATION OF CEREBRO-SPINAL FLUID
IN GENERAL PARALYSIS FOR PURPOSES OF
DIAGNOSIS.

By HAMILTON C. MARR, M.D., F.F.P.S.G.,

Medical Superintendent of the Glasgow District Mental Hospital, Lenzie.

“ A slight tremor of the lips, and a hesitating utterance, as if the
lips and tongue had no grip (so to speak) over the consonants,
will, along with a peculiarity in the gait, an unusual stillness in
the muscles of expression, and a slight disparity of the pupils,
reveal with almost absolute certainty an early stage of one of the
most hopeless of diseases—general paralysis of the insane." 1

The diagnosis of general paralysis is not, however, so easy.
The above signs are found associated with forms of chronic

1 Gairdner, “The Physiognomy of Disease ,” from Finlayson's Clinical Manual .

636

HAMILTON C. MAKE

alcoholism, neurasthenia, advanced cerebral arterio-sclerosis,
cerebral apoplexia and softenings, syphilitic affections, tumour of
the brain, and lead poisoning. Many of these mental conditions
are recoverable, but as yet no hope of improvement can be held
out to the general paralytic. Under these circumstances it is
important to be able to differentiate between the several conditions
named. An examination of the cerebro-spinal fluid is of great con¬
sequence in reaching a diagnosis. In an investigation extending
over three years, and embracing an examination of the cerebro¬
spinal fluid of all varieties of insanity, fifty-three cases of general
paralysis have come under my observation. Elaborate physical
and chemical examinations have been made in every case, and in
this paper I will draw attention more particularly to a summary
of the cytology, the significance of the presence of the serum-
albumen, and the bacteriological conditions of these cases.

In fifty-two of the cases a lymphocytosis was noted. The
exception was a case of juvenile general paralysis, where the
cerebro-spinal fluid exhibited a few lymphocytes, but not a
sufficient number to constitute a lymphocytosis.

The methods of discovering the presence of a lymphocytosis
are varied. That suggested by Widal 1 is best for clinical
purposes. He applies the term “ lymphocytosis ” when the
cerebro-spinal fluid contains six to ten lymphocytes in each field
of the microscope when an oil immersion lens is used. Ten
several fields should be examined before a decision is reached.
An objection has been raised that the cellular elements do not
stain well by Widal’s method, but this objection is averted by
the use of Leishman’s stain, which allows of a differentiation be¬
tween the cellular elements. These elements are generally large
and small lymphocytes, and in each field one or two plasma cells
are found—that is to say, large cells with a nucleus stained
blue like that of the lymphocyte, the stained material radiating
from the nucleolus toward the periphery of the nucleus. The
protoplasm of the cell stains a reddish pink.

The only form of insanity of those enumerated in which a
lymphocytosis occurs is syphilitic insanity, and there only when
the syphilitic condition is active. In three cases of syphilitic
insanity observed, two showed the presence of a few lymphocytes
in the cerebro-spinal fluid ; in the third there was a lymphocytosis.

1 Widal, Bevue Neurologique , No. 8, March 30, 1908.

EXAMINATION OF CEREBRO-SPINAL FLUID 637

The first syphilitic patient died, and a post-mortem examination
revealed a gummatous deposit in the left frontal region. The
second also died, and a large mass of tumour occupied the right
motor cortex, causing crossed hemiplegia. The third.case, in
which lymphocytosis was noticed, made a good recovery. The
lymphocytosis and serum-albumen, which were present in the
cerebro-spinal fluid, disappeared as a result of anti-syphilitic
treatment. The first of these three cases was the only one
which could have been mistaken clinically for a case of general
paralysis.

The amount of serum-albumen present in the cerebro-spinal
fluid of general paralytics varies from *05 per cent, to ‘4 per
cent.; the average amount is *15. The presence of serum-
albumen is common to many insanities. I have invariably
found it associated with chronic alcoholism, and have discovered
it in some cases of epilepsy and in many of organic brain
disease, whether due to cerebral softening, haemorrhage, or
senile decay.

The presence of serum-albumen is apparently associated with
an inflammatory or congested condition of the cerebral meninges.
Its persistence is an indication that the patient is not likely to
recover by his mental affection. Thus, in one case of lead
poisoning and in five cases of alcoholism, all of which ultimately
recovered, serum-albumen varying from *1 to 25 per cent, was
present at the onset of illness, but this disappeared gradually in
every case until there was only a trace of albumen in one of the
alcoholic cases.

A bacteriological examination has been made in every case.
At first culture tubes of blood agar were used, and into these a few
drops of cerebro-spinal fluid were passed from the needle at the
time when the fluid was being collected from the spinal canal.
Latterly, in view of Dr Ford Robertson’s use of byno-hsemoglobin,
by no-haemoglobin agar and blood agar have been used. Dr Ford
Robertson states that he has obtained the bacillus paralyticans in
the cerebro-spinal fluid of four general paralytics. In this
respect my observations are different. I have not obtained a
bacillus or other organism from the cerebro-spinal fluid of any
of the fifty-three cases under review. In eighteen cases tubes of
blood agar and byno-hsemoglobin agar were used as culture media;
iD the remainder, blood agar tubes only. The cerebro-spinal

638 EXAMINATION OF CEREBROSPINAL FLUID

fluid, after being received into a sterile tapered tube, had the
deposit carefully examined for organisms, with negative results.

So far as insanity is concerned, the presence of lymphocytes
to the extent of causing a lymphocytosis, and plasma cells, is
diagnostic of general paralysis. The simplicity of lumbar
puncture, and the absence of ill effects in withdrawing 10 c.cm.
of cerebro-spinal fluid, which is sufficient to form a diagnosis,
make it an important means of investigation in many mental
cases which might, from their clinical symptoms, be classed as
incurable.

abstracts

PHYSIOLOGY.

AN INVESTIGATION OF THE PRINCIPLES UNDERLYING

(560) WEIGERT’S METHOD OF STAINING MEDULLATED
NERVE. J. Lorrain Smith and W. Mair, Joum. Pathol, and
Baderiol., Vol. xiii., 1908, p. 14.

CHOLESTEROL FLUID CRYSTALS, AND MYELIN FORMS.

(561) Charles Powell White. Dreschfeld Memorial VoL Publica ¬
tions Univ. of Manchester , Med. Series, No. 8 (Med. Chron.,
March 1908).

Lorrain Smith and Mair have shown that Weigert’s method of
staining medullated nerve can be applied to fat. At a meeting of
the Pathological Society of Great Britain and Ireland in June
1907, they showed sections of adipose tissue, fatty liver, fatty
heart, kidney, etc., in which the fat globules had been stained and
differentiated with the same degree of clearness and definition as
is obtained in the case of medullated fibres in sections of spinal
cord. The sections were cut by the freezing microtome after
formalin fixation, and were then exposed to the action of strong
solutions of bichromate. Similar results were obtained with
cigarette papers which had been smeared with pure olein and oleic
acid. The bichromate solution action acts much more rapidly on
myelin substance than on ordinary fats. In both cases chromium
compounds are formed which are insoluble in alcohol, ether, etc.,
and which at the same time are capable of forming coloured lakes
with haematoxylin. These results suggested that Wlassak’s

ABSTKACTS

639

view that protagon is the substance in the nerve sheath on which
the staining by Weigert’s method depends required recon¬
sideration.

An extended series of observations on the action of bichromate
solutions on various fats, fatty acids, alcohols, and aldehydes, was
therefore undertaken. It was found that in the case of fats and
fatty acids, only those which contained an unsaturated grouping
of carbon atoms are capable of forming chromium compounds
which are able to lake hematoxylin; and further, that if the
action of the bichromate solution be sufficiently prolonged, these
uusaturated fats can be completely oxidised to saturated com¬
pounds which are no longer capable of laking hematoxylin. It
is, therefore, only during a certain stage of the process of oxidation
that chromium compounds capable of laking hematoxylin are
formed. As has been shown by Dr Thorpe, the chromium com¬
pounds in question are comparatively loose addition products of
chromium trioxide, and are not organic salts of chromium. The
difference in the rapidity of the action of bichromate solutions
on fats and on myelin substance is due, in part at least, to the
cholesterin contained in the latter.

Powell White has shown that mixtures of cholesterin and
the higher fatty acids give rise to fluid crystals and anisotropic
globules, and on the addition of water produce myelin figures.
These mixtures are, in a sense, compounds, the acid probably
playing the part of an “ acid of crystallisation,” but they are not
true esters of cholesterin. The anisotropic globules and myelin
figures are best developed when the cholesterin and fatty acids are
mixed together in equimolecular proportions. It appears probable
that it is in the form of this loose combination with fatty acids
and other substances that cholesterin most commonly occurs in
the body, and that the myelin of the white nerve sheath is in a
fluid crystalline condition in virtue of the presence of cholesterin
in such combination.

Pure cholesterin is not acted on by bichromate solutions at
ordinary temperatures, but a mixture of cholesterin with any of
the higher fatty acids which gives myelin forms in water is readily'
acted on by the bichromate solution. Chromium compounds are
formed which are insoluble in alcohol and which lake hemato¬
xylin, and the mixture behaves in all respects towards these
reagents exactly like the myelin of the white nerve sheath. As
in the case of fats, if the action of the bichromate solution be
prolonged, oxidation is carried too far for staining purposes, and
the saturated compounds formed become incapable of laking
hsematoxylin. These facts lead us to recognise different stages
of oxidation in the process of bichromating tissues. The staining
with ha;matoxylin after bichromating depends on the presence in

640

ABSTRACTS

the tissues of various unsaturated substances. At any particular
stage of oxidation only certain of these substances are capable of
combining with hsematoxylin, and thus at different stages of the
process of bichromating different elements will retain the stain.
In the spinal cord the ordinary Weigert effect is only obtained
at a particular stage of the process of oxidation by the bichromate
solution. If frozen sections of spinal cord from tissue fixed either
in formalin or in bichromate be exposed in the incubator to the
action of a solution of bichromate saturated at a temperature of
37° C., and examined at intervals of a few days by staining in
hematoxylin, and differentiating as in Weigert’s method or any
of its modifications, a remarkable series of changes in the elements
which retain the stain may be observed. The first element to
stain after bichromating has begun is the medullary sheath, and
for a time it alone is coloured. Following this we find the colour
reaches the lipochromes in the nerve cells, then the nucleoli, and
by the time the myelin sheath has ceased to stain, the axis
cylinder stands out clearly stained, and surrounded by a yellow
ring of oxidised and bleached myelin. Then the cell body and its
processes stain diffusely, and finally the neuroglia takes on a clear
blue stain. In other words, by continuing the bichromating pro¬
cess, we can exactly reverse Weigert’s method and stain all the
elements in the tissue which in the ordinary process are left
unstained. Authors’ Abstract.

THE ACTION OF 8TRY0HNINE AND OAFFEINE. (Em Beitra*
(562) zur Kenntnis der Strychnin- und Koffeinwirkung.) Torato

Sano, Arch. f. die gesam. Physiol., Sept. 10, 1908, p. 381.

It has long been known that a frog poisoned with strychnine
reacts to chemical stimulation slightly, if at all, at a time when it
shows a hyper-excitability to mechanical or electrical stimulation.

Baglioni has explained this phenomenon as due to the fact
that chemical stimulation is less sudden and represents a large
number of weaker ineffectual stimuli which must be summated in
the co-ordination mechanism. In the strychnine-poisoned frog
this power of summation is almost completely lost.

The author suggests, as a result of further experiments, another
explanation—namely, that there is, at a certain stage of strychnine
poisoning, a diminution in the excitability of the central mechanism
for pain sensation, but an increase in the excitability of the central
mechanism for touch sensation. Strychnine—and caffeine behaves
similarly—resembles a group of poisons, e.g. morphine, in increas¬
ing the reflex excitability, while at the same time exercising an
anaesthetic action. J. A. Gunn.

ABSTRACTS

641

THE ANTAGONISTIC ACTION OP PARTICULAR FARTS OF THE
(563) BRAIN TO STRYCHNINE (Ueber das Entgiftende Ver-
mogen einzelner Gehirn&bschnitte gegeniiber dem Strychnin.)

Torato Sano, Arch. f. die gesam. Physiol ., Sept. 10, 1908,
p. 369.

A certain dose of strychnine was allowed to stand in contact, for
fifteen to twenty-four hours, with an emulsion of grey matter of
human brain, and the mixture was then injected into the dorsal
lymph sac of a frog. Parallel experiments were carried out with the
grey matter of motor and of sensory regions. From a large number
of such experiments the author draws the following conclusions :—
The cortical grey matter can antagonise strychnine, the grey
matter of the motor regions being more effective in this respect
than that of the sensory regions, and this property is due to the
cell elements. The antagonism is of a chemical nature.

The morphologically and functionally characteristic cell
elements of the grey matter of the human cortex probably possess
one or more substances differing chemically from one another.

The motor elements of the central nervous system possess a
higher affinity for strychnine than do the sensory.

J. A. Gunn.

THE PHYSIOLOGY OF THE PITUITARY BODY. (Sur la physi-

(564) ologie de rhypophyse.) Salvioli and Carraro, Arch. ilal. de
Biol., Tome lxix., 1908, p. 1.

The authors confirm the observations of Schafer and others that
injection of extract of the pituitary body exercises an important
influence upon the blood-pressure.

The effects observed are a slight fall succeeded by a rise of
blood-pressure. These are to be attributed to the posterior or
nervous lobe of the gland, whose extract remains active, although
it has been deprived of the epithelial layer associated with it.
The action is not one which is common to cerebral tissue generally.
Injections of cerebral extracts give negative results.

An influence further is exerted upon the cardiac rhythm re¬
sulting in increase of systolic force and slowing of the pulse.
When the vagi are cut the blood-pressure curve presents appear¬
ances which have been described by Cyon. Periods of slowing
and strengthening of the systole alternate with periods during
which we have acceleration and diminution of the pulse. There
are also to be observed after injection oscillations in the curves
forty to fifty seconds in duration, which are due to variations

642

ABSTRACTS

in vascular tone and are independent of the above-mentioned
alternations.

The amount of the injection is an important factor as affecting
blood-pressure and cardiac rhythm. With small doses the action
is chiefly upon the former, while the latter is principally affected
when large injections are made.

When the injections are repeated, the second and later ones
have less effect than the first both on blood-pressure and systole.

The extract acts directly upon the vessel walls and not to any
considerable extent through the vaso-motor centres.

If the influence of the vaso-constrictor centres of the oblongata
is excluded by section of the cord in the cervical region, changes
are produced by injection similar to those obtained in the intact
animal.

When blood containing pituitary extract is artificially circu¬
lated through the vessels of a limb isolated from the rest of the
circulatory system, vaso-constriction is obtained, succeeded by
dilatation when blood free from extract is passed through the
vessels.

The active substance exerts a stimulating influence upon the
centres of the vagus, producing slowing of the pulse, but as this
is also observed when the vagi have been cut, it is probable that
there is a direct action upon the ganglia and muscle fibres of the
heart. The extract acts although the vagi are paralysed by atro¬
pine, and the effect is not abolished by section of the depressors.

The response of the vagi and depressors to electrical stimulation
is not abolished by the action of the extract.

When the depressors are excited during the period of action of
pituitary extract a conflict arises between vaso-dilatation and vaso¬
constriction. The vessel musculature remains, although the extract
is acting, under the influence of the vaso-motor nerves and the
action of the latter may modify or abolish the effect of the extract.

W. A. Jolly.

PATHOLOGY.

THE SEQUEL TO ASEPTIC LESIONS OF THE BRAIN. (Snr
(565) les faits qui se cWveloppent & la suite des blessures aseptiques
du cerveau.) Sala, Arch. UaX. de Biol., Tome 69, 1908, p. 1.

Incisions in the cerebral substance were carried out aseptically in
a series of young dogs, cats, and rabbits, and the cicatricial tissue,
stained by Cajal’s method, was examined histologically forty-six
hours, five days, and fourteen days after operation. The author
regards his results as closely resembling the appearances presented

ABSTKACTS

643

during regeneration of a divided nerve, but reserves his decision as
to whether we have yet sufficient proof of a true regeneration.

There are present forty-six hours after operation numerous
nerve rings, fine nerve fibrils terminating in closed rings, round,
oval, or button-shaped.

After five days there are observed a certain number of rounded
or spindle-shaped cells with granular protoplasm and large nuclei.
There are also many nerve fibrils running alone or in small bundles,
with a straight or tortuous course. On the borders of the incision
lie rings and knob-like formations similar to those appearing after
peripheral lesions. From the knob or bud an extremely fine fibre
may occasionally be seen to pass out.

After fourteen days the cicatrix is found to be invaded by
bundles of fine nerve fibrils arranged in a plexiform manner, with
divisions and intercrossings. These are more numerous and closer
around the vessels. Some of the fibrils present terminal enlarge¬
ments. At points along the margins of the wound lie groups of
rounded, oval, or pear-shaped bodies of homogeneous or reticulated
structure. These are always in relation to fairly coarse nerve
fibres, some lying at the extremity of a fibre, some on its course;
others give origin to fine fibrils.

The pyramidal cells in the neighbourhood of the incision were
examined forty-six hours after incision. The first part of the axis
cylinder exhibits a club-shaped swelling, staining deeply, and of
finely fibrillated structure. The part below this enlargement,
lying adjacent to the wound, is ribbon-shaped, homogeneous, and
stains light yellow. The appearance resembles that observed in
the central stump of a divided nerve. W. A Jolly.

POSTERIOR COLUMN DEGENERATIONS FOLLOWING INJURY
(566) TO THE POSTERIOR ROOTS OF THE 7th CERVICAL
NERVES. H. W. Mitchell and A. M. Barrett, Jaurn. of
Nerv. and Ment. Dis., Oct. 1908, p. 545.

The case is one in which the arches of the 5th cervical vertebra
were fractured as the result of a fall. Death occurred a fortnight
later. The 7th cervical segment was severely injured. The
posterior columns, however, appear to have largely escaped, but
nearly all the posterior fibres of the entering posterior roots at this
level were blackened by the Marchi method, and were traceable
up to the top of the cord as a compact bundle in the posterior
column on either side. Descending degeneration in the comma
tract was traceable down to the 6th dorsal segment.

Edwin Bramwell.

644

ABSTRACTS

CLINICAL NEUROLOOT.

INVESTIGATIONS ON THE CONVERGENCE REACTION WITH
{567) REFLEX IMMOBILITY OF THE PUPIL. (Untereuclraiigen

fiber die Oonvergenzreaktion bei reflektoriseher Papillenstarre.)

Lachmund (Munster), Berl. Jelin. Woch ., July 1908.

Db Lachmund cites the case of a female servant, aged 28, who had
been an inmate of the asylum at Munster for seven months on
account of hallucinations, etc.

The condition of the eyes was as follows:—The right pupil
fairly wide, larger than the left, irregular, not reacting to light
either consensually or directly. In a dim light the pupils were
of equal size. The left pupil reacted promptly to light. Both
pupils reacted promptly to convergence, but the right remained
always a little larger than the left, and after contraction was not
quite round. Accommodation good in both eyes. Vision good,
fields good, muscular movements unimpaired, fundi normal, colour
vision good. Examination of other cranial nerves and the whole
nervous system gave negative findings. There was no evidence
of syphilitic infection, and the patient had never suffered from any
eye affection.

Dr Lachmund raises the question as to whether the right eye
afforded a true instance of one-sided reflex immobility of the pupil,
or whether the convergence reaction was also partly affected, as
the right pupil on convergence remained a little larger than the
left. Seeking further light on this question Dr Lachmund selected
twenty-seven cases of general paralysis from the material of the
asylum. He examined them as to the following points:—Whether
the convergence reaction was plainly present, whether it was prompt
and large in amount, whether both pupils after contraction were
equally large, and whether they were round or misshapen. Among
the twenty-seven cases he found twenty cases in which both pupils
failed to react to light. In two cases there was only a trace of
reaction, in two a good reaction, and in four the right and left
pupils reacted differently. In sixteen cases the convergence
reaction was present, while the light reaction was lost. In all
these cases the contraction was prompt, though sometimes owing
to the mental condition it was difficult to get the patient to
converge properly. In twelve of the cases the pupils when con¬
tracted during convergence were unequal. In some of the cases
the difference was very great. Further, out of the thirty-two
pupils, twenty-nine were not round when contracted—namely, in
thirteen pairs of eyes and in three single eyes. Again, it was

ABSTRACTS

645

noted that among the pairs of eyes which showed unequal pupils
after contraction eleven showed a difference also before the con¬
vergence reaction. Only in one case in which the pupils were
equal before contraction did a difference make its appearance
afterwards. This persistent difference in the pupils even when
contracted Dr Lachmund does not ascribe to any defect in the
convergence reaction, but 6imply to the fact that the convergence
reaction though actively present is not able to make equally small
those pupils which were unequal before the contraction started.
In the case cited Dr Lachmund thinks that the pupil anomaly was
probably congenital. J. V. Paterson.

A COMPARISON BETWEEN THE CLINICAL APPEARANCES

(568) IN NUCLEAR AND TRUNK LESIONS OF THE VAGUS
RECURRENT AND THE OCULOMOTOR NERVES. (Ein
Vergleich der klinischen Erscheinungen bei Kern und Stamm-
lfthmungen des Vagus-Recurrens und des Oculomotorins.)
O. Korner, Ztschr. f. Ohrenheilk., 1908, Bd. 56, S. 153.

Korner showed in 1894 that in an otitic temporo-sphenoidal
abscess sufficiently large to compress the oculomotor nerve, the
levator palpebrse superioris, or the sphincter iridis, or both, were
first paralysed, while the remainder of the muscles supplied by
the nerve were affected later or not at all. Albert Knapp’s
observations in the case of tumours confirm this.

This compares exactly with lesions in the trunk of the vagus
nerve; there the abductors are first affected.

In nuclear lesions of the oculomotor nerve there is no such
selective paralysis observed, and this raises the question, Is
Semon’s law correct in the case of nuclear lesions of the vagus ?

Kussmaul and Cahn have shown that this law cannot be
extended so as to include such lesions, and Cahn has shown that
the paralysis of the vagus in tabetics (which Semon looks on as
supporting his theory) is due to a neuritis of the nerve trunk and
is not due to a nuclear lesion. W. G. Porter.

CEREBRAL COMPLICATIONS OF NASAL ORIGIN. (Ubdr die

(569) rhinogenen Gehimkomplikationen.) 6nodi (Budapest!)), Wien.
Med. Woch., No. 33, 1908.

This paper commences with an account of the relations of the
frontal, ethnoidal, and sphenoidal sinuses to the frontal and tem¬
poral lobes of the brain; the sphenoidal sinus may also come into
relationship with the pons. Inflammatory conditions of these

646

ABSTRACTS

accessory sinuses may give rise to intracranial complications,
especially if the organism causing the sinusitis be very virulent.
There is a direct communication between the veins of the sinuses
and the meningeal network of veins, and an indirect connection
through the diploic veins with the venous system in the dura
mater. Statistics as to the frequency of sinus suppuration at
post-mortem examinations vary very greatly, e.g. from 2 per cent.
(Lichtwitz) to 50 per cent. (Martin). The cerebral complications
of nasal origin are extra- and intra-dural abscess, meningitis, septic
sinus thrombosis, and abscess of the brain. Wertheim has re¬
corded 127 cases of intracranial suppuration out of 10,394 post¬
mortems, but only 14 of these were of nasal origin. The statistics
as to cure of cerebral abscess of nasal origin are not favourable
(Dreyfus, 2 cures out of 30 cc os; Onodi, 7 out of 73 cases).
Attention is called to the fact that brain abscess in these regions
may remain latent, and a list is given of the symptoms without
revealing any new or interesting points. (5nodi remarks that
at operation the posterior or cerebral wall of the frontal sinus
may be intact, and yet at post-mortem an extra-dural or frontal
abscess may be found. If indications of intracranial complication
exist, the cranial cavity should be explored, even in the absence
of necrosis of the posterior wall of the frontal sinus. Exploratory
puncture of the brain here, as elsewhere, gives unreliable results,
but the author is in favour of this proceeding. If, on exposing
the dura, it appears tense and non-pulsating, it should be opened ;
but if the dura is normal in appearance and pulsates, the question
of further operation depends on the operator himself and on the
symptoms, because cerebral abscess may be present although the
dura shows pulsation. The rest of the paper, which is not very
interesting, is occupied with statistics as to distance of the
lateral ventricles from the frontal sinus and other regions.

J. S. Fraser.

A CASE OF SEVERE VERTIGO AND TINNITUS; DESTRUC-
(570) TION OF THE LABYRINTH; CURE. Macleod Yearsley,
Lancet, Sept. 19, 1908.

liAKK and Milligan were the first to treat “ unbearable ” vertigo
and tinnitus by operation on the labyrinth: the present case
brings the number of these operations up to nine. The patient,
a man of 47, had had otorrhoea in childhood, and since then had
been somewhat deaf; for twelve months before operation he had
not been able to hear his own voice. His first attack of vertigo
occurred twelve years ago, and for the last three years he had con¬
tinuous roaring noises in the ears and frequent attacks of giddiness.

ABSTEACTS

647

There was a history of vertigo and deafness in the family, and the
patient himself was very constipated. Drug treatment had been
tried and found to be useless. The noises in the ear were always
worse before an attack of giddiness. Turning the head quickly to
one side or looking up brought on an attack, during which external
objects appeared to move to the right, but the patient himself felt
that he would fall to the left. The tympanic membranes were
indrawn, and naso-pharyngeal catarrh was present. Tuning-forks
were not heard by bone conduction, the left ear was quite deaf,
and the right ear could only hear the Edelmann-Galton whistle
up to 4000 D.Y.S. C 612 , C 1024 , C 2048 were heard for a short time by
air conduction. With feet together and eyes closed the patient
swayed to the left; nystagmus was produced by rotation.

It is a pity that there is no note of the results obtained by
syringing the ears with hot and cold lotion. As nystagmus was
produced by rotation, the patient must have had at least one
functionating vestibular apparatus.

Yearsley at first prescribed hydrobromic acid and quinine, and
inserted a seton in the neck; in spite of change of air, the vertigo
and tinnitus became “ unbearable,” and operation was agreed to.
On completion of the radical mastoid operation, the left cochlea
was opened and cleared out through the inner wall of the tympanic
cavity. Above and behind the facial nerve the external and
posterior semi-circular canals were opened and followed to the
vestibule, which was scraped with a fine spoon. As a result of
this operation there was a left-sided facial paralysis, but in a few
months this almost entirely passed off. Immediately after the
operation there was nystagmus, vomiting, and tinnitus for a few
days, but these also improved, so that in ten days the patient was
able to walk downstairs. Three months later the patient was
quite free from giddiness and nystagmus, but had slight tinnitus
after taking tea or coffee. He had become an adept at lip-reading,
though he could hear the ordinary voice by means of an ear-
trumpet applied to the right ear. J. S. Fraser.

ACUTE GONORRHOEAL INFLAMMATION OF THE LABYRINTH.
(571) (Labyrinthite bleuorrhagique aigue double.) A. Hubert, Bull,
de la Soc. de mid. de Rouen, 1907, p. 117.

A MAN, aged 20, who had suffered from aural trouble for several
years, contracted gonorrhoea in November 1905. Examination of
the ears at this time showed tubal obstruction and deafness,
which under appropriate treatment considerably improved. On
December 25 he developed epididymitis. On the same day he
became completely deaf, and suffered from vertigo, tinnitus, and

648

ABSTRACTS

staggering. Nystagmus was present, and was most marked on
looking to the right. No tubal obstruction was found, and the
diagnosis, subsequently confirmed by Lermoyez, of gonorrhoeal
inflammation of the labyrinth was made. Lumbar puncture, in
which 18 c.c. of cerebro-spinal fluid were removed, was followed by
disappearance of the vertigo and titubation and diminution of
the tinnitus, but the deafness persisted unchanged in spite of
pilocarpine injections, which were continued for over a month.

J. D. Rolleston.

A FURTHER CONTRIBUTION TO THE HERPETIC INFLAMMA-
(572) TIONS OF THE GENICULATE GANGLION, etc. J. Ramsay
Hunt, Am. J. of Med . Sci ., Aug. 1908, p. 226.

In this paper the author elaborates in detail the syndrome
previously described by him, of which the distinctive features
are herpes zoster oticus, facialis or occipitocollaris, with facial
palsy and auditory symptoms. There are various clinical types
which may be fused into a single large group. The underlying
pathology is a specific inflammation of ganglia of the spinal
(unipolar) type, including, in addition to the geniculate, the
ganglia of the acoustic nerve and possibly those of the glosso¬
pharyngeal and vagus. Emphasis is put on the fact that mild
inflammatory reactions may be preseut in ganglia above or below
the chief focus, producing pains but not eruptions in their zones.
He regards the gasserian, geniculate, acoustic, glosso-pharyngeal,
vagus, second, third, and fourth cervical ganglia, as embryologically,
histologically, and clinically a series or chain (the acoustic only
differing in having bipolar cells), and concerned in the production
of the syndrome. A haemorrhagic inflammation in any one will
be followed by the usual manifestations of herpes zoster, the
eruption being on its respective zone. The term heiyes oticus
should be confined to those cases where the eruption is confined to
the cone-shaped zoster zone of the geniculate ganglion (the tym¬
panum, auditory canal, concha, and an adjacent marginal area on
the external surface of the auricle). The other features of the
syndrome come from the proximity of the geniculate ganglion to
the facial and terminal divisions of the auditory nerve, the inflam¬
mation extending to these by contiguity of structure, the effects
being enhanced by the enclosure of these structures in a common
sheath, situated in a narrow osseous canal. Hence the facial
palsy and symptoms referable to the auditory nerve, which are
of two types — hypo-acousis merely, or symptoms resembling
Meniere’s disease, tinnitus, deafness, vertigo, vomiting, nystagmus,
and disturbances of equilibrium. J. H. Harvey Pirie.

ABSTRACTS

640

<H)NORRH(EAL NEURITIS OF THE AUDITORY NERVE. (Neuritis

(573) aclistica gonocdccica.) P. J. Martino, Rev. Med. del Uruguay ,
March 1908, p. 66.

A MAN, aged 25, who had suffered two years previously from
gonorrhoea, followed by orchitis, and had had a second attack four
months ago, was suddenly affected by buzzing in the right ear a
month after leaving off urethral injections. Shortly afterwards
both ears became affected. Subsequently complete deafness in
the left ear developed. Examination showed the existence of a
bilateral otitis interna, the external and middle ear being quite
normal. The only focus of infection was the persistent urethral
discharge, in which gonococci were still present. Under appropriate
treatment the urethritis was cured, and the patient concurrently
noted a diminution of the noises in his right ear, though the deaf¬
ness in the left persisted without modification. Small doses of
potassium iodide and electrical treatment were adopted, and
complete recovery took place within one and a half months.
Martino regards the case as one of auditory neuritis, which started
with a period of irritation and ended in paralysis of the nerve, and
thinks that a large number of cases of obscure deafness may be
due to gonorrhoeal infection. J. D. Rolleston.

SCARLATINAL RHEUMATISM. (Zur Frage vom Scharlach-
(574) rheumatismus.) G. E. Wladimiroff, Archiv f. Kinderheilk.,
Bd. 48, 1908, p. 214.

Wladimiroff thinks that two different affections are included
under the denomination of scarlatinal rheumatism. Whereas in
some cases the complication appears as a serous synovitis in which
the morbid process is exclusively located in the joint, in others it
develops as a scarlatinal neuritis. In such cases there is no
swelling of the joint. Though the pain is situated chiefly in the
joint, it is not confined thereto, but is felt throughout the limb,
and varies in character and intensity, as is usually the case in
neuritis. Wladimiroff examined the superficial peroneal nerves and
one of the dorsal digital nerves of the foot in two children of seven
and nine years, who died in the second and third week of scarlet fever,
after suffering from rheumatoid pains in the legs, and found the
characteristic lesions of all stages of neuritis present. Wladimiroff
thinks that in further investigations attention should be paid to
changes in the other nerves, especially the vagi and phrenics, and
that if similar changes are found in these nerves in scarlet fever to
those described by him in diphtheria, more light will be thrown

650

ABSTRACTS

on those cases which die within the first few days of the disease
in which macroscopical data are often insufficient to explain the
cause of death. J. D. Rolleston.

SEROUS SPINAL MENINGITIS. (Zur Kenntniss der Meningitis
(575) serosa spinalis.) Kurt Mendel and S. Adler. Berl. Idin.

IVoch., 1908, p. 1596.

Mendel was consulted by a woman, aged 36, in whom spastic
paraplegia with exaggerated reflexes, positive Babinski, Oppenheim
and Mendel-Bechterew signs, sensory disturbances and sphincter
troubles pointed to a spinal cord affection, while tenderness over
the spines of the second, third and fourth thoracic vertebrae in¬
dicated the situation of the affection. The predominance of the
pain in the right side of the back and chest and of the motor
weakness in the right leg suggested that the right half of the cord
was chiefly compressed. A history of lung trouble of ten years’
duration pointed to tuberculous disease of the vertebra) as the
cause of the compression. On the other hand, the good state of
nutrition, the absence of deformity, pyrexia, cough or sputum,
and a negative ophthalmo-reaction rendered this doubtful. Finally
the diagnosis was made of an extra-medullary tumour of unknown
nature, situated at the level of the second and third thoracic
vertebrae. In favour of this view was the fact that at the first
examination Brown-Sdquard’s syndrome was present, which was
consequently replaced by the condition just described.

Laminectomy was performed by Adler. The spines and
laminae of the second to fourth thoracic vertebra were removed.
The bones and periosteum showed no pathological change. No
tumour was found. The normal pulsation of the cord was
absent. The dura was opened, and some scanty fluid escaped
under slight pressure. The arachnoid was then punctured, and
about one and a half drachms of clear fluid spirted out. The
cord, which now began to pulsate regularly, showed nothing
abnormal beyond a slight depression and a milky opacity of the
arachnoid. The operation was followed by slow but decided im¬
provement. Five months later the patient was able to stand and
walk a few steps without support. The sphincter troubles had
entirely disappeared, and the sensory disturbances were much
less. The reflexes were now abnormal only on the right side.

In the present case the cause of the meningitis was not
ascertained. In most of the published cases disease of the
vertebra or of the cord was present. In his review of the
literature Adler shows that circumscribed spinal meningitis is by
no means rare. Its tendency to simulate a tumour of the spinal

ABSTRACTS

651

cord is illustrated by the fact that out of twenty-two laminectomies
performed by Krause for the removal of a supposed tumour, a
localised serous meningitis was found to be the essential, if not
the only, cause of the paralytic phenomena in six cases.

J. D. Rolleston.

SERODIAQNOSIS IN PSYCHIATRY AND NEUROLOGY. (Die
(576) Serodiagnostik in der Psychiatrie und Neurologic.) Stertz,
Allg. Ztschr. f. Psychiat. u. psychisch-gericht. Med., Bd. lxv., 19Q8,
p. 565.

Employing Wasserman’s serodiagnostic method in 111 cases,
Stertz obtained a positive reaction only in such conditions as were
associated with syphilis. Forty-five cases of general paralysis
were tested by this method, the cerebro-spinal fluid giving a
positive reaction in 88*8 per cent., and the cerebro-spinal fluid or
blood in 95*5 per cent. The cerebro-spinal fluid was examined in
five cases of tabes: three gave a positive reaction. In eight cases
of syphilis of the central nervous system, the cerebro-spinal fluid
gave a uniformly negative reaction, but the blood serum, examined
in five of those cases, gave a positive reaction in two. Seven cases
of late latent or cured syphilis were tested. The cerebro-spinal
fluid was negative in all; the blood serum was once positive and
once negative. In the remaining forty-six cases (cerebral tumour,
tuberculous meningitis, alcoholism, hydrocephalus, myelitis,
multiple sclerosis, etc.) the reactions both of the cerebro-spinal
fluid and of the blood serum were constantly negative.

W. T. Ritchie.

BIOLOGICAL STUDY OF THE CEREBRO-SPINAL FLUID IN
(577) ANTERIOR POLIOMYELITIS. Martha Wollstein, Joum.
of Exper. Med., July 8, 1908, p. 476.

This is the record of an attempt to find evidence of a micro-
parasitic origin of the disease by the employment of the biological
reaction of complement deviation, according to the methods of
Bordet and of Wassermann and Bruck. The cerebro-spinal fluid
was employed as a probable container of the hypothetical antigen.
The fluid was obtained by lumbar puncture from tweuty different
cases of varying age aud stage of the disease. The results obtained
show, in the words of the author, that no two interacting substances,
presumably antigen and antibody, capable of uniting and anchoring
complement were demonstrable in the blood serum, cerebro-spiual

652

ABSTRACTS

fluid, and organ-extracts studied. Therefore the diagnosis of
poliomyelitis by means of a serum reaction is apparently not
possible, and no light could be thrown on the etiology of the
disease by this reaction. J. H. Harvey Pirie.

LARYNGEAL GRISES AND PARESIS OF THE ABDUCTORS OF
(578) THE VOOAL CORDS AS IMPORTANT EARLY SYMPTOMS
OF TABES, WITH THE REPORT OF A CASE. Otto T.

Freer, Journ. Amer. Med. Assoc., 1908, Yol. xli., p. 815.

The patient, a man set. 37, had been ill for six months. The illness
began with attacks of vomiting. Three months ago he had a sudden
catch in his breath; two days later he had an attack of spasmodic
stoppage of breathing which began with a cough which was arrested
by a closure of the throat so forcible that he could not breathe,
and fell to the ground unconscious. He had had many similar
attacks since then, but has not again become unconscious. On
laryngeal examination, faulty abduction was observed of both
cords. Neurological examination showed typical signs of tabes.
There is sometimes a tickling sensation in the larynx before an
attack, and during the seizure there is severe pain in the larynx.
The number of attacks varies greatly; there have been as many
as seven in one day, and sometimes several weeks pass without
one occurring. W. G. Porter.

A CASE OF OERVIOO BULBAR SYRINGOMYELIA, COMMENC-
(579) ING WITH HICCOUGH. (Un cas do syringomyelia cervico-
bulbaire: debut par un hoquet persistant.) Sollier and
Chartier, L'Endph.aU, Sept. 1908, p. 249.

Symptoms of reflex irritation, such as nausea and vomiting, are
rare in syringobulbia, though not unknown. Hiccough is even
rarer. When it has been recorded it has appeared as a symptom
late in the disease, and has been neither regular nor constant.

In the present case it was the first bulbar symptom, preceded
solely by slight thermal hypsesthesia, of spinal origin; further, it
persisted with great regularity, after a sudden onset. It is due in
all probability to irritation of bulbar sensory nuclei.

S. A. K. Wilson.

ABSTRACTS

653

SEGMENTAL HYPERTROPHY OF THE ARM IN SYRINGO-
(580) MY ELIA. (Hypertrophie segmentaire considerable du bras
et de l’avant-bras avec dissociation syringomyClique des
sensibilitds.) Desplats, Nouv. Icon, de la Salpet., May-June
1908, p. 200.

A case of syringomyelia, in which the right upper arm was eight
centimetres more in circumference than the left, and the girth
at the epicondyle six centimetres more, an increase which involved
not merely the superficial structures but also the bone.

S. A. K. Wilson.

A CONTRIBUTION TO THE STUDY OF DISEASES OF THE
(581) CONUS MEDULLARIS. (Beitrag zu den Erkrankungen des
Conus Medullaris.) S. S. Robinowitsch, Berl. klin. JFoch.,
Aug. 31, 1908.

The author points out that disease of the conus medullaris
(sacral segments 3, 4, 5), except of traumatic origin, is very
rarely met with. As a rule the epiconus (4th lumbar to 2nd
sacral segments) is involved in the cord lesion. He records a case
which exhibited symptoms of an almost pure conus lesion. The
patient—an engine-driver—after a night of exposure complained
of paresthesia in the perineal region and of slight pains at the
bottom of his back. Next followed difficulty in passing his water
and constipation. This shortly gave way to complete incontinence
both of bladder and rectum, with loss of sexual power. There was
no weakness in the legs at any time. When examined, besides
the symptoms complained of, the author was able to demonstrate
anaesthesia (complete) of urethral and rectal mucous membranes,
and of the skin supplied by the 3rd, 4th, and 5th sacral segments.
There was loss of the anal sphincter reflex. The right ankle jerk
was lost, a fact which proved that the lesion was not strictly
limited to the conus medullaris. The other reflexes were normal.

As syphilis could apparently be excluded with certainty, the
author diagnosed a myelitis, due to cold, invading the conus
medullaris and affecting the epiconus only to a very slight degree.
He excludes a lesion of the cauda equina by the absence of pain
at onset or through the course of the disease.

The patient was given a thorough course of iodide of potassium
to no purpose, and after five months without any improvement
taking place, a course of strychnine was adopted with local treat¬
ment by faradism to the rectal and urethral mucous membranes.
Improvement began to occur almost at once and progressed till

654

ABSTRACTS

the patient eventually made a good recovery. A stationary
period, in this instance of five months, seems to be the rule in
lesions of the conus. Eulenburg and Rosenthal have recorded
cases where it persisted for two and four years respectively before
improvement set in. The author lays considerable stress on the
importance of local electrical treatment in such cases.

C. M. Hinds Howell.

ANOSMIA IN TEMPOROSPHENOIDAL ABSCESS. (Anosmia
(582) bei Schl&fenlappenabszess.) Bloch and Hechinger, Arch. f.

Ohrenkeilk., 1908, Bd. 76, S. 32.

Only two cases appear in the literature of anosmia iu temporo-
sphenoidal abscess, one reported by Stokes and the other by
Habermann.

The authors have observed a third case (in 1902). A radical
operation had been previously performed in 1901 on the right ear ;
in 1902 the same operation was performed on the left side. Five
weeks later symptoms of cerebral abscess appeared. The temporo-
sphenoidal lobe was explored and an abscess found. Three weeks
later the sense of smell was tested and was found to be absent on
the left side.

Tn July 1907 the patient could smell as well on the left side
as on the right.

In Cases 1 and 3 the loss of smell was on the side of the
lesion. In Case 2 it was on the opposite side. It would appear
from these observations that the sense of smell should be tested in
a case of suspected temporo-sphenoidal abscess.

W. G. Porter.

APHASIA. REPORT OF TWO OASES. John Hay, Liverpool Med.-
(583) Chir. Joum., Jan. 1908.

Case I.—An example of the serious disturbance, including aphasia,
which may occur as the result of a slight ocular defect, and in
which relief is obtained when the error of refraction is corrected.

Case II.—A man, aged 68, with arterio-sclerosis and high
blood-pressure, was attacked by complete sensory and almost
complete motor aphasia, unaccompanied by any paralysis or loss of
consciousness. Two days after the onset of the aphasia some
weakness was noted in the right hand. Three days later recovery
was almost complete, and he was able to give an accurate and
detailed account of the onset of the symptoms and of his condition
during the continuance of the aphasia. The recovery was brief.

ABSTRACTS

655

lasting about six days. Speech became again affected, and finally
the aphasia, both sensory and motor, was complete: right hemi¬
plegia developed, most marked in the arm and hand, which were
flaccid and powerless; this was accompanied by right hemi¬
anesthesia, especially noticeable in the hand and forearm.

The paralysis both of motion and sensation became worse,
respiration became Cheyne-Stokes in character; he passed into a
stuporose condition and died.

Cerebral thrombosis appears to be the likely explanation of the
symptoms and course of the disease, but as no autopsy was
permitted this supposition could not be verified.

The gradual onset, without any signs of cortical irritation or
intra-cranial pressure, the temporary recovery, followed by the
appearance and slow increase of the paralysis, and the peculiar
and suggestive disposition and progression of the loss of power—
for the lesion spread by stages corresponding to the areas supplied
by the branches of the middle cerebral—all suggest thrombosis of
these vessels.

The writer suggests that Broca’s area had escaped, the motor
and sensory aphasia being caused in the first instance by the
involvement of the fourth division of the middle cerebral, by
which means the integrity of the auditory and visual speech
centres was destroyed.

The outcome of this was motor and sensory aphasia, uncompli¬
cated by paralysis or loss of consciousness, but as the thrombosis
spread down the vessel the motor cortex became involved.

Author’s Abstract.

A CASE OF PURE APHE MIA (CORTICAL ANARTHRIA). Ladame
(584) and von Monakow, L'Endphale , March 1908, p. 193.

This case formed the subject of a brief communication at the
International Congress at Paris in 1900. It concerned a woman of
fifty-five, who at the age of forty-five suffered a slight apoplecti¬
form attack, with transient right facio-brachial paresis, which was
followed by absolute and complete mutism. The patient pre¬
sented all the symptoms of so-called sub-cortical motor aphasia,
without a trace of agraphia. Up to the time of her death, eleven
years later, she was able to write spontaneously and correctly. In
these eleven years she said “Yes” once, “No” once or twice;
seven months after the attack she said “ Good-bye, my little
one ”; two days later she said “ Good-bye.” With considerable
effort she said “ Thanks very much ” once, but with these excep¬
tions she remained dumb to the day of her death.

656

ABSTRACTS

Her condition consisted of the following:—

(a) Loss of spontaneous or voluntary speech.

(5) Inability to repeat words.

On the positive side—

(a) Complete integrity of “le language int^rieur.” No

word-deafness or word-blindness.

(b) Conservation of spontaneous writing.

of copying.

„ of writing to dictation.

„ of the comprehension of words (spoken or

read).

„ of the power of reading to herself.

She was not completely aphonic; she could emit a laryngeal
sound which she was capable of modulating; in chanting psalms
in church she could make a rhythmical humming sound, her lips
being closed. She died of diabetic coma in 1901.

At the autopsy an area of disease was found to occupy the foot of
the third left frontal convolution and the lower part of the ascend¬
ing frontal convolution, with the exception of a small section of
the operculum covering the insula. The lesion was a haemorrhagic
cyst, with cicatricial thickening of the neuroglial wall. The left
cortical centres for face, larynx, tongue, maxilla, hand and thumb
were completely destroyed by the lesion. Yet clinically these
structures were not paralysed.

A. Relation between the clinical symptoms and the anatomical
lesions. —The area of disease involved association, commissural, and
projection fibres of the white matter, as well as the cortex. But
measurements show that more of the cortex was destroyed than of
the white matter, so that the lesion may be fairly said to be
cortical rather than sub-cortical, although, according to present
views, the clinical picture was one of sub-cortical motor aphasia.

Examination revealed many cortical areas on the left side
which were secondarily impaired as a result of degeneration
attendant on the primary lesion. From this lesion of Broca and
the operculum the projection fibres are completely lost as far as
the bulbar nuclei. Although their number is relatively less than the
loss of association fibres passing in all directions through the white
matter, fibres both trans-cortical and sub-cortical, of varying
lengths and of indeterminate origins, yet the sole clinical
cerebral symptom was that of mutism.

There was unmistakable anatomical evidence of complete
interruption of all fibres passing between Broca’s area and the
hypothetical centre for writing (the latter, indeed, was certainly
involved in the lesion), as well as those to or from auditory and

ABSTRACTS

657

visual centres. In spite of these lacunes, the patient was able to
write perfectly well with the right hand, though a large portion of
the projection and association fibres of the arm area in the ascend¬
ing frontal had disappeared. These facts constitute the best proof
that memory functions are not seriously impaired by purely local
and unilateral lesions. There was not the slightest impairment of
movement of the right hand, neither ataxia nor astereognosis.

The most remarkable feature in this connection, contrary to all
current ideas on cortical localisation, is that the total destruction
of the motor centres for tongue, larynx, jaw, palate, throat, mouth,
and arm has produced neither paresis nor ataxia of these muscular
distributions (cf. Hunk’s experiments on the extirpation of limited
area of the cortex in monkeys).

The negative symptom of mutism which this patient showed is
far from being the necessary consequence of the destructive lesion
of Broca and the operculum. Yon Monakow’s explanation is that
it is the result of a prolonged cortico-bulbar diaschisis (inability to
overcome the difficulty of innervating the medullary centres).
Yet in some cases of Broca’s aphasia certain words return. Why
there should have been none in this case is difficult of explanation,
except perhaps as above. Ladame dissociates himself somewhat
from von Monakow over this point.

B. Anatomical conclusions. —Thalamo-cortical fibres forming
tracts in the corona radiata passing from the thalamus to the
cortex (Broca and the operculum) have their origin in the lateral
part of the median nucleus and in the ventral nuclei, but not in
the median portion of the median nucleus nor in the lateral
ventral nucleus. These fibres going to the cortex from the
thalamus form the centripetal path for phonation.

The corticofugal path is in the present instance easily followed,
a centrifugal path for phonation which in the internal capsule is
mixed with fibres of the pyramidal tract, and passes down in the
pons dorso-lateral to the latter. The course of the tract for
phonation can be followed clearly, as there is no pyramidal
degeneration.

This abstract can convey little idea of the great value of this
unique case, in which various points are recorded for the first time
in medical literature. S. A. K. Wilson.

BILATERAL MOTOR APRAXIA, WITH RIGHT HEMIPARESIS
(585) AND APRAXIA OF THE E7E MUSCLES. Deny and
Maillard, Socittt de psychiatric, Paris, July 16, 1908.

A case of arterio-sclerosis in a man of 55, with right herni-
paresis but no aphasia or dysarthria, who understands perfectly

658

ABSTRACTS

what is said to him and answers correctly. Apart from various
apraxic defects in the performance of movements of expression,
etc., the chief point of interest in the case is the condition of the
eye muscles. During the examination the patient frequently made
the remark, “ I can’t do what you want, because I can’t see.” Yet
his visual acuity is normal and there is no hemianopia. In order
to see, his eyes must turn, so to speak, automatically to the object
presented to him. Otherwise he may pick up the wrong object
several times in succession. If a newspaper or a book be given
him he can read only those lines on which his eyes fall involuntarily,
but he is voluntarily incapable of following a line, and therefore of
reading a sentence. The defect is therefore not one of vision but
of voluntary gaze. His eyes remain fixed when he is told to
follow an object as it is moved in front of him, but there is no
ocular paralysis, for if he fix his eyes his head can be moved about
passively and the eyes move in the opposite direction to the head.
Apraxia of the ocular musculature is rare, but has been previously
described.

S. A. K. Wilson.

A CASE OP APRAXIA, WITH AUTOPSY. John H. W. Rhein,

(586) Journ. of Nerv. and Ment. Dis., Oct. 1908, p. 619.

This is an elaborate account of a case of apraxia. The literature
is widely referred to in the discussion of the problems which the
case presents. The author summarises the case as follows:—A
man of 55 ; at the time of admission to the home he was blind;
was totally unable to designate the position of his limbs; could
not locate touch anywhere; could not recognise objects by the
sense of touch ; and his touch and temperature senses were imper¬
fect in the left hand. The left hand, although capable of some
reflex acts, could not be moved voluntarily. The right hand was
apraxic, and apraxic phenomena were present in chewing and
walking. The autopsy revealed the presence of degeneration of
the white matter of the right occipital and parietal regions on the
convexity and the posterior portion of the temporal lobe, the
calcarine region remaining intact. The inferior longitudinal
fasciculus and the optic radiations were degenerated on the right,
and probably, though less markedly, on the left. On the left side
there was degeneration in the occipital and temporal regions to a
much less degree, leaving the median surface intact. The corpus
callosum in its posterior portion was degenerated. Elsewhere the
brain was apparently normal.

Edwin Bramwell.

ABSTRACTS

659

PRECOCIOUS HEMIPLEGIA IN SECONDARY SYPHILIS. (Con-
(587) tribution k l’4tude de l’hdmipldgie prdcoce k la pdriode
secondaire de la syphilis.) G. Dutheil, Theses de Paris,
1907-08, No. 336.

Hemiplegia, which is essentially a phenomenon of secondary
syphilis, often occurs eight, ten or fifteen months after the chancre,
but may occur much earlier— e.g. two months (Mauriac), or fifty-six
days (Laseigne). Dutheil records the case of a man, aged 43
years, who was admitted to hospital on December 2, 1907,
with a generalised syphilitic eruption of a fortnight’s duration.
The chancre had been noted five weeks previously. A papulo-
tubercular eruption testified to the precocious malignancy of his
syphilis. Energetic treatment was therefore adopted, but after
thirteen injections pronounced mercurial stomatitis developed, and
treatment was suspended from December 15th to the 25th.
Twenty-six days after admission and seventy days after the
chancre drowsiness and hebetude developed. Lumbar puncture
showed an excess of mononuclears. Eight days later right
hemiplegia with Babinski’s sign and motor aphasia occurred.
Death took place on January 12, 1908. At the autopsy
no lesion could be found to explain the cause of the
hemiplegia.

J. D. Rolleston.

A CONTRIBUTION TO THE DISCUSSION ON EXOPHTHALMIC
(588) GOITRE, WITH SPECIAL REFERENCE TO THE ANTI¬
THYROID TREATMENT. A. Gordon Gullan, Liv. Med.

Chir. Journ., July 1908, p. 325.

This paper gives brief summaries of the author’s experience with
rodagen and thyroidectin in the treatment of exophthalmic goitre.
Nine cases were treated by the former, of which one was cured,
seven greatly improved, and one remained in static quo. Five cases
were treated with thyroidectin; all improved greatly (one after
non-improvement by rodagen). The largest dose of rodagen
employed was 3i four times a day, but the author thinks
larger doses, given with caution, might have even a better
effect.

J. H. Harvey Pirie.

660

ABSTKACTS

EXAMINATION OF THE BLOOD IN EXOPHTHALMIC GOITER
(589) (Blut tmtennchungen bei Morbus Basedowii mit Beitr&gen snr
Friihdiagnose und Theorie der Krankheit.) Theodor Kogher,
Arch./, klin. Chir., Bd. 87, H. 1 , p. 131.

This paper consists of a record of blood examinations, in a large
number of cases, of exophthalmic goitre and a general review of
the latest views on the etiology of the disease.

Kocher had full blood examinations made in 106 cases. The
red corpuscles, especially in young females, were frequently above
five millions. The leucocytes were almost invariably reduced, in
very many cases to about 5000, the lowest count being 3500.
The reduction was almost entirely in the polymorphs, which in
one case formed 35 per cent, instead 75 per cent, of the total
number of leucocytes. The lymphocytes were proportionately and
sometimes actually increased, in some cases forming 57 per cent,
of the total. The eosinophils were frequently increased, some¬
times to 15 per cent, of the total, but this was not a constant
finding.

A marked lymphocytosis is a bad sign. Lymphocytosis with¬
out a general leucoptenia is prognostically not such a bad sign as
when it occurs along with leucopaenia.

In early cases a lymphocytosis is present, but is not well
marked.

Operation on the gland had a striking immediate effect on the
blood counts. In one case, on the day following operation, the
leucocytes rose from below normal to 12,900; the neutrophils rose
from 42 per cent, to 89-2 per cent., while the lymphocytes fell from
48 0 per cent, to 2*7 per cent.

Some months after successful operation blood examination
showed, as compared with the counts before operation, an increase
in the total number of leucocytes, and a return to nearer the
normal proportion of neutrophils to lymphocytes. The coagulation
time of the blood is lengthened, and the viscosity of the blood is
increased in this disease.

The lymphocytosis points to a chronic infection or toxaemia,
and many of the symptoms of this disease resemble closely those
seen in cases of lymphatic leucocythaemia.

Kocher decides that the disease is no etiological entity, but
that it is of toxic nature, the toxin acting either directly on the
gland or on the nervous system.

D. P. D. Wilkie.

ABSTRACTS

661

OSSEOUS PLAQUES OF THE PIA-ARAOHNOID AND THEIR
<590) RELATION TO PAIN IN ACROMEGALT. S. Leopold,

Journ. of Nerv. and Ment. Dis., Sept. 1908, p. 552.

A case of acromegaly and one of arterio-capillary fibrosis are
described in which these osseous plates were well marked. Sainton
and State advanced the view in 1900 that these plates account for
the pains in different parts of the body which occur as a common
symptom in acromegaly. The author combats this view. The
following are the conclusions arrived at:—

1. Osseous plates are frequently present in the pia-arachnoid.

2. They are found in many diseases, such as uraemia, tuber¬
culosis, retrogressive conditions, etc.

3. Arterio-sclerosis seems to be the underlying factor in their
causation.

4. The presence of these plaques upon the spinal pia in
acromegaly does not explain the production of pain in that disease.

5. There is no definite pathology of the spinal cord in

acromegaly. Edwin Bramwell.

PSEUDO-APPENDICITIS HYSTERICA. (Uber Pseudo-Appendicitis

(591) Hysterica.) Karl Urban, Wien. med. Wchnsch., No. 35, 1908,
p. 1918.

By this term is meant a combination of the well-known signs of
hysteria and the signs of appendicitis, with localised or diffuse
peritonitis and high fever. The writer found records of twenty cases
in the literature, and records one case of his own. This was a
boy, 18 years of age, who was suddenly seized with acute pain
in the right side of the abdomen and vomiting, which continued for
twenty-four hours before his admission to hospital. On admission
his tongue was dry, respiration shallow, abdomen slightly dis¬
tended and rigid, especially the right rectus muscle, temperature
99’2, pulse 72. He complained of “unspeakable” pain, and his
whole behaviour was somewhat theatrical.

He was treated with hot fomentations, and the pain subsided,
though the tenderness, the exact site of which varied from day to
day, remained. Three weeks later he had a rigor, the temperature
rose to 104 - 4, pulse to 144, without there being much to be made
out in the appendix region, and on the following day pulse and
temperature were normal. Twelve days later another rigor with
temperature of 104 , 2, pulse 84, the patient complaining of great
abdominal pain in the appendix region, and entreating the surgeon

662

ABSTKACTS

to operate. As on the following morning the temperature was
still 104° F., laparotomy was performed. The appendix was found
normal, but was removed. Six weeks after his discharge from
hospital he returned complaining of pain over the left mastoid
region and demanding operation, but nothing abnormal could be
found. While in hospital he became maniacal, and had to be
removed to an asylum.

The writer regards the rises of temperature as being of a purely
hysterical nature, being, indeed, disturbances of the thermal centre
comparable to those commonly seen in the motor and psychical
centres in hysterical subjects. D. P. D. Wilkie.

A NEW SION FOR THE DETECTION OF MALINGERING AND
(592) FUNCTIONAL PARESIS OF THE LOWER EXTREMITIES.

C. F. Hoover, J. Am. Med. ^4ss., Aug. 29, 1908, p. 746.

A normal person, lying on a couch in the dorsal position, when
asked to lift the right foot up, keeping the leg extended, presses
the left heel dcntm to get a point of opposition. This can be felt
by the observer’s hand placed under the tendo Achilles. A hemi¬
plegic, if requested to lift the extended paretic leg, will be found to
offer this opposition with the healthy limb, whether any voluntary
muscular strength be exhibited or not on the affected side. In
malingering or functional cases, however, when the apparently
paretic limb is requested to be raised, there will be found to be no
complemental opposition offered by the normal limb, provided the
subject is unaware of the object of the examination. The author
has observed and used this test on two malingerers and two hysteri¬
cal cases and in a large number of hemiplegics.

J. H. Harvey Pirie.

AN INTERESTING NERVOUS SYNDROME IN SECONDARY
(593) SYPHILIS. (Una interessante sindrome nervosa della sifllide
secondaria.) G. Boschi, Riforma medica, 1908, p. 907.

Boschi records the case of a woman, aged 32, who for the
past two years had been subject to insomnia, hysterical convulsive
attacks, and psychical disturbances. Large doses of morphia and
heroin only aggravated her symptoms. Other sedatives, and
hypnotics such as veronal, and tonics proved of no avail. The
simultaneous occurrence of osteocopic pains suggested specific

ABSTRACTS 663

treatment. The hysterical symptoms soon disappeared, but the
insomnia persisted in spite of thirty sublimate injections, and only
yielded to salicylate of mercury.

J. D. Rolleston.

PERSISTENT HEREDITARY (EDEMA OF THE LOWER
(594) EXTREMITIES. ((Eddme persistant hlrgditaire desjambes,
avec exacerbations aigues.) Hope and French, Nouv. Icon, dt
la Salpit., May-June 1908, p. 177.

A. W., aged 18, was only three months old when it was observed
that her feet were swollen, without there being any apparent
reason for this. This oedema never disappeared, but gradually
crept up the legs, till at the age of eleven she was forced to wear
bandages constantly to keep the oedema within bounds. In 1904,
aged fourteen, she commenced to have a series of acute exacerbations
of the condition, which usually lasted for some days. In these
attacks there was a smart rise of temperature with shivering;
the legs, specially the right, became intensely swollen and red,
and exquisitely tender.

On coming under observation in 1906 the patient presented
a condition of marked swelling of the legs, from Poupart’s
ligament to the toes, not involving the genitalia or spreading on
to the abdomen. The swelling was not unlike elephantiasis.
All the bony landmarks in the legs were completely obliterated;
the skin was not discoloured; the oedema was more or less
uniform, and prolonged pressure of the finger was requisite to
produce a dimple. Evidently the subcutaneous connective tissue
was greatly increased, although some infiltration too was present.
Sensibility was unimpaired. The muscular weakness of the legs
was probably mechanical in origin. The sphincters were normal,
and the urine contained no abnormal constituent. Examination
of the blood revealed no obvious deviation from the normal.

The family history presented remarkable features. Thirteen
cases of the same condition were traced to have occurred in forty-
two individuals of five generations. Some of these gave a history
of acute exacerbations, identical with those of the patient. A
consideration of these facts makes the diagnosis of chronic
hereditary trophcedema or persistent hereditary oedema clear.

A lucid discussion of the various hypotheses capable of ex¬
plaining the condition is closed by the authors declaring in favour
of a vasomotor neurosis.

S. A. K. Wilson.

664

ABSTRACTS

HIGH INCIDENCE OF NERVOUS COMPLICATIONS IN A HOUSE
(595) EPIDEMIC OF DIPHTHERIA. (GeMufte Erkrankungen des
Nervensystems bei einem Hansepidemie von Diphtheric.) W.

Feilchenfeld, De/ui. med. Woch., 1908, p. 1632.

Eight children whose ages ranged from three to thirteen years
were attacked with diphtheria. One died on the sixth day of
disease, and of the remainder, five had nervous complications.
Two presented palatal and ocular palsies, three disturbance of
cardiac innervation manifested by syncopal attacks, and in one
paresis of the lower extremities occurred.

J. D. Rolleston.

PSYCHIATRY.

THE THYROID GLAND IN INSANITY. (La glande thyroids chez

(596) les alidnds.) Ramadikr and Marchand, L’Encdphale, Aug.
1908, p. 121.

No fewer than 278 thyroid glands were examined in patients
dying in different French asylums (Villejuif, Rodez, Rennes,
Blois).

(1) The weight of the thyroid gland presents no constant
peculiarity in various mental diseases, apart from cretinism.

(2) Macroscopic lesions of the gland vary very much in the
different asylums, but, again, present no constant peculiarity in
relation to mental disease. The commonest change is the exis¬
tence of colloid cysts.

(3) Microscopic lesions are, of course, very common. In old
people they are practically constant, and this makes caution
desirable in any statement as to their frequency among the insane
part of the population.

In forty-eight cases only eight presented no abnormality.
The lesions found were commonly diffuse sclerosis with atrophy
of many of the vesicles ; less commonly, parenchymatous or
interstitial thyroiditis, with desquamation of the epithelial lining
of the vesicles. The conclusion is that it is impossible to establish
any constant relation between the thyroid change and the form of
mental disease from which the patients suffered.

S. A. K. Wilson.

ABSTRACTS

665

THE BULBOOAVERNOSUS KEFLEX IN DEMENTIA PRiEOOX.
<597) (11 segno di Onanoff nei dementi precoci.) F. Vincenzo,
Biforma mediea, 1908, p. 876.

Vincenzo examined the bulbo-cavernosus reflex in thirty-three cases
of dementia precox whose ages ranged from nineteen to fifty-three
years. In only one was the reflex normal, in sixteen it was very
feeble, and in sixteen it was completely absent. The histories of
these cases show that the sexual life of precocious dements is
abnormal. All were celibates but three, and these were childless.
The great majority were confirmed masturbators or perverts, while
the rest were characterised by frigidity, torpor and mysticism.
Corresponding to the functional disturbance Vincenzo found various
anomalies of the sexual apparatus, such as deficient development or
malformation of the penis, scarcity of pubic hair, hypo- or
hyperesthesia of the mucosa of the glans and loss of pulsation
in the dorsal artery of the penis.

The writer concludes that Onanoffs reflex is of importance in
the diagnosis and prognosis of the various forms of sexual
neurasthenia, and that it is a valuable symptom in the study of
dementia. J. D. Rolleston.

A CASE OF DEMENTIA PRjEOOX (PARANOID FORM), WITH
(598) AUTOPSY. (Un cas de d&nence prgcoce k forme paranoids,
avec autopsie et examen histologique). Anglade and Jacquin,
L'Endphale, June 1908, p. 453.

Information on the pathological anatomy of dementia precox is
so scanty and uncertain that the findings in this case are of
interest.

Apart from certain chromatolytic and pigmentary changes in
the cells of the cortex, changes the interpretation of which is always
difficult, the authors found definite areas of subcortical sclerosis
throughout the brain, which were easily identifiable both by
touch and to the naked eye, and microscopical examination only
served to render them more evident. They predominated in the
ascending frontal, the frontal lobes, and the occipital lobes.
They consisted of areas of intense gliosis in which were recognis¬
able gliomatous elements, with a dense reticulum formed of large
neuroglial fibres. They bear a certain resemblance to what is
known as VUat vernumlu of senile brains. Whether the lesions
described are to be considered the anatomical substratum of
dementia precox it .would be premature to decide. The authors

666

ABSTRACTS

suggest that there exists a diffuse sclerous sub-cortical encephalitis
during the course of the disease which may become concentrated
at certain points and lead to certain more or less focal symptoms,
as existed in the case here reported.

S. A. K. Wilson.

APRAXIA AND DEMENTIA PR£OOX. Fromard, L’Encfyhak,
(599) Aug. 1908, p. 162.

Two cases of dementia praecox (it is, however, permissible to
question the diagnosis on the facts supplied) presented more or
less typical ideational apraxia. The patients, in the performance
of somewhat complicated acts, “ went off the rails ” in various
ways, either by short-circuiting (apraxia by anticipation), or by
inattention (apraxia by suspension), or by mistakes of a “ persever¬
ation ” type (apraxia by substitution), or by division of attention
(apraxia by “ interversion ”). As an instance of the first of these,
the patient was asked to pour water out of a carafe into a tumbler
and drink it, but he drank out of the carafe instead ; of the
second, the patient was asked to make the sign of the cross, when
he brought his finger to his forehead and then stopped altogether;
of the third, he was asked to “ put his fingers to his nose,” when
he brought his hand up to his nose and then began to scratch an
eczematous area on the skin; of the fourth, the patient had a
tumbler in his hand, which he was asked to put down, and he was
then directed to close an envelope in his other hand; he put the
envelope down, and proceeded to lick the edge of the glass with
his tongue. A division of this kind, into apraxia by anticipation,
substitution, suspension, or “ interversion,” can be simply one of
convenience ; it is obvious that the limits of each cannot be
drawn rigorously. S. A. K. Wilson.

JUVENILE GENERAL PARALYSIS, WITH APRAXIC SYMPTOMS.

(600) Claude and Levi-Valeusi, SocUM dc psychiatric, Paris, July 16,
1908.

The patient is a girl of 22, with a definite syphilitic heredity
and clear indications of the accuracy of the diagnosis. She
presents apraxic phenomena in the shape of perseveration, motor
apraxia, and ideational apraxia. Agnosia, however, cannot
be excluded, which renders the clinical picture less instructive.

S. A. K. Wilson.

ABSTRACTS

667

TREATMENT.

THE TREATMENT OF SPINA BIFIDA B7 DRAINAGE OF THE
(601) CEREBRAL SUBDURAL SPACE. Peter Paterson, Lancet ,
Aug. 15, 1908, p. 456.

The author’s case was that of a dorsi-lumbar meningo-myelocele in
an infant two months old, associated with double congenital
talipes equino varus, paresis of the lower limbs, and a mild degree
of hydrocephalus. As the sac of the spina bifida was on the point
of rupture it was excised, the spread-out cord and nerves separated
with difficulty and returned inside the spinal groove, while the
wound was firmly closed by suturing the edges of healthy skin
round the base of the tumour. Shortly after this operation the
fluid re-accumulated, the skin stretched, and cerebro-spinal fluid
began to escape through the stitch-holes. In order to relieve the
tension, the cerebral subdural space was drained into the tissues of
the scalp by trephining over the right parietal bone, opening the
dura mater with a crucial incision, and stitching the turned-back
edges of the flap to the pericranium, the wound in the scalp being
sutured and covered with collodion. The effect of this was to
produce a very marked oedema of the scalp for some days, but
also a great diminution in the tension of the swelling. Two months
after this operation the hydrocephalus began to increase, in con¬
sequence of which drainage of the ventricles was performed. The
author employed several silk threads, the inner ends of which were
tied together and inserted into the ventricles, while the outer ends
were spread out like a wick into the superficial tissues of the scalp.
This was followed by oedema of the scalp, which lasted for ten days,
and a gradual diminution in the size of the head. The foutanelles
became lax and the parietal bones overlapped. Death, which took
place three weeks after, was attributed to persistent vomiting,
from which almost from birth the child had suffered. At the
autopsy the opening made for draining the spina bifida was found
to be closed, but the threads in the ventricles were draining satis¬
factorily. In summing up, the author states that in future he
would utilise the threads to drain both the subdural space and the
ventricles, as it would appear from this case that they were acting
as a drain for the spina bifida by way of the subdural space, since
» the opening made for the former was found to be occluded.

C. B. Paul.

668

ABSTEACTS

CLINICAL STUDIES OF THE 8URGEBY OF OTOGENIC MEN'
(602) INGITIS. (Klinische Stndien rur Cbimrgie der Otogenen
Meningitis.) G. Alexander, Arch. f. Okrenhcilk ., 1908, Bd.
75, S. 222, and Bd. 76, S. 1.

The author classifies cases of otitic meningitis as follows:—1.
Meningitis in otherwise uncomplicated cases of acute middle ear
suppuration; 2. meningitis in otherwise uncomplicated cases of
chronic middle ear suppuration; 3. meningitis in cases of otitic
brain abscess; 4. meningitis in cases of otitic thrombo-phlebitis
and extradural abscess; 5. meningitis in cases of suppuration in
the labyrinth.

Each group can be further divided into:—1. Those cases
where there is a visible anatomical connection with the ear con¬
dition ; 2. those cases where there is no such visible connection;
3. tuberculous meningitis. Thirteen illustrative cases are fully
reported and discussed.

The value of lumbar puncture is discussed. Increased pressure
of the cerebro-spinal fluid is certain evidence of meningitis; the
colour of the fluid is also important. Of great diagnostic value is
the appearance of coagulation in fluid which has stood for from
three to twenty-four hours. Lumbar puncture gives exact evi¬
dence as to the state of the meninges, but it can never in itself
form a contraindication to operation. The opinion that no opera¬
tion should be performed where the cerebro-spinal fluid is turbid
is now happily abandoned; that does not mean that every case of
purulent meningitis is to be operated on, however far advanced,
but that the question of operation must be determined from the
clinical symptoms, deep coma, paralysis, and so on. It must
always be borne in mind that a purulent fluid may be obtained
in cases of brain abscess, suppuration in the labyrinth, or in sinus
thrombosis.

As regards the operation, the first essential is the thorough
clearing out of the disease in the ear, and in suppuration of the
labyrinth wide opening of the vestibule and cochlea is indicated.
The sinus and the dura of the middle and posterior cerebral fossae
must be widely exposed, several incisions may be made in the
dura. After operation frequent changes must be made in the
dressings, and repeated lumbar puncture is of value.

W. G. Porter.

ABSTRACTS

669

THE SURGICAL TREATMENT OF EXOPHTHALMIC GOITRE.
(603) (Die chirargische Behandlnng des Basedow’schen Krankheit.)

August Hildebrandt (Berlin), Berl. klin. fPchnschr., July 20,

1908, S. 1362.

The writer is strongly in favour of early operation in this disease,
and brings forward evidence in support of this view. Nothing
has yet been discovered which will influence the thyroid secretion,
and although anti-thyroidin does good in some cases, it very fre¬
quently fails. The bad results with surgical treatment have all
been in severe cases which have resisted prolonged medical
treatment, and the mortality after operation is not greater than that
from the disease itself. Out of 177 cases of resection of the thyroid
gland for exophthalmic goitre, there were 57‘6 per cent, cured,
26’5 per cent, improved, 2*2 per cent, unimproved, and 13 - 5 per
cent. died. He considers a patient cured if he can resume his
daily work and if the tachycardia disappears. In hospitals where
early operation is the rule the death-rate is very low. Klemm in
32 cases had no deaths. Kocher in his last 52 cases had only one
death. Although operation in early cases is associated with very
little risk, the writer does not recommend it unless the case has
resisted medical treatment for one month. The operation of
choice is to remove one-half of the gland, and should this not cure
the symptoms the arteries supplying the other half should be
ligatured. In advanced and severe cases he strongly approves of
Kocher’s method of ligaturing both superior thyroid arteries as a
preliminary operation to removal of one-half of the gland.

The operation should always be conducted under local anaes¬
thesia, a 1 per cent, solution of cocaine being used. Convalescence
is usually very slow, months, and sometimes even years, elapsing
before the body is completely freed of the poison.

Complete rest for several months after operation is an essential
in the after-treatment of all cases. D. P. D. Wilkie.

POLYGLANDULAR SYNDROMES AND OPOTHERAPY. (Les
(604) syndromes polygl&ndulaires et l’opothfrapie associle.) L.

R6NON, Jour, des Prod., July 25, 1908, p. 465.

Experimental work has shown the correlation of the different
glands which possess an internal secretion. Thus R4non and
Delille found that repeated injections of pituitary extract into
rabbits caused over-activity and hypertrophy of the suprarenals,
while after injection of suprarenal extract the pituitary body
appeared normal or showed over-activity without hypertrophy.

670

ABSTRACTS

Ovarian extract caused considerable pituitary congestion, as a
rule accompanied by glandular over-activity. In man, as in animals,
infections and intoxications produce more or less marked alterations
in the thyroid, suprarenale, and hypophysis. Rdnon examined
these organs in typhoid fever, pneumonia, acute and chronic
tuberculosis and uraemia, and found very marked though variable
changes. Thus a woman with tuberculosis of the right thumb and
hallux showed a total caseous degeneration of the suprarenals,
hypertrophy and sclerosis of the thyroid, hypertrophy and over-
activity of the hypophysis, and bilateral ovarian sclerosis. In a
case of pulmonary tuberculosis, which was much improved by
suprarenal medication, there was very marked sclerosis of the
suprarenals and thyroid and over-activity and hypertrophy of the
hypophysis. Such findings show that polyglandular lesions are
the rule and uniglandular lesions the exception. In clinical
medicine, though the syndrome is polyglandular, the disturbance
of function may be more marked, and appear earlier in one gland
than in the rest. In a typical uniglandular syndrome, although
the changes in one gland predominate, the changes in the
other glands play a more or less prominent part. Thus inyxcedema
and exophthalmic goitre are both constantly attended with genital
troubles, e.g. amenorrhcea or testicular atrophy. Genital disturb¬
ance is also constant in acromegaly and gigantism, and the
association of acromegaly with myxoedema or with Graves’ disease
is relatively frequent. In many women ovarian insufficiency is
associated with signs of hyper- or hypothyroidism, or both. A
polyglandular syndrome is well illustrated in the different periods
of a woman’s life. Thus hypertrophy of the thyroid is normal
during puberty, and is associated with ovarian ataxia. Acromegaly
may also commence at this time. Affection of the suprarenals,
thyroid, and hypophysis during pregnancy explains the tachycardia,
sensations of heat, perspiration, and rise of blood pressure observed
at this time. At the menopause ovarian insufficiency is often
associated with other glandular symptoms. Thus most cases of
obesity at the time are due to an association of thyroid and
ovarian insufficiency, and involvement of the suprarenals and
hypophysis is shown by hypertension and symptoms of acromegaly.
Acute and chronic infections and intoxications affect the genital
apparatus, especially of women, producing dysmenorrhcea, irregu¬
larity of the menses, and amenorrhcea. The activity of the thyroid
may become excessive, as in tuberculosis and acute rheumatism.
Insufficiency of the suprarenals and pituitary body ( v . Rev. of
Neurol., 1907, pp. 324 and 719), either separately or in combina¬
tion, may produce tachycardia, asthenia, insomnia, and psychical
troubles. The pathogeny of certain dystrophic disorders becomes
clearer when a systematic examination of the blood vascular

REVIEWS

671

glands is made. Thus in a case of sclerodermia in a young woman
who showed marked troubles of menstruation, with migraine,
headache, and anorexia, the symptoms were due to a combined
insufficiency of the thyroid and ovaries. In adiposis dolorosa,
obesity, and some cases of acromegaly, thyro-ovarian insufficiency
is also present, and the corresponding opotherapy is indicated. In
a case of myasthenia gravis, in which the onset of the affection
was definitely associated with menstrual disturbance, ovarian
insufficiency was followed by signs of pituitary incompetence—viz.,
tachycardia, hypotension, and oliguria. The combined administra¬
tion of the ovary and hypophysis caused these symptoms to
disappear rapidly. A polyglandular syndrome also enters into
the pathogeny of some cases of myopathy, neuro-fibromatosis, and
paralysis agitans. In instituting treatment one should always
start with uniglandular medication. In a polyglandular syndrome,
in which the disturbance of a single gland predominates, corre¬
sponding uniglandular treatment will often suffice, since the
exhibition of the extract of one gland often causes over-activity
of the rest. When uniglandular treatment is insufficient, or
produces no effect whatever, polyglandular treatment must be
adopted, and, unless signs of intolerance develop, be continued for
three weeks or a month, at the end of which time uniglandular
opotherapy should be resumed. Glandular extracts must be
employed with care, for their activity is considerable.

J. D. Rolleston.

IReviews

THE SIMULATION OF INSANITY. (La simulation de la folie.)
Professor A. Maiket (Montpelier). Coulet et Fils, Mont¬
pelier, 1908.

In this book, which is one of the first works wholly devoted to
such a study, the subject of Simulated Insanity is treated of under
four headings, viz., 1. Its Historical Aspect; 2. Its Clinical
Aspect; 3. The Contrast between Simulated and Actual Insanity;
4. The Relation of Simulation to Responsibility.

Insanity has been feigned in all ages, and where history is
available, as iu the Bible and in the works of ancient Greek and
Roman authors, instances are given to substantiate this assertion.
David feigned insanity to gain the protection of Achish, King of
Gath. Ulysses, Solon and Brutus also feigned insanity. To a
study of the character of Hamlet, from the point of view of

672 REVIEWS

simulated insanity, the author devotes twenty-four pages. He
concludes that Hamlet is both a melancholic and a simulator, and
that the portrayal of such states of mind is the result of an
intimate knowledge by Shakespeare of the clinical aspects of
insanity. To prove this, an interesting comparison is made
between the first and second MSS. of Hamlet ; or, as the author puts
it, “ The Shakespeare of about twenty-one years of age is compared
with the Shakespeare of about thirty-six years of age.” The
younger Shakespeare knows practically nothing of insanity, the
older Shakespeare has acquired a very intimate knowledge of it.

Hamlet, from a technical point of view, is considered a very
bad simulator; his simulation is intermittent, and he puts too much
spirit and depth into it.

Having considered feigned insanity in relation to general
history, the author devotes a chapter to its history in medicine.
The most important contribution to this subject is that of Zachias,
who in 1688 wrote a chapter about it in his “ Book of Medico-
Legal Questions.” Since the days of Zachias, the forms of insanity
simulated have increased in number, as have the facilities of
diagnosis, owing to a wider knowledge of the subject. The sources
of inquiry indicated by Zachias are still the best modern elements
for diagnosis.

The bulk of Prof. Mairet’s book naturally deals with the
clinical features and diagnosis of simulation. As a general rule,
insanity is feigned for two main reasons: (1) To obtain an im¬
mediate personal satisfaction; and, in the majority of cases, (2) to
escape punishment. Eighty-four per cent, of the cases exemplified
had committed criminal acts. In this connection it is important
to notice that it is not the gravity of the crime that induces
simulation. Feigned insanity is rare, and the reason for this is the
general repulsion that insanity inspires. The majority of prisoners
prefer to pass as criminal rather than lunatic. The idea of simu¬
lating insanity does not usually originate in the mind of the
simulator. It is generally suggested by a relative, a warder, or a
fellow-prisoner. To simulate is very difficult, and all criminals
are not capable of it. The simulator is usually a degenerate, in
whom predisposition to insanity shows itself by moral perversion,
and sometimes added to this, epilepsy or hysteria; or an arrest of
development, more or less marked, is noticed, proceeding in some
cases to imbecility. The simulator may, however, be very
intelligent.

The forms of insanity simulated are dealt with in detail. They
embrace mania, melancholia, stupor, delusions of persecution and
grandeur, dementia, deaf-mutism and atypical forms; and in
simulating these forms, not only their symptoms but also their
evolution can be imitated.

EE VIEWS

673

The elemeuts that raise doubts in the mind of the physician as
to the genuineness of a case of insanity are the shades or faults in
the picture when it is compared with that of actual insanity. The
perfect simulator is rare. Where he exists, insanity has been
copied as the result of association with, and the study of the
insane.

In making a diagnosis, the author suggests an indirect and a
direct examination. The indirect examination embraces an in¬
quiry into the antecedents of the patient, the motives of any
crime committed, the relation of the first appearance of signs of
insanity to the crime, and the manner in which the mental
troubles arose. In making an indirect examination, it is necessary
to remember that parents, friends and neighbours may, by
affection, interest, or pity exaggerate the mental state of the
patient, or even falsely affirm the existence of a pathological state.
Direct examination is to a great extent concerned in the in¬
accuracies of the clinical picture presented, by comparison with
that of actual insanity. A precise knowledge of insanity and its
several clinical forms is essential to the examiner. To obtain a
correct diagnosis it is necessary not only to visit the patient
frequently, but also to have the reports of persons accustomed to
watch and record the course of insanity, and under whose care the
examinee has been placed.

The elements which make for doubt as to the reality of the
presence of insanity are brought prominently before the reader in
concise paragraphs printed in italics, as follows:—

“ When a prisoner, suspected of insanity, shows neither
inheritance nor predisposition, doubt as to the existence of
insanity in him should be entertained.”

“ When a prisoner . . . has a history charged with crime,
these doubts should again occur to the examiner.”

“ The epoch of the appearance of mental troubles may have,
in the discovery of feigned insanity, according to the case
either no role, or a role more or less important—sometimes
very important. The suddenness of the appearance of insanity
ought always to raise doubts, more or less strong, according to
the cases—weaker when the insanity takes the form of general
delirium, considerable, and even of major importance, when
there is the appearance of mental aberration with partial
delirium.”

Complementary processes of diagnosis consist in attempting to
elicit certain passions, which, if felt normally, would add to the
suspicion that simulation is present.

In view of the proverb, “ In vino veritas,” attempts have also
been made to assist the diagnosis by putting the patient under the

674

REVIEWS

influence of wine, opium or ether, and noting the mental results.
It is important to have the avowal that the mental condition is
simulated. This may be obtained by a ruse—by threats, pain, or
punishment, such, for instance, as the use of the cephalic douche.

Feigned insanity is also found amongst the insane, but the
author does not accept Greisinger’s reason for it, viz., that it is
done to satisfy some morbid pleasure. Prof. Mairet is of opinion
that the insane simulator has a more practical end in view—like
the criminal, but not knowing of his insanity , he wishes to escape
punishment.

Insanity simulated by an insane person consists either of an
exaggeration of his particular form of insanity, or of an entirely
different form from that which already exists in him. The clinical
phenomena in sane and insane simulators are alike.

The next part of Prof. Mairet’s book is devoted to “alleged
insanity,” of which a prisoner, who alleges that he was in a state
of dementia when he committed the criminal act, is invariably the
subject. Two forms of “ alleged insanity ” are considered:—(1) The
Amnesic Form, and (2) The Maniacal Form, resulting from alcohol,
morphia, fear and impulse. Examples of “alleged insanity”—
which is rare—are given in detail.

Finally, simulation and responsibility are considered. The
author discusses whether simulation, as a blameable act, should be
looked on as an aggravation of the crime, and the prisoner
punished accordingly. He suggests that the mental condition of
all simulators should be examined in order to find out whether
they are not responsible.

This work, from beginning to end, sustains the interest of the
reader. There are very few typographical errors, and much
subject matter that is original. It will well repay study and
perusal by all interested in mental problems.

Hamilton C. Mark.

DISEASES OF THE SPINAL COED. R. T. Williamson. Oxford
Medical Publications. London: Henry Frowde and Hodder &
Stoughton, 1908. 15s.

This work, as the author states in his preface, is based upon notes
of lectures delivered at the Manchester Medical School during the
last fifteen years. The notes have been largely added to, and the
lecture-form has been altered. The aim of the work is to be a
text-book, and an introduction to, rather than an exhaustive account
of, the diseases of the spinal cord. The book, however, is no mere
compilation. In every chapter there is abundant evidence of the
author’s independent judgment and original investigations. The

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675

illustrations, of which there are 190, are with one exception made
from the author’s own drawings, photographs, and micro-photo¬
graphs. The schematic drawings especially will prove of the
utmost value to the student, as they tell their tale with singular
clearness and are most suitably chosen to explain the text. The
author’s style is direct, clear, and attractive, and unessential details
are not allowed to obscure the general perspective.

Students into whose hands the reviewer has placed the book
are unanimous in their praise of the work in these respects, all
agreeing also that the explanations and descriptions it contains
are exactly what they need as an introduction to the subject.

With all this it should be further said that the author is fully
abreast of all the modern work on the anatomy, pathology, and
symptomatology of diseases of the spinal cord. There are six
introductory chapters on the structure of the cord, general path¬
ology, histology and functions of the cord, symptoms of spinal
diseases, electrical and other modern methods of examination, and
on the diagnosis and localisation of diseases of the cord. In his
consideration of the individual diseases the writer has departed
from the usual sequence, and has grouped them according to the
predominance of some main symptom, such as symptoms of a
transverse lesion of the cord, atrophic paralysis, spastic paralysis
or paresis, ataxia, etc., and has given three additional chapters on
spinal meningitis, spinal syphilis, and traumatic neuroses. This
arrangement is obviously not a scientific one, and it may be
doubted if its disadvantages do not outweigh its advantages, but,
after all, it does not materially interfere with the description of
the individual diseases. There is a final chapter on the histological
methods which have been found most useful by the writer. Each
chapter contains sufficient references to the bibliography.

The book has been admirably produced, the text and the
illustrations being clearly printed. It would have been more
satisfactory had the illustrations of transverse sections of the
cord been printed on a uniform plan, with the anterior columns
directed either upwards or downwards. Might we suggest that
such a change might be made with advantage in the next edition,
which, we feel confident, will be soon called for ?

DISEASES OF THE NERVOUS SYSTEM. By H. CAMPBELL
Thomson. London, Paris, New York, Toronto, and Mel¬
bourne : Cassell & Co., Limited, 1908.

This work by Dr Campbell Thomson forms one of a series of
medical publications by Cassell & Co. As the whole ground
of neurology is covered in 467 octavo pages, the descriptions are

676

REVIEWS

necessarily very concise. The author has, however, succeeded in
producing a volume which, while free from all trace of redundancy,
is yet full of facts, marshalled in such a manner as to be capable
of ready absorption by the student of medicine, for whom it is
primarily intended as an introductory text-book.

It contains 98 illustrations, largely borrowed from other works,
but well chosen and well reproduced.

B00K8 AND PAMPHLETS RECEIVED.

Georg Merzbach. “ Die krankhaften Erscheinungen dee Geschlecht-
sinnes.” Alfred Holder, Wien and Leipzig, 1909, M. 6.20.

Max Lowy. “ Daa Krankheitsbild der iibervertigen Idee und die
chronische Paranoia.” Verlag Lotos , Prag, 1908.

Gilbert Ballet. “ Neurasthenia.” Translated by P. Campbell Smith.
Henry Kimpton, London, and Alexander Stenhouse, Glasgow, 1908. 6s.

Charles S. Potts. “ Nervous and Mental Diseases, for Students and Prac¬
titioners.’’ 2nd Edition, revised and enlarged. Henry Kimpton, London,
and Alexander Stenhouse, Glasgow, 1908. 12s. 6d.

Francois Moutier. “L’Aphasie.” ( Gaz . des E6p., sept. 1908.) Levd,
Paris, 1908.

L. Dugas. “Une TWorie Nouvelle de l’Aphasie.” (Jounu dt Psychol,
norm, et pathol ., No. 6, 1908.) F41ix Alcan, Paris, 1908.

Max Lowy. “ Die Aktionsgefiihle : Ein Depersonalisationsfall als Beitrag
zur Psychologie des Aktivitatsgefiihles und des Personlichkeitsbewusstseins.”
Bellmann, Prag, 1908.

Dercuni. “The Supposed Evils of Expert Testimony.” N.Y. Med.
Joum., July 26, 1908.

Nacke. “ tlber Familienmord durch Geisteskranke.” Marhold, Halle,
1908.

Wieg-WickenthaL “Zur Klinik der Dementia praecox.” Marhold,
Halle, 1908. M. 3.

Dreyfus. “ Ober Nervose Dyspepsie.” Fischer, Jena, 1908. M. 2.60.

Sir James Sawyer. “Points of Practice in Maladies of the Heart.’
Cornish Brothers, Ltd., Birmingham, 1908.

IRevlew

IReucoloGS ant> flteEcbiatrg

Original articles

TUMOUR MALFORMATIONS OF THE CENTRAL
NERVOUS SYSTEM.

By WILLIAM G. SPILLER, M.D.,

Professor of Neuropathology and Associate Professor of Neurology
in the University of Pennsylvania.

Malformations of the central nervous system occurring as
tumour-like structures are recorded in the literature, but the cases
are not very numerous. Within the past few years two interest¬
ing examples of embryonic structural defect have come under
my observation. In one of these a tumour was found in the
cerebello-pontile angle; in the other, the tumour was at the lower
end of the cord.

(a) Medformation of the Cerebello-pontile Angle .—In examin¬
ing a brain in which a tumour having the appearance of
an endothelioma, and growing from the region of the Gasserian
ganglion, had been found, I observed a small flat growth about
the size of a small bean, situated on the under surface of the
right lateral lobe of the cerebellum, at the angle formed by the
cerebellum, medulla oblongata, and pons. This tumour, when
studied microscopically, gave the following findings:—

Though lying close upon the brain, it did not form an
intimate part of its tissue. It was closely connected with the
choroid plexus of the fourth ventricle, and in a few places was
B. OF N. & P. VOL. VI. NO. 12.—3 C

678

WILLIAM G. SPILLEK

not differentiated from the pia covering the cerebellum. The
choroid plexus was almost everywhere distinct from the tumour,
but in a few places it formed intimate union with it, and the
tumour in small areas had a border of cells of the ependymal
type. The groundwork of the tumour was a loose neuroglia, with
irregular, short and rather massive bands of denser neuroglia of
varying thickness running through it in all directions. In some
areas the ground substance was denser than in others. The
tumour contained numerous blood vessels. Scattered all through
the tumour, without any definite arrangement, were nerve cells,
round, elongated, or triangular, resembling in shape and size the
cells of Betz in the paracentral lobule, or the cells of the spinal
ganglia. Some of the cells appeared degenerated, had peri¬
pherally-placed nuclei and swollen cell-bodies, and contained few
or no chromophilic elements. Others had chromophilic elements
like those of the pyramidal cells of the motor cortex.

The tumour in places had numerous medullated nerve fibres,
as shown by the Weigert hsematoxylin stain. These were
almost confined to the periphery, and in some portions were
parallel with the border of the tumour, and in others radiated
from the periphery a short distance toward the centre. Most of
these fibres had a distinctly degenerated appearance. In some
places they formed a meshwork.

The interpretation of this tumour was made easy by the
excellent article by Kasimir v. Orzechowski. 1 This writer states
that his finding seems to be the only one of malformation of the
recessus lateralis reported in the literature. He believes that the
so-called acusticus tumours, and other tumours of the cerebello-
pontile angle, are probably remains of the wall of the lateral
recess. The tumour that he describes was covered in places by
an endothelial lining, and contained nerve cells and nerve fibres,
and seems to have been similar to the malformation in my
case.

The embryological malformations of this region, as v.
Orzechowski suggests, are probably not so rare as appears at
present, and when attention is directed to the subject, the reports
of such conditions will doubtless become more numerous.

It is difficult to decide whether any relation existed in my
case between the malformation of the cerebello-pontile angle and
1 v. Orzechowski, Obersteincr's Arbeiten, voL xiv., 1908.

TUMOUR MALFORMATIONS OF NERVOUS SYSTEM 679

the tumour growing from the region of the Gasserian ganglion,
but such connection is possible, inasmuch as Marchand holds
that tumours of the Gasserian ganglion arise in the undifferentiated
Anlage of the ganglion.

I have referred briefly to my findings in this case in a
recent paper, but their importance seems to justify more con¬
sideration than was given to them there. 1

(6) Malformation on the Sacral Region of the Cord .—The case
was one of extensive carcinoma, and has been reported without
reference to the malformation of the spinal cord. 2

The patient, a man, was admitted to the Philadelphia
General Hospital, December 24, 1904. The face and upper limbs
were not affected, but the lower limbs were almost completely
paralysed, although some movement was possible at each hip
and each knee, and the toes were moved slightly. The patellar
reflex was exaggerated on each side, but ankle clonus was not
obtainable. Babinski’s reflex was distinctly present on each
side. Sensations for touch and pain were preserved in the
lower limbs, but tactile sensation was diminished on the soles
of the feet. Retention of urine was present. There was only
one record of pain, and that was made July 10, 1905.

He came again into my service in January 1906. At that
time his condition was as follows:—He lay in bed with the thighs
strongly flexed on the abdomen and the legs flexed on the
thighs. He had slight voluntary power in flexion of each thigh,
but it was very doubtful whether he had any voluntary move¬
ment of his toes. The slight upward movement of the toes
which sometimes occurred was probably reflex. The lower
limbs were much wasted. The patellar reflex and Achilles
tendon reflex were absent on each side. The Babinski reflex
was very typical on each side. Tactile and pain sensations were
entirely lost in the lower limbs. He had no control of the
urine or faeces, and the bowels did not move without enema.
He moved the upper limbs freely, but the movements were
weak. These limbs were also wasted. Biceps and triceps
tendon reflexes were present on each side, and about normal,

Marchand, “Festschrift fur Rindfleisch,” 1907, p. 265; Spiller, American
Journal of the Medical Sciences , Nov* 1908.

2 Spiller and Weisenburg, Journal of Nervous and Mental Disease , Aug. 1906 ;
and Weiner klinisch-therapeutische Wochenschrift, Nos. 29, 30, and 31, 1906.

680

WILLIAM G. SPILLER

considering the general emaciation. The pupils were equal.
The movements of the eyeballs probably were good, although it
was impossible to get him to respond promptly. No impair¬
ment of cranial nerves was detected. The abdominal muscles
were intensely rigid, and the abdomen was distended. A
necropsy was obtained. Numerous carcinomata were found in
various parts of the body.

A flat tumour was observed on the anterior part of the cord
in the upper sacral region. It was about 2 cm. long x 1*2 cm.
broad, and was covered by the pia. Some of the nerve roots
were implicated in the tumour. It was very friable.

The spinal ganglion of about the ninth thoracic root and
this root also showed a little of the loose tissue seen in the
tumour, but here, of course, it was outside the dura. This tissue
contained osseous plates, here and there a few striated muscle
fibres, fatty connective tissue, numerous vessels filled with red
blood cells, and at one part a small mass of densely-packed
round and elongated nuclei between which were connective
tissue fibres. Between these various structures were loose bands
of wavy connective tissue.

The tumour within the pia was of the structure described
above. The bony plates stained purple, especially along the
edges, with htemalum, and contained cells separated from one
another. Masses of cartilage-like tissue also were found. These
stained very faintly, had a somewhat hyaloid appearance, and
contained numerous cells with a large amount of protoplasm, much
larger and very different from those within the bony plates.
The muscle fibres were striated transversely and longitudinally,
contained many elongated nuclei, and were like fully-developed
muscle fibres. Here also were fat cells and some connective
tissue fibres. Sections were taken from both the upper and
lower ends of the tumour.

A spinal tumour containing striated muscle fibres resembling
the findings in my case is described by J. Graham Forbes. 1 It
was in the cervical region. The patient, a child aged five years
and six months, had paralysis of both upper and lower limbs,
supposed to be caused by cervical caries. He had always been
“ tottery ” on his legs, had looseness of the bowels, and frequent
and copious micturition. His bead and shoulders drooped when

1 Forbes, St Bartholomew’s Hospital Reports f vol xli., 1906, p. 221.

TUMOUR MALFORMATIONS OF NERVOUS SYSTEM 681

he was three years old. Later he had pain in the course of the
posterior cervical nerves and rigidity of the neck. An operation
was performed, an incision was made through the dura, and a
growth about the size of a haricot bean protruded through the
•opening, and seemed to grow from the spinal cord. It was
covered by the pia. The bulging portion of the tumour was
removed.

The tumour on its posterior aspect was covered by a layer of
dense fibrous tissue, probably thickened and adherent meninges.
On the reverse side were many small strands of well-defined
striated muscle fibres, portions of which were embryonic, and*
appeared as long fusiform cells with several nuclei arranged in
columns toward the tapering end of the cell. (Such embryonic
muscle cells were not found in my case.) These structures
formed the most striking and characteristic feature of the
growth. The strands of muscle fibres and cells were separated
by broad bands of wavy fibrous tissue and small collections of
fat cells. The centre of the tumour was occupied by poorly-
staining connective tissue, interspersed with inflammatory cells
and a large number of oval and round cells with fibrillary net¬
work, some of which possibly was neuroglia. In the anterior part
of the growth was a cluster of large multinucleated giant cells
resembling the myeloplaxes or osteoclasts of bone marrow, and
apparently indicating the existence of young osseous tissue. The
tumour was richly supplied with vessels. Many of the cells
were free in the connective tissue; they stained poorly and
showed an oval nucleus with a hyaline margin of protoplasm
and shadowy ill-defined processes, and resembled degenerated
nerve cells. The presence of fully-developed muscle fibre, with
embryonic muscle cells and osteoclasts, showed that the growth
was a teratoma, and on account of its vascularity it was regarded
as a myo-angioma.

Forbes mentions a case of senile dementia described by Pick,
in which bundles of smooth muscle fibres were found in the
thickened membranes over the posterior surface of the cord.
These muscle fibres were connected by strands with the hyper¬
trophied muscle of the arterial walls.

Gowers’ 1 case of a lipoma, with striated muscle fibres
attached to the conus, is well known.

1 Gowers, Traiuadiont of the Path. Soe. of London , vol. xxvii., 1876.

682 TUMOUR MALFORMATIONS OF NERVOUS SYSTEM

I am indebted to Dr Alfred Reginald Allen for the photo¬
graphs of the tumour on the conus medullaris.

Legends.

Fig. 1.—Photograph of the brain, showing the malformation of the cerebello-
pontile angle, indicated by a line.

Fig. 2.—Photograph of the malformation on the sacral cord, indicated by a
line.

Fig. 3.—Cartilage-like substance found within the tumour.

Fig. 4.—Bony plates within the tumour.

Fig. 5.—Striated muscle fibres within the tumour.

A RAPID METHOD FOR STAINING THE MYELINS IN
NERVE FIBRES OF THE BRAIN AND SPINAL
CORD (SIMPLE FORMOL OR FORMOL SULPHATE,
FREEZING, ALUM-HJEMATEIN).

By Dr J. NAGEOTTE,

Physician to the Bicetre Hospital, Paris. 1

There are numerous methods for the staining of healthy
myeline. With the exception of Exner’s method, which does not
respond to all the requirements of pathological anatomy or
give permanent preparations, these are all more or less derived
from Weigert’s method. The disadvantage which they all have
in common is the necessity for a prolonged mordanting of the
preparations. Weigert’s rapid method does, it is true, give in a
week excellent results as regards the cord, especially if the
sections are treated with sulphate of copper, as I have indicated;
but the sections are often friable, and the method does not apply
to the brain.

The new method which I propose is based, like its pre¬
decessors, on the foundations established by Weigert, but in it
the alum-lac of haematoxylin is used without previous mordant.
By its means sections made by freezing pieces fixed in formol
may be stained in a few seconds, and thus we may have sections
of nerves, of spinal cord , and of portions of the brain the day
after autopsy, and large serial sections of the whole of the brain
may be made, without embedding, eight to fifteen days later, if we
1 Communication made to the Soci4t6 de Biologic, November 7, 1908.

A RAPID METHOD FOR STAINING MYELINE 683

have a suitable microtome. The necessity of complete fixation
before freezing must not, however, be forgotten. As any
method may be employed after formol, the technique of Nissl,
Bielschowski, and others may be used for sections from the same
block as those which are treated with the view of studying the
myeline fibres.

I shall first describe the staining technique in itself, and
then the modes of applying it to large sections of the brain.

Method .—For the nerves, spinal cord, and white matter of the
brain, fixation may be carried out in a 10 per cent, solution of
formol (containing 4 per cent, of formic aldehyde). But I have
satisfied myself that the finest fibres of the cerebral cortex are
affected by this solution, a fact which is of great importance in
view of the almost general use of formol as a fixing agent. In
order to stain the fibres of the cortex and to procure cortical
plexus as rich as those given by Exner’s method, we must add a
corrective to the solution of formol. Starting from the idea that
the density of the liquid might be a factor, I tried sulphate of
soda and obtained excellent results by means of the following
solution:—

Water ...... 900

Formol ...... 100

Sulphate of soda hydrated . . . 10-70

This solution fixes the other elements as well as the simple
solution of formol, and it does not prevent the employment of
the methods of Nissl and Bielschowski. Strong solutions have
the advantage of being slightly more dense than the brain,
which at first floats and does not lose its shape, but they have
the disadvantage of causing greater shrinkage and of fixing much
more slowly than simple formol. I do not at present know
exactly what proportion (perhaps variable) of sulphate of soda
gives the best results, but I can affirm that the addition of this
salt is useful. There is, therefore, every reason to use a sulphated
solution instead of the ordinary solution for the formolisation of
the cadaver, according to P. Marie’s excellent method, and for
the subsequent treatment of the pieces. Other salts should be
tried and compared with sulphate of soda as modifications of
formol solutions.

The sections, made by freezing, are placed in water. Before

684

DE J. NAGEOTTE

staining, any fatty matter on the surface should be removed by
alcohol For this purpose it is sufficient to spread the sections
out upon a plate and sprinkle them with alcohol In this way
their shape is not distorted. Prolonged immersion in alcohol
does not affect the staining, but it has the disadvantage of con*
tracting the sections, especially those of the cord. The finer the
pieces are, the more easily is the fat removed from them.

Staining is carried out by means of the alum-lac of
hematoxylin. The sections may be mordanted in alum and
then treated by Weigert’s hematoxylin solution, but by this
method the fibres of the grey matter are badly stained. It is
better to stain them directly in the hematein solution of P. Mayer.
During the staining process the sections should be carefully
spread out and should not cover each other. For this purpose
spread the section out on a plate, drain it, and pour over it
some drops of haematein. Then place the preparation in a warm
moist chamber for half an hour. As regards sections of the
cord, one can operate more rapidly by heating the preparation
over a Bunsen burner till it begins to steam. The section will
then be saturated in a minute. The haematein solution, which is
poured off after staining, may be kept until it is exhausted.

After being washed in water the section is differentiated in
a solution of Weigert’s stain (ferricyanide, 2*5 ; borax, 2 ; water,
100), more or less diluted, then washed and mounted in the
usual way. The sections must be well washed if the staining
is not to become faint during mounting. It may be of advantage
to add a trace of ammonia to the water in which they are
washed. Pal’s method does not give such good results.

Application to Large Sections of the Brain .—The brain,
divided into segments one centimetre thick, 1 can be perfectly
frozen and cut into sections. The most favourable temperature
is between 1° and 2°. The sections are thoroughly flexible, and
one may take them up with pincers without tearing them, and
throw them into water. They may then be again caught with
pincers or a needle, taken out of the water in a wrinkled
condition, and the little bits of rag which they then look like
are laid out on damp blotting paper and arranged in order.

1 There are special microtomes for the purpose of making this division
according to exactly parallel planes, so that the sections lost in this operation
may be very few in number.

A EAPID METHOD FOR STAINING MYELINE 685

They will not be spoiled by being kept damp, and one can thus
arrange them without any trouble in series, which may subse¬
quently be stained. These manipulations are much more rapid
than those necessitated by sections of pieces embedded in
collodion and cut under the water.

To stain these sections, they are made to float in the water,
which smoothes them out; they are then placed on a glass plate,
the fatty matter on the surface thoroughly removed, and after
having been sprinkled with absolute alcohol they are again made
to float in the water. Then they are once more placed on a
glass plate, draiued, and after a thin ring of paraffin is traced
round them by means of a hot iron, to keep it from running
away, the staining fluid is poured over them. It should be
noted that the sections become rigid and friable when they are
fully stained, but as soon as they have been differentiated they
regain their flexibility and may again be moved on the end of a
needle from one receptacle into another.

ON THE ORIGIN OF THE FACIAL NERVE.

By ALEXANDER BRUCE, M.D., F.R.C.P.E., Physician to the Royal
Infirmary, Edinburgh; and J. H. HARVEY PIRIE, M.D., B.Sc.,
Clinical Tutor in the Royal Infirmary, Edinburgh, Assistant to
the Professor of Medical Jurisprudence, University of Edinburgh.

The origin of the facial nerve has been the subject of much
investigation and of many controversies. It is long since its
alleged connection with the abducens nucleus has been disproved
by Van Gudden and Gowers (1), and since Lockhart Clarke’s (2)
view as to the inferior facial nucleus has been set aside ; but a
number of other questions, which are of interest and importance
from both the anatomical and the clinical standpoint, still remain
to be settled. The object of the present paper is to endeavour
to answer some of these, such as, for instance :—

(1) Whether all its fibres arise from the well-known main

nucleus in the pons ?

(2) Whether any of them have a crossed origin from the

corresponding nucleus of the opposite side ?

(3) Whether there is a separate nucleus for the muscles of

the upper face, viz., the orbicularis palpebrarum

686 ALEXANDER BRUCE and J. H. HARVEY PIRIE

frontalis, corrugator supercilii, and, if so, where is
it situated ?

(4) Whether there is a separate nucleus for the muscles of
the lips, and, if so, where is it situated ?

The third and fourth questions have been raised by physicians in
order to explain certain clinical phenomena which appear to be
incompatible with the assumption that all the muscles of the
face could be innervated from a common centre. The fact that
in such diseases as bulbar paralysis and amyotrophic lateral
sclerosis there is a comparative escape of the muscles of the
upper face, while the muscles of the middle and of the lower
face are profoundly involved, has suggested the possible exist¬
ence of a nucleus for the nerves of supply of the upper face
independent of the main nucleus of the facial nerve in the pons.
On the other hand, the close association which exists between
certain movements of the tongue and of the lips has led to the
view that there must be a similarly close association of their
nuclei of supply. Charcot (3) and Ross (4), following Lockhart
Clarke (2), held that the muscles of the lips are innervated from
an inferior facial nucleus, situated partly above the hypoglossal
nucleus and partly also between it and the ependyma of the
fourth ventricle ; while Gowers (1) maintains that the centre
for the lip muscles is in the upper extremity of the hypoglossal
nucleus itself.

A. With regard to the nucleus for the upper facial muscles,
Mendel (5), after section of the upper facial nerve in young
rabbits and guinea-pigs, found atrophy of the cells in the lower
part of the oculo-motor nucleus of the same side, and traced a
connection to the facial nerve through the posterior longitudinal
fasciculus. MendeUs belief that this group of cells constituted
the nucleus for the upper facial nerve, apparently so completely
solved the difficulty of the clinician that there has been a
tendency to accept its existence as an independent nucleus
without further sufficient proof. The remarkable immunity of
the upper facial muscles in bulbar paralysis and in amyotrophic
sclerosis, even where there is a high degree of paralysis of the
lower face, has from the first been difficult to explain, and it has
seemed essential to premise the existence of a nucleus altogether
independent of the facial nucleus and escaping the degeneration

ON THE ORIGIN OF THE FACIAL NERVE 687

in which the latter is involved. Mendel’s discovery seemed to
supply the long-sought explanation. The clinician could now
understand (or think he understood) why the nucleus of the
facial nerve could suffer so severely and yet the middle and
lower face alone be paralysed. The'upper face escaped because
its nucleus, far away from the main nucleus, was not involved in
its degeneration.

There is reason to think, however, that the immunity of the
upper facial muscles is not always so complete as from a mere
examination of the position and movements of the eyelids it
would appear to be. There is not infrequently a degree of
paresis of the orbicularis with a greater or less dilatation of the
palpebral aperture, and even when this dilatation is not apparent,
there may be a considerable degree of paresis as evidenced by the
reaction of degeneration in the muscles of the upper face. We
have recently, in a case of amyotrophic lateral sclerosis, had
occasion to demonstrate a reduction to a nearly equal degree of
the electrical reactions in the upper and lower face muscles, in
which there did not seem on inspection to be any paresis of the
upper face; and we would draw attention in this connection to
the condition of the eyelids and their electrical reaction noted in
the remarkable case of diplegia facialis published in this review
by Drs Fowler and Rainy (6), and which will be again referred
to in another relation. They note that their patient, a child of
ten months old, showed nothing particularly wrong with its eye¬
lids before entering hospital; that during the few days of its
stay in hospital before its death the lids could not be voluntarily
shut very tightly, but that they covered the eyeballs fully during
sleep. In spite of this the electrical responses were at first very
feeble and subsequently absent altogether. The entire escape
of the upper facial muscles is thus, in our opinion, more often
apparent than real. Indeed, we venture to doubt if in any case
in which there is advanced degeneration of the muscles of the
lower face, the electrical examination of the muscles of the upper
face will fail to show some degree of reaction of degeneration.
It is also a remarkable fact that degenerations of the oculo¬
motor nuclei do not appear to be associated with paresis or
paralysis of the upper face, as would almost certainly be
frequently the case if the nucleus for the latter formed part of
the oculo- motor nucleus, as stated by Mendel.

<588 ALEXANDER BRUCE and J. H. HARVEY PIRIE

Wilbrand and Saenger (7), in their valuable work on the
neurology of the eye, summarise the evidence in favour of
Mendel’s view. It is not very convincing.

(a) Obersteiner (8) found that after destruction of one oculo¬
motor root the posterior (of inferior) part of the corresponding
-oculo-motor nucleus was intact. It does not, however, necessarily
follow that the part of the nucleus which has escaped is Mendel’s
centre for the upper face muscles. It is now a well-recognised
fact that some of the fibres of the oculo-motor root have a
crossed origin from the lower part of the nucleus of the other
side. Therefore it is practically certain that division of one
oculo-motor root would necessarily leave untouched those cells
of the nucleus which are the centre for the fibres crossing from
the undivided nerve of the other side. In support of this view
we have the discovery by Siemerling and Boedeker (9) that a
unilateral paralysis is followed by a degeneration in the anterior
part of the nucleus of the same side, and by a bilateral paralysis
in the distal—that is, the posterior or inferior part of the
nucleus.

( b ) The clinical evidence quoted by Wilbrand and Saenger (7)
is as follows :—Hughlings Jackson described three cases of
ophthalmoplegia externa associated with involvement of the or¬
bicularis palpebrarum. Turner observed a case of nuclear oph¬
thalmoplegia, with paresis of the upper facial muscles. Meyer
has described an analogous case. Woods mentions a case of
ophthalmoplegia externa with ptosis, in which there was a
weakness of both orbiculares palpebrarum. Smith found in a
case of total ophthalmoplegia a participation of the frontalis and
orbicularis palpebrarum. Fuchs, in a case of bilateral ptosis,
found also weakness of the frontalis muscles. Hanke noted in
a case of bilateral ophthalmoplegia externa, which was either of
congenital origin or dated from earliest infancy, that at a later
period ptosis and paralysis of the frontalis appeared. Birdsall in
a case of external ophthalmoplegia observed a diminution of the
electrical excitability of the upper division of the facial nerve.

Such evidence, in the absence of control by post-mortem
examination, must be regarded as merely suggestive. It is
obvious that by the law of probability such associations of symp¬
toms may occasionally arise without their being dependent on
lesions of a single centre. There is nothing in the clinical

ON THE ORIGIN OF THE FACIAL NERVE 689

history of those cases to exclude multiple lesions either of similar
or of different kinds ; that is to say, there may have been more
than one nuclear lesion or more than one peripheral lesion, or
nuclear and peripheral nerve or muscle lesions may have been
associated together.

On the other hand, Wilbrand and Saenger quote a case
carefully examined by Cassirer and Schiff (10), in which, with
complete degeneration of the oculo-motor nucleus, even in its
posterior segment, the function of the upper facial nerve was not
in any way interfered with, and they note, without, however^
giving cases, that Bernhardt (11), Sauvineau (12), and Siemer-
ling (13), have stated categorically that they have found the
upper facial nerve intact in nuclear ophthalmoplegia. Siemerling
and Boedeker (9), after a series of exhaustive microscopical
examinations of cases of progressive ophthalmoplegia, have
arrived at the conclusion that there is no evidence whatever that
the oculo-motor nucleus has any connection with the muscles supplied
by the upper facial.

Wilbrand and Saenger, while admitting that the question of
the upper facial nucleus is not yet settled, are inclined, on the
strength of their own observations, to agree with Cassirer and
Schiff, Siemerling and Boedeker, etc., in their opinion.

More recently the question has been attacked from another
side—namely, from the study of the reaction h distance (or axonal
reaction), which follows in the cells of origin of a nerve when its
continuity is interrupted. 1

Marinesco (15) in 1898 divided the branch to the frontalis,
orbicularis, and corrugator supercilii, and found a degeneration in
the inferior part of the facial nucleus, and in the posterior part
of its median nucleus. Section of the inferior facial produced
degeneration in the external group of the facial nucleus. Com¬
plete division of the facial nerve caused axonal reaction in all
the cells of the facial nucleus. 2

1 This method is calculated to giro reliable data when the subsequent examination
of the nerve centres is made at a sufficiently short interval after the initial section
or destruction of the nerve. It is not of value, however, when an interval of many
months, and still less of many years, has elapsed; therefore, such oases as
Oianelli’s (14), where the frontal branch of the facial nerve was divided fifty years
before death, must be set aside.

2 Marinesco has shown that the common facial nucleus varies in its outlines at
different levels of its course, and slightly also according to the animal used. In the

€90 ALEXANDER BRUCE and J. H. HARVEY PIRIE

Koteiewski (16), after experimental section of the upper
branch of the facial, found degeneration in the dorso-lateral
portion of the facial nucleus. This in all probability corresponds
to the dorsal portion of the middle group of Marinesco, as the
dorsal nucleus seems rather to lie behind the outer than the
middle group (see Van Qehuchten’s Fig. 487).

Parhon and Nadejd^ (17) examined a case of cancer involv¬
ing the superior facial, and found that what they term the first
dorsal group 1 showed cells which were greatly atrophied. (The
second and even the third dorsal group also showed less marked
changes, which they regarded as due, in some measure at least,
to lesions of nervous filaments which do not form part of the
superior facial. They describe as belonging to the facial nucleus
a group, also described by Wyrubow (18), situated between the
common nucleus of this nerve and the nucleus of the sixth
pair. They regard this group as the centre of the occipital
muscle.)

Parhon and Minea (19) found that the nucleus of the
upper facial nerve is represented by the first dorsal group of
the nucleus of the seventh pair. They state categorically that
the oculo-motor nuclei, including that portion which is situated
in the depression of the posterior longitudinal fasciculus, do not
send fibres into the trunk of the facial nerve.

All these observers, therefore, are unanimous that the origin
of the upper facial is situated within the facial nucleus in the
pons, and apparently in its dorsal part.

With regard to the origin of the nerve to the orbicularis
oris, it is now universally admitted that the inferior facial
nucleus of Lockhart Clarke (2) has no connection with the facial
nerve; but the view of Gowers (1) as to the upper part of the
hypoglossal nucleus constituting such a centre has met with
wide acceptance. He has brought forward strong arguments in
its support. He says : “ The orbicularis oris and the transverse

middle of its length three cell groups—internal, middle, and external—can be
distinguished. The middle group is again sub-divided into an anterior and
posterior segment. At the upper and lower extremities of the nucleus the groups
become reduced to one. (For illustration, see Rev. Neurol ., 1898, p. SO ; also Van
Gehuchten, Anat. du System* Neroeux , 4me ed., pp. 589 to 591; and Quain’s
“Anatomy,” 11th ed., Vol. iiL, Part i., p. 152.)

1 The reference in the Rev . Neurol . does not give figures, so that it is not quite
clear what the authors mean by the first, second, and third dorsal groups.

ON THE ORIGIN OF THE FACIAL NERVE 691

muscles of the front of the tongue have a functional relation
closer, perhaps, than any other two muscles in the body equally
distinct. Neither can be put in action without the other. The
orbicularis is always involved in degenerative disease of the
hypoglossal nucleus, and escapes in disease of the chief nucleus
of the facial, as in a case of acute atrophic paralysis in which
the face was involved.” . . . “ Considerable degeneration has
been found in the fibres of the ‘ loop ’ of the facial nerve, even
when the cells of the chief facial nucleus were but little affected
—a mysterious fact. The posterior longitudinal fibres may be
normal or partly degenerated (in proportion, it is said, to the
affection of the hypoglossal nucleus) ; especially the longitudinal
fibres suffer in the inner part of the reticular formation which
are supposed to continue the anterior ground fibres of the cord.
The degeneration is always bilateral.”

Illustrations of the possible path from the hypothetical
centre in the hypoglossal nucleus have been given by one of us
(A. B.) (20), by Ferrier (21), and by Purves Stewart (22), who,
in his valuable work on the “Diagnosis of Nervous Disease”
states that the facial nerve arises from a nucleus in the lower
part of the pons, but derives some of its fibres, namely, those
for the orbicularis oculi, from the nucleus of the 3rd nerve, and
others, namely, those for the orbicularis oris, from the hypo¬
glossal nucleus. 1 On the other hand, however, Oppenheim (23),
while figuring the connection from the 12 th nucleus to the
8 th nerve, regards it as being very improbable.

If it is the case that the nerve to the lower face arises from
the hypoglossal nucleus, it must, as Gowers states, undergo
degeneration in disease of the hypoglossal nucleus. A complete
destruction of one hypoglossal nucleus should cause paralysis of
the lips as well as the half of the tongue on the same side.
The converse must also follow, that a section or destruction of
the nerve of such a character as to produce reaction d distance
in the main facial nucleus of the pons must also produce
reaction d distance in that portion of the hypoglossal nucleus
in which the lip muscle fibres take their origin. A case, there-

1 Dr Purves Stewart, in the second edition of his book, which has just appeared,
has modified this statement, saying that the cells for the orbicularis oculi extend as
high as the nucleus of the third nerve, and those for the orbicularis oris as low as
the hypoglossal nucleus.

692 ALEXANDER BRUCE and J. H. HARVEY PIRIE

fore, of complete facial paralysis in which there was total
reaction of degeneration in all the muscles of the face would be,
if examined sufficiently early, adapted to prove or disprove the
alleged association. If it be found that the facial nucleus is
alone involved, and the hypoglossal nucleus quite intact, that
would be indisputable proof that the hypoglossal nucleus has no
connection with the facial nerve. On the other hand, if the
facial nucleus were degenerated, but a portion of the hypoglossal
nucleus were also similarly affected (the hypoglossal nerve being,
of course, in a normal condition), then the presumption would be
very strong, or the proof even absolute, that the lip-facial
muscles arose from the hypoglossal nucleus.

Similar reasoning would serve to prove or disprove the
origin of the upper facial nerve from the oculo-motor nucleus.

The opportunities for clinical observation of such cases and their
confirmation by autopsy are exceedingly rare, and therefore the
question has remained for a long time in doubt; but we are in a
position to describe a case which has been under the charge of
one of us (A. B.) during life, and in which the medulla and pons
have been examined microscopically by both of us after death, and
which appears to us to justify the conclusion that the facial nerve
has no origin in either the oculo-motor or the hypoglossal nucleus.

Clinical Case .—A M., 65, harbour-master; recommended by
Dr Dickson of South Queensferry; admitted to the Royal
Infirmary, Edinburgh, in February 1908.

Abstract of Notes of History and Examination, as made by
Drs Hugh More and W. Kelman Macdonald:—Sudden onset on
1st December 1907, with pains all over his body. Fourteen
days later development of giddiness, which gradually increased,
producing great uncertainty in walking, with fear of falling and
tendency to sway towards the right side, without, however, any
actual fall. Simultaneously there developed deafness, with buzzing
noises in the left ear, the deafness in a short time becoming
absolute. Also left facial paralysis. No headache. No other
sensory or motor disturbances.

Previous history was satisfactory, except that his left eye was
removed thirty years before for “some inflammatory trouble.”
Otherwise there was no personal or hereditary taint.

Examination of the face showed a complete left facial
paralysis, the left forehead being smooth and immobile, the left

ON THE ORIGIN OF THE FACIAL NERVE 693

eyebrow lower than the right, and the aperture of the mouth
having the characteristic obliquity. The mouth was somewhat
drawn to the right side. The palpebral aperture, owing to the
absence of the eye, was only slightly open. None of the muscles
of the face were capable of any voluntary or reflex movement.
There was no response to faradic stimulation. On galvanic
stimulation of the muscles a slow and feeble contraction was
obtained, but the cathodal closing contractions remained slightly
stronger than the anodal closing contractions. The tongue was
protruded without lateral deviation. The sense of taste was
equally well conserved on both sides of the tongue. The
examination of the ear by Dr Logan Turner showed no evidence
of any middle-ear catarrh, past or present.

Closer examination of the nervous system showed nothing
abnormal, with the exception of some defect of sight in the
right eye, associated with an increased depth of the anterior
chamber, tremulousness of the iris and hippus. There was no
optic neuritis. The movements of the right eye were unimpaired.
The stump of the excised eye-ball was capable of a little move¬
ment which was communicated to the eye-lids.

The superficial and deep reflexes were normal, the plantar
reflex being of the flexor type on both sides.

Further examination revealed evidence of chronic tuberculosis
in the upper part of both lungs, some dilatation of the heart,
especially in its left ventricle, with a stenosis of the mitral
orifice. The heart’s action was somewhat irregular, the pulse
tension low, the arteries tortuous and their walls thickened and
beady. The urine showed a specific gravity of 1014, but it was
otherwise normal. There was some evidence of rheumatoid
arthritis in the hands, feet, and hip. There was also a reducible
left femoral hernia and some tendency to varicose eczema in his
lower limbs.

Diagnosis was made of neuritis of the facial and auditory
nerve in the internal auditory meatus. The absence of evidence
of middle-ear catarrh and the retention of the sense of taste
and the association of deafness, giddiness, and facial paralysis
indicated that the lesion was probably situated between the side
of the pons and the bottom of the internal auditory meatus.
The completeness of the facial paralysis was evidence of a total
involvement of the facial nerve.

3 D

694 ALEXANDER BRUCE and J. H. HARVEY PIRIE

Subsequent Progress. —The patient, who was treated with
rest and iodide of potassium, regained strength to a considerable
extent, but did not recover from his giddiness, and died suddenly
from heart failure on 2nd May 1908.

Autopsy. —The autopsy revealed general fibrous adhesions
of pleura, chronic interstitial pneumonia in the upper halves of
both lobes, the remainder of the lung showing chronic venous
congestion with oedema. The heart was soft and flabby, with
fatty infiltration, especially on its right side, dilatation of all its
chambers without hypertrophy of the walls except to a slight
degree in the left auricle. The mitral valve was dilated, with
some thickening of its cusps. The tricuspid valve was also
dilated. There was diffuse epicardial thickening, with localised
“ milk-spots ” towards the apex of the left ventricle anteriorly
and posteriorly over the lines of the vessels. There was exten¬
sive fatty infiltration of the wall of the greatly dilated right
ventricle. Both coronary arteries were thickened and showed
atheromatous patches. The aortic cusps were dilated, with
thickening along their attachments and towards the corpora
Ar&ntii. The left ventricular wall was thin, friable, soft and
fatty, the papillary muscles being fibrous towards their tips.
The liver and kidneys showed a marked degree of chronic
venous congestion, the kidneys also showing atrophy of the
cortex, increase of pelvic fat, and some chronic interstitial
nephritis.

The left optic nerve was atrophied, and the left 3rd, 4th, and
6th cranial nerves were somewhat thinned. There was some
slight milky thickening of the arachnoid over the inferior sur¬
face of the cerebellum and between the lobes; also to a slight
extent over the circle of Willis, and extending 1 $ inches in
front of the optic chiasma to near the tips of both temporal
lobes.

The brain was carefully hardened in formalin. The pons
and medulla were embedded in paraffin, and serial sections were
cut of the whole length of the facial, oculo-motor, and hypoglossal
nuclei. These were stained throughout with Unna's polychrome
blue and by Van Gieson’s method.

Within the pons the facial nucleus of the same side teas com¬
pletely affected ; not a single cell teas found to be normal. The
nucleus itself showed a considerable diminution in the number

ON THE ORIGIN OF THE FACIAL NERVE 695

of its cells. Those that remained had all reached the stage of
atrophy, still showing a well-marked axonal reaction, with
eccentric nuclei, chromatolysis, and more or less convex outline.
Many of them also contained large masses of yellowish pigment
granules. 1

On the other hand , there was no degeneration whatever in the
facial nucleus of the opposite side. Its cells were without exception
healthy. Many of them contained some yellow pigment, hat apart
from that , the Nissl's granules and the position and character of
the nuclei were quite normal. It is hardly possible to conceive a
more positive demonstration that none of the fibres of the facial
nerve arise from the nucleus of the opposite side. Had it been
otherwise we should have found normal cells in the de¬
generated nucleus, as well as degenerated cells in the opposite
nucleus.

A similar examination of the hypoglossal nuclei demonstrated
that their component cells were throughout quite intact. Here and
there a cell showed some slight degree of pigmentation, but that
was perfectly explainable by the age of the individual. Apart
from that, the cells were well formed, their Nissl’s granules
everywhere presented their normal characters, and the nucleus
occupied its normal position.

On examining the oculo-motor nuclei, no distinction could be
made out between the two sides. Notwithstanding the removal of
the eye-ball, and the resulting comparative inaction of the
muscles, there was no indication of any change in the character
of the cells on the affected side. Their nuclei were invariably
central, their form normal, and their Nissl’s granules stained with
great distinctness. The nuclei on both sides were searched from
end to end, and in no part was there any evidence of degenera¬
tion. The sections were submitted to several other workers in
the Neurological Laboratory, and they likewise failed to find any
difference between the two sides.

We might again refer to Drs Fowler and Rainy’s (6)
case of cerebral diplegia, in which they found, in what was
practically a complete bilateral facial paralysis, that there

1 Almost midway between the main nucleus and the abducens nucleus a small
group of motor cells, described by Wyrubow (18), was found to be atrophied on
the affected side and normal on the other. They thus evidently belong to the
facial nerve.

696 ALEXANDER BRUCE and J. H. HARVEY PIRIE

was no abnormal change in either the oculo-motor or the hypo¬
glossal nucleus, and no degeneration in the posterior longitudinal
fasciculus.

Conclusions :—

1. That the upper facial nerve does not arise from the oculo¬
motor nucleus.

2. That the lip-facial fibres do not arise from the hypo¬
glossal nucleus.

3. That there is no crossed origin of the facial nerve from
the main nucleus.

4. That no crossed origin for any of the fibres has yet been
discovered.

5. That all the fibres of the facial nerve arise from the
groups of cells in the pons which lie behind the superior olive,
and are known generally as its main nucleus—these groups
being regarded as including the small accessory group situated a
little behind it (Wyrubow), i.e. nearer to the abducens nucleus.

6. That the upper facial nerve probably arises from the
dorsal part of the nucleus.

7. That further localisation of function of the nucleus has
not yet been clearly established.

Literature.

1. Gowers. “ Diseases of the Nervous System,” vol. ii., pp. 563, 570.

2. Lockhart Clarke. Phil. Trans., 1868.

3. Charcot. Arch, de Physiol., 1870, p. 247.

4. Ross. “ Diseases of Nervous System,” 2nd edition, voL i., p. 794.

5. Mendel. Neurol. Centralbl., 1898, p. 537.

6. Fowler and Rainy. Rev. Neurol, and Psychiat., vol. i., p. 149.

7. Wilbrand und Saenger. “ Die Neurologic des Auges," Wiesbaden,
1900.

8. Obersteiner. “The Anatomy of the Central Nervous Organs” (Hill’s
Translation), p. 225.

9. Siemerling und Boedeker. Arch. f. Psychiat., Bd. 29, pp. 744 and 452.

10. Cassirer und Schiff. Arb. a. d. Institut. f. Anat. «. Physiol, des Central-
nervmsystems, Wien, 1896, p. 110.

11. Bernhardt Neurol Centralbl., 1894, p. 1.

12. Sauvineau. “ Pathog^nie et Diagnostic des Ophthalmoplegics,” Thke
de Paris, 1892.

13. Siemerling. Arch./. Psychiat. and Neurol., xxii. Supplementband.

14. GianellL Riv. di Patol nerv. e merit., vol. xi., 1906.

16. Marineaco. Rev. Neurol., 1898, p. 30 ; Presse mid.. No. 66,1899, p. 85.

ON THE ORIGIN OF THE FACIAL NERVE 697

16. Kotelewski. Dissert, Warschau, 1901 (Ref., Neurol. Centralbl., 1902,

p. 160).

17. Parhon and Nadejd4. Riv. Stuntelor. Tried., vol. ii., No. 2, 1907, p. 204
(Ref., Rev. Neurol., 1907, p. 1033).

18. Wyrubow. Neurol. Centralbl., 1901, p. 434.

19. Parhon and Minea. Presse mid.. No. 66, 1907, p. 521.

20. Alexander Bruce. “ Illustrations of the Mid and Hind Brain,” 1892.

21. Ferrier. Brit. Med. Journ., 1893, vol. ii., p. 724.

22. Purves Stewart “Diagnosis of Nervous Diseases,” 1906, p. 121.

23. Oppenheim. “ Lehrbuch fur Nervenkrankheiten,” 5th edition, p. 561.
See also Alexander Bruce. “ Contribution to the Question of the Origin of
the Facial Nerve,” Scot Med. and Surg. Joum., Nov. 1898. Tsuchida, “Uber
die Unprungskerne der Augenbewegungsnerven, etc.” (Arb. a. d. himanatom
Institut. in Zurich, H. 2, 1908).

Hbstvacts

ANATOMY

DESCRIPTIONS OF THREE CHINESE BRAINS. (Presented by

(605) Dr F. W. Mott, F.R.S., to the Museum of the Royal College
of Surgeons.) Part II. E. H. J. Schuster, Joum. Ami. and
Physiol., Oct. 1908, p. 59.

This is a description of Brain No. II. The principal fissures are
first described, and there follow (a) the principal sulci, and ( b ) the
gyri and the remaining sulci in each of the lobes of both hemi¬
spheres. The position, length, and characters of the fissures; the
position, shape, and dimensions of the gyri, and the peculiarities
of both are given. Photographs of the various aspects of both
hemispheres, with outline tracings of sulci and gyri, accompany
the text. E. B. Jamieson.

BRAIN MATTER. (Tiber die Himmaterie.) M. Reichardt,

(606) MoruUsschr. f. Psychiair. u. Neur., Oct. 1908, Bd. 24, S. 285.

After deploring the disappointing results of brain histology in
psychiatry, the author discusses at great length the possibility of
discovering physical differences in the brain by non-microscopical
methods, in particular by careful weighing. He summarises in
this preliminary communication the various problems he has set
himself to study by this means. Ernest Jones.

698

ABSTRACTS

THE ANATOMY OF THE PROJECTION FIBRES OF THE OOOI
(607) PITAL LOBE. (Znr An&tomie der Projections- und Balken-
str&hlang des Hinterhauptlappens sowie des Oingulums.) Van

Valkenburg, Monatsschr. f. Psychiatr. u. Neur., Oct. 1908,
Bd. 24, S. 320.

This is a careful description of a case of thrombotic softening,
with a detailed consideration of the lessons taught by the suc¬
ceeding degeneration. The author concludes that the geniculo-
cortical radiation in its occipital portion is confined to the inferior
longitudinal bundle. In contradistinction from Beevor, he main¬
tains that the lateral portion of the cingulum is occupied by fibres
having a fronto-caudal course. Ernest Jones.

ON THE FIRST PHASES OF THE DEVELOPMENT OF THE
(608) NERVE CENTRES IN THE VERTEBRATES. (Sulle prime
Cues dello sviluppo del centri nerroai nei vertebrati.) V.

Bianchi, Ann. di Neurol ., Fasc. 1-2, 1907.

The existence of spongioblasts, first shown by Golgi and His, has
since been confirmed in the work of many writers. Opinions
have differed as to the origin and mode of growth of what has been
generally recognised as a supporting tissue.

The author deals with experiments performed by himself on
the developing chick. He finds that the osmium bromide, the
osmium bichromate, and osmic acid solutions, are greatly superior
to all others. He obtained the best results with safranin, magenta
red, and magdala red.

Two types of cells in the elements which form the medullary
canal were distinguished in the earliest stages of development—
the one consisting of elongated cells in contact with the internal
and external surfaces of the tube, and the other of round cells
with little protoplasm round the nucleus. The former he calls,
with His, spongioblasts; the latter, neuroblasts.

As regards the position of the spongioblasts—many are
situated under the meningeal surface, and send inward a long
process that loses itself on the surface of the central canal, and a
short prolongation to the external surface that frequently branches
on reaching the meningeal surface.

According to the author the neuroblasts, besides becoming
transformed into nerve cells, and contributing to the formation of
the neuroglia, undergo frequently karyolysis. This phenomenon

ABSTRACTS

699

may be witnessed on a large scale throughout the nervous system,
and is to be regarded as a process of selection. It is possible that
this material arising from nucleolysis may be utilised by other
elements which go to constitute the nervous system.

F. Golla.

THE CUTANEOUS BRANCHES OF THE POSTERIOR PRIMARY
(609) DIVISIONS OF THE SPINAL NERVES AND THEIR DIS¬
TRIBUTION IN THE SKIN. Henry M. Johnston (Dublin),
Joum. Anat. and Physiol ., Oct. 1908.

The writer of the paper has made a number of complete dissections
of these nerves, and draws conclusions based upon his work
regarding their origin, course, and distribution in the skin. He
shows that contrary to what is generally stated a variable number
of external branches from these nerves arising high up in the
thoracic region succeed in reaching the skin. Though small in
size, these filaments may travel a very long distance through the
deep structures before becoming cutaneous, and supplying an area
of skin which lies to the outer side of, or sometimes below, the
area supplied by the internal branch from the same spinal nerve,
yet is contiguous with it. The long course which the cutaneous
nerves of the back take amid the muscles and fascia is clearly
shown in the plates accompanying the paper, this course being
in all cases more or less curved. The remarkable plexus on the
back of the sacrum formed by the posterior primary divisions in
this region is described.

It is interesting to compare the figures given to illustrate the
areas of skin supplied by the individual branches of the posterior
primary divisions of the spinal nerves as determined by dissec¬
tion with those obtained clinically. A comparison with Head’s
figures shows that there is considerable agreement. Owing,
however, to variations in origin in the lower cervical and upper
thoracic regions, and to the free communication found between the
nerves in their deep course, such pictures showing the areas of
skin distribution obtained by clinical and dissecting-room methods
must of necessity show some differences. The tracing of fine
nerve fibrils into the skin presents obvious technical difficulties
which one can hardly hope to entirely overcome. The paper is
illustrated by drawings in the text and three plates in colour.

Author’s Abstract.

700

ABSTRACTS

▲ METHOD FOR THE RAPID AND EAST DEMONSTRATION
(610) OF THE INTERNAL RETICULAR APPARATUS OF
NERVE CELLS. (Use mlthode pour la prompte et facile
demonstration de l’appareil rdticnlaire interne des cellules
nerrenses.) Golgi, Arch. ital. de Biol., T. 49, F. 2, Sept. 1908,
p. 269.

The peculiarity of the structure in nerve cells, which the writer
has described as “the internal reticular apparatus,” has not
received the attention it deserves, because, till now, there has not
been a method to demonstrate it rapidly and correctly. Many
writers still regard it as hypothetical. Others identify it with
different structures, which have nothing in common with it.
Holmgreen has identified it with structures which he describes
under the name of “ trophosponges.” And still more remarkable,
Cajal has identified it also with Holmgreen’s trophosponges,
referring to these two different organisations by the name of the
“ Reticular Apparatus of Golgi-Holmgreen.” Others have followed
in the same line.

Apart from the fundamental difference between the interpre¬
tation which Golgi has given to his reticular apparatus and that
given by Holmgreen to his trophosponges, a glance at the figures
of the two writers will exclude the possibility of identification.

With the method which Golgi now gives, this structure is
revealed in almost all the ganglion cells of the nervous system
(specially the intervertebral ganglia) hitherto studied.

The method is merely a modification of the photographic one
used by Cajal and others. The most important point is the
fixation of pieces—both as regards composition of the fixing fluid
and duration of immersion in it.

1. Fixing mixture—Formaline (20 per cent, solution), 30 gr.

Saturated sol. of arsenic acid (very pure,
about 1 per cent.), 30 gr.

Alcohol of 96°, 30 gr.

Leave in this six to twenty-four hours.

Best results in pieces left in solution six to eight hours.

When fixing prolonged, one finds gradual modifications of the
reaction, up to cessation of all elective reaction on reticular
apparatus.

2. Pass into 1 per cent, solution of nitrate of silver.

Leave in this one to three hours. Longer immersion, even
for several days, does not prevent good results.

3. Wash rapidly in distilled water.

Then develop in usual photographic solution (Golgi uses hydro-
quinone, 20 gr.; sulphate of soda, 5; formalin, 50 ; water, 1000)

ABSTRACTS

701

In a few minutes superficial parts show reaction; in some
hours development will have taken place through all the portions
of tissue.

4. Wash pieces again with distilled water; harden in alcohol;
this may be rapidly done.

5. Plunge into solution prepared at the moment, by mixing the
two following:— Sol. A. —Hyposulphite of soda, 30 gr.; sulpho-
cyanide of ammonium, 30 gr.; water, 1000 gr. Sol. B .—Chloride
of gold, 1 gr.; water, 100 gr.

Sections, whether embedded in paraffin or celloidin, may be
left exposed to action of this bath (in a watch glass) for a number
of minutes, which we cannot pre-determine, for there are marked
differences in different cases; the process should be watched, and
stopped when sections have a marked grey colour.

6. Following operations are important, because they give more
relief to various parts of tissue and demonstrate them distinctly:—

(a) Wash repeatedly in distilled water.

(b) Pass rapidly into following solution—

Permanganate of potassium, 0 50 gr.

Sulphuric acid, 1 gr.

Distilled water, 1000 gr.

(This operation should be watched, so that decolorisation is not
excessive.)

(d) Stain with alum-carmine, and then wash.

(e) Pass through alcohol and mount in balsam.

Alexander Bruce.

CONTRIBUTION TO THE STUDY OF THE CELLS OF THE LOCUS
(611) CCERULUS AND SUBSTANTIA NIQEA. (Beitrag zum
Stadium der Zellen des Locus coeruleus und ddr Substantia
Nigra.) Guiseppe Calugaris, Monatsschr. /. Psychiatr. u. Neur.,
Oct. 1908, Bd. 24, S. 339.

After a brief description of the common yellow pseudo-pigment,
the author describes the rarer, black, true pigment. His contrast
between the two deserves quotation :—

Yellow Pigment. Black Pigment.

1. Begins usually, at the sixth year, Appears constantly in the first year,

in the spinal ganglia. The time first in the locus coeruleus.
of appearance is inconstant.

2. Found in all nerve cells (rarest in Found exclusively in certain areas

Purkinje’s). Shows great indi- (locus coeruleus, substantia nigra,
vidual variation. vagus nucleus, spinal ganglia).

Similar in all individuals.

702

ABSTRACTS

Yelloto Pigment. Black Pigment.

3. Increases with age, and is related Does not increase with age, and is not

to various pathological processes related to any pathological process,
(poliomyelitis, paralysis, etc.).

4. At times gives fat reaction. Never any fat reaction.

5. Manifold staining reactions. Stains only with great difficulty.

6. Also found in animals. In above-mentioned localities is found

only in man.

7. Single foci are small, spherical, and Foci are larger, only irregularly

yellowish. spherical, and darker.

Besides the black pigment, which the author maintains is
identical with melanin, yellow pigment and also, though far
rarer, Marinesco’s erythrophilic, paranuclear pigment were found
in the cells of the locus cceruleus. The neurofibrils pierce the
melanin masses, instead of encircling them as they do the pig¬
ment masses in senility or in amaurotic idiocy. The author regards
all these pigments as being physiological metabolic products of
past cellular activity. Ernest Jones.

PHYSIOLOGY.

THE COORDINATION OF SINGLE MUSCULAR MOVEMENTS
(612) IN THE CENTRAL NERVOUS 8YSTEM. C. E. Beevob,

Joum. Amer. Med. Assoc., July 1908.

The co-ordination of single muscular movements is, in this paper,
considered under four headings: (1) prime movers; (2) synergic
muscles ; (3) fixation muscles ; (4) antagonists. The writer points
out that in every movement the prime movers contract in a
regular orderly sequence, and that the muscles successively come
into action, adding to their number according to the amount of
work that is required to be done. Relation between the prime
movers and the synergic muscles is very close, and it seems im¬
possible to contract one without the other. Moreover, if a prime
mover be weakened by a peripheral neuritis, the brain has no
power to moderate the impulse sent to the synergies to make
them act proportionately to the weak prime movers. It is pointed
out that if a prime mover be paralysed, the patient has no power
to contract a muscle which is in the secondary position of a
fixation muscle, although he can do so when that same muscle
is used as a prime mover.

The relaxation which takes place in an antagonistic muscle
during the performance of a movement may be, as suggested by
the author, of great practical use in two ways: (1) When difficulty
is experienced in getting a patient to relax a given muscle, a sub¬
jacent joint or other structure can be easily examined by getting

ABSTRACTS

703

the patient to use the muscle as an antagonist, when it will be
relaxed; (2) relaxation of the antagonists, which should normally
occur, does not do so in many cases of functional paralysis, and
the author considers this to be a symptom of functional disease
as opposed to organic.

As to where, in the central nervous system, all these co¬
ordinations of single muscular movements take place, the author
considers that all the evidence is in favour of the linkage of the
ultimate constituents of a movement being in the spinal cord.

W. Kelman Macdonald.

STUDIES ON SENSORY CONDUCTION IN THE SPINAL CORD
(613) BASED ON CLINICAL AND PATHOLOGICAL CON¬
SIDERATIONS. (Studien fiber die sensible Leitung im
menscblichen Ruckenmark anf Grand klinischer and path-
ologisch-anatomischer Tatsachen.) H. Fabritius, Sonderab-
druek. a. d. Path. Instil, d. Uttiv. Helsingfors, Bd. 2, Hft. 1.
Karger, Berlin, 1907.

This study is based on two cases of cord injury (one with sectio)
and the analysis of a large number of cases collected from various
sources, all of which are given in tabular form. A translation is
here given of the conclusions arrived at by the author:—

1. Mechanical stimulation of the skin originates a conduction
stream which travels by two distinct paths in the spinal cord.
Our sensations of touch and pressure arise through the simul¬
taneous action of these two components on the brain cells.

2. One of these components is represented by conduction
through the posterior columns, the other through the contra¬
lateral path.

3. Both touch and pressure sensations are conveyed by the
first path, but the resulting sensation is lacking in tone.

4. This arises through the agency of the second component,
which, indeed, calls forth the whole scale of sensibility from the
faintest touch to the most severe pain.

5. Under certain conditions this component may become
abnormally active relatively to the stimulation applied, and the
tone of the resulting sensation will be unusually strong (hyper¬
esthesia).

6. This hyper-activity probably arises through an increased
reaction on the part of those posterior horn cells from which the
tone-carrying contra lateral paths arise.

7. The causes of this alteration are various. Sometimes it is
a general toxemia, or more frequently transverse lesions (injuries,
hematomyelia, etc.), by which the fragile posterior horn cells are

704

ABSTRACTS

suddenly torn out of their original relationships in the nervous
system, especially their relationships with higher parts.

8. This isolation arises principally from lesions in the region
of the cross pyramidal tracts. J. H. Harvey Pirie.

THE SATE OF TRANSMISSION IN HUMAN MEDULLATED
(614) NERVE. (Tiber die Leitungsgeschwindigkeit in den nuurk-
haltigen menschlichen Nerven.) Piper, Pfliiget's Arehiv,
Bd. 124, 11 and 12 Heft, 1908.

Attempts to measure the rate of transmission in human nerves
have been made in various ways.

Helmholz measured the difference between the reaction times
when stimulation is applied to points on the skin near to and
distant from the central nervous system. By this method the
rate of transmission in sensory nerves was found to be 60 metres
per second, but the reaction time is very variable and the method
uncertain.

More exact measurements are made by recording the con¬
traction of the thumb muscles when stimulation is applied over
the median nerve at two points successively. The rate has been
found to alter with the temperature. Figures ranging from 17 to
87 metres have been given by observers who have recorded the
contraction of muscles.

In the present research, the difference between the latent
periods of the electrical reaction of the flexor muscles of the fore¬
arm was measured on stimulation of the median nerve by break
induction shocks from the cathode of an induction coil.

The recording instrument employed was the small model of
Einthoven’s string galvanometer constructed by Edelmann.

The median nerve was stimulated at two points: (1) 5 cm.
above the internal condyle of the humerus, and (2) in the axilla.
The two points were distant about 16 to 17 cm.

The string of the galvanometer is affected by the stimulating
shock through current escape or induction, and the author makes
use of this as indicating the moment of stimulation.

The latent period of the muscle reaction to stimulation from
the near electrode is, on an average, 0*00442 seconds; from the far
electrode, 0*00578 seconds. The rate of transmission in the
human median nerve, calculated from these figures, is 117 to
125 metres per second.

The measurements are made upon the assumption, founded on
Einthoven’s work, that his galvanometer reacts instantaneously.

The muscle contraction and action current are found to be
greater when the nerve is stimulated above the condyle than when

ABSTRACTS

705

the electrode is applied in the axilla. This is attributed not to
variations in excitability in different parts of the nerve, but to the
greater thickness of skin and adipose tissue in the latter position.

It is assumed that the latent period of the reaction does not
vary with alterations in the strength of the stimulating current,
and that excitability and conductivity are the same in different
parts of one nerve.

It has been stated that temperature has an influence upon the
rate of nerve transmission. The experiments recorded were per¬
formed in the month of June, and there remains the possibility
that slower rates would be obtained in cold weather.

W. A. Jolly.

ACTION OF BARIUM CHLORIDE ON THE FOWL’S MUSCLE.

(615) C. W. Edmunds and G. B. Roth, Amer. Joum. Physiol., Vol.
xxiii., No. 1, Oct. 1, 1908, p. 46.

In this short article barium is shown to act on the contractile
substance of muscle cells, while curara, nicotine, and physostigmine
act probably on some other constituent of the cell, which might be
the “ receptive substance.”

Langley has postulated two constituents of cells:—

(1) Substance concerned in the carrying out of the chief

functions of the cells—secretion, contraction, etc.

(2) “ Receptive substance,” capable of setting the chief sub¬

stance into action, and which does not degenerate when
the nerve is cut. W. Kelman Macdonald.

PATHOLOGY.

CHANGES IN THE NERVOUS SYSTEM AFTER STOVAINE
(616) ANAESTHESIA. (Ver&nderungen des Nervensystems nach
StovainanSsthesie.) W. Spielmeyer (of Freiburg), Munch,
med. JVochenschr., Aug. 4, 1908.

The author examined the nervous system of thirteen cases who
had been operated on under stovaine ansesthesia. In only one case
was the stovaine the cause of death. In six cases *05- 07
grammes of stovaine were administered ; in seven cases *12 or *1
gr. In nine of the cases examined, including the whole of the first
group, no characteristic pathological changes were observed. The
cell changes were such as to be most naturally explained on the
basis of the general condition of the patient. In the case where
the injection led to paralysis of respiration the cell changes were

706

ABSTRACTS

apparently due to the respiratory disorder. In three cases char¬
acteristic cell changes were found; the alteration was of the
nature of axonal reaction. The cells affected were the anterior
cornual cells of the spinal cord. No changes could be demon¬
strated in the posterior roots or peripheral nerves, but they might
easily have escaped observation as comparatively few cells were
affected.

Experimental work on dogs and apes produced the same cell
changes, and in addition changes in the posterior roots and also in
the posterior columns. In one case the periphery of the lateral
and anterior columns was also affected. The author calls attention
to the fact that the cell changes do not necessarily lead to the
destruction of the cells, and that damage of a few motor cells may
produce no clinical evidence of weakness in the general muscu¬
lature, but may be sufficient in the case of the eye nuclei to cause
transitory paresis; C. Macfie Campbell.

A CONTRIBUTION TO THE PATHOLOGICAL ANATOMY OF
(617) MULTIPLE SCLEROSIS, WITH PARTICU LAR REFER¬
ENCE TO THE AREAS OF DISEASE MET WITH IN THE
CORTEX. (Zur pathologischen Anatomic der multiplen
Sklerose mit besonderer Beriickgichtigung der Himrindenherde.)
Gustav Oppenheim, Neurol. Centraibl., Okt. 1, 1908, 8. 898.

Successive sections of various parts of the brain and cord from
four cases of disseminated sclerosis were stained by different
elective tissue methods with the object of obtaining as complete a
picture as possible of the alterations in the component tissue
elements. Disappearance of the white sheaths and integrity of
the fibrillar structure of the nerve elements in the islets of
disease were demonstrated by the nerve sheath method of Weigert
and the method of Bielschowsky respectively. In Marchi pre¬
parations some islets remained unstained, while in others con¬
siderable quantities of fat were found, chiefly at the periphery
of the patches, often indeed forming a complete ring around
the central apparently older portion of the patch. The nerve
cells, axis cylinders, and fibrils were relatively intact A special
study was made of patches which involved both the cortex and
subjacent white matter. Whereas the subcortical portion of these
patches presented a more or less dense feltwork of neuroglial
fibres, in the cortex itself the neuroglial increase consisted of an
increase of spider cells. This accounts for the statements of
observers, who worked before the introduction of the method
of Weigert, to the effect that subcortical patches did not
extend into the cortex, but terminated sharply at the junction of

ABSTRACTS

707

the grey and white matter. In three of the four cases examined
there was a widespread adventitial plasma cell infiltration, an
appearance in favour of the exogenous cause of the disease. The
absence of inflammatory changes in the fourth case does not, in
the author’s opinion, exclude this possibility, for it may be that
the appearances met with were merely the later features of a
process which in its earlier stages was of an inflammatory nature.

Edwin Bramwell.

THE PRIMARY LESIONS OF THE NERVE FIBRES IN
(618) TJRjEMIA, STUDIED IN EXPERIMENTAL CONDITIONS
BY THE METHOD OF DONAGOIO. (Le lesion! primaria
delle fibre nervosa nell’ urinaemia and stndiate in condizioni
sperimentali con la colorazione positive di Donaggio.) Scar-
pini, Riv. di Paiol. nerv. 6 ment., Agosto 1908, p. 349.

The author uses the method of Donaggio, which may be thus
briefly described. Pieces of tissue are fixed in a 4 per cent, solution
of bichromate or in Muller’s fluid. They are stained by haemato-
xylin and then subjected to mordant action of three types, i.e.
the double chloride of tin and ammonia is used simultaneously
with the staining (prima modality of Donaggio), or the acetate of
copper or perchloride of iron used subsequently to staining
(second and third modalitk).

The tissue is then subjected to decoloration by the method
of Pal, which is carried on further than the stage of differ¬
entiation.

After such treatment fibres in which primary or secondary
degeneration is commencing resist the action of the permanganate
and oxalic and remain intensely stained among the normal fibres,
which are colourless. Tissues which have been a very long time
in chromic acid solution give this reaction.

The two first of these three reactions of Donaggio give the
following results:—

The first renders visible the most minute structural differences
in the altered fibre. The second, by giving the fibre a uniform
coloration, allows it to be isolated with precision from the
normal fibres.

The paper is a preliminary communication of the changes
found in three rabbits dying after ligature of the ureters. In the
spinal cord a certain number of fibres belonging to the tracts of
Gowers and Flechsig were found to be affected. In two of the
rabbits there were also lesions in the posterior columns, which
were completely absent in the third.

In the bulb the restiform bodies showed numerous affected
fibres, and a few of the internal arcuate fibres were affected.

708

ABSTRACTS

Beyond referring to the singular symmetry of the lesions, the
author makes no remarks on his pathological findings, but pre¬
sents the paper as a preliminary note, showing the possibility of
localising the nervous lesions in toxic affections.

F. Golla.

CLINICAL NEUROLOGY.

NERVOUSNESS AND NUTRITION IN CHILDHOOD. (Nervomttt

(619) und Em&hrung im Kindesalter.) Siboert, Munch, med. Woeh.,
Sept. 22, 1908, p. 1963.

In this most interesting paper the “ nervous ” child discussed is
the child that shows symptoms of nervousness owing to un¬
satisfactory feeding.

The condition is frequently brought about by overfeeding,
especially with albuminous substances. Excess of meat, eggs, and
milk is the common cause, and the results are most marked when
at the same time there is lack of green vegetables and fresh fruit
in the diet.

The author proceeds to describe some typical cases of the
condition in which the nervousness is only one symptom—there
are many others.

Cure is only brought about by regulation of the diet—by
cutting down the amount of albuminous food, and often also
the fat, and by increasing the amount of vegetables and fruit
The condition is exceedingly common.

A. Dingwall-Fordyck

REPORT OF A CASE OF MYASTHENIA GRAVIS PSEUDO

(620) PARALYTICA, WITH NEGATIVE PATHOLOGICAL
FINDINGS. J. Arthur Booth, Joum. of Nerv. and Meni.
Dis., Nov. 1908, p. 690.

This is a record of a case of myasthenia gravis occurring in a boy
aged 11. The symptoms, which came on gradually a few days
after an operation for adenoids, presented nothing exceptional
Death occurred eighteen months later. Post-mortem a slight enlarge¬
ment of the thymus gland was found. Otherwise nothing abnormal
was detected. The muscles, central nervous system, thyroid, para¬
thyroids, and pituitary body were all carefully examined. In view
of the negative findings in this and similar cases “ the symptom
complex of the disease is best explained on the basis of its being
a nutritional disorder impairing the vital processes in the muscles
from some unknown toxine.” Edwin Bramwell.

ABSTRACTS

709

OCCUPATION NEURITIS OF THE DEEP PALMAR BRANCH

(621) OF THE ULNAR NERVE. J. Ramsay Hunt, Joum. of
Nero, and Meat. Dis., Nov. 1908, p. 673.

The author describes three cases of what he regards as an occupation
neuritis characterised by an atrophic paralysis of all the intrinsic
muscles supplied by the ulnar nerve, the reaction of degeneration
in the atrophic muscles, and absence of any objective sensory
disturbance in the ulnar nerve distribution. Sensation is un¬
affected, therefore the nerve must be involved after the superficial
or sensory branch has left the motor, while the fact that all the
muscles supplied in the hand by the ulnar nerve are affected
shows that the nerve has been implicated before it breaks up to
supply the individual muscles.

The paralysis is caused, he believes, by pinching of the nerve
as it passes between the abductor and short flexor muscles of the
hypothenar eminence near their origin.

The occupations of the three patients referred to were those of
jeweller, a machinist, and a brass polisher. The cases recorded by
Gessler, in the opinion of the author, in all probability belong
to the condition here described. Edwin Bbamwell.

ACUTE POLIOMYELITIS FOLLOWING TONSILLITIS. Kendall

(622) Emerson, Boston Med. and Surg. Journ., 1908, p. 500.

A boy, aged 8 years, three days after recovery from a severe
attack of tonsillitis, in which no diphtheria bacilli were found,
complained of tingling in the left hand. Two days later loss of
the left triceps reflex and weakness of the left arm muscles
occurred. During the following five days the development of the
paralysis was progressive until all power was lost except weak
flexion of the fingers. Emerson regards the tonsils as the atrium
of infection for the toxines, which later affected the cord, and
considers that the bodily resistance was lowered by the boy
refusing to rest after the initial attack. J. D. Rolleston.

CASE OF CHRONIC ANTERIOR POLIOMYELITIS. (Uber einen

(623) Fall von Poliomyelitis anterior chronica.) R. Cassirer and
Otto Maas, Monatsschr. f. Psychiair. u. Neur., Oct. 1908,
Bd. 24, S. 306.

The following case is fully and carefully described. A woman of
sixty suffered from weakness of the legs, which gradually ascended
and affected the trunk and arms. Marked atrophy was present in
the legs. The paralysis was throughout a flaccid one. She died
in three years, and at the autopsy was found extensive degeneration
3 E

710

ABSTRACTS

of the anterior horn cells, with, as is the rule in such cases, a few
scattered lesions in the white substance. The pathological appear¬
ance is especially fully described.

The diagnosis lay between progressive muscular atrophy and
chronic anterior poliomyelitis. Pointing to the latter was: the
continuous spread of the affection, no special groups of muscles
being picked out, the onset in the legs, the chronic course during
which the neck and bulbar muscles were quite unaffected.

Ernest Jones.

ON THE QUESTION OF IDIOPATHIC “ MENINGITIS SPINALIS

(624) SEROSA CIRCUMSCRIPTA.” (Zur Frage der idiopathischer
Form der “meningitis spinalis serosa circumscripta.” L.

Bruns, Berl. klin. fFoch., Sept. 28, 1908, S. 1753.

In view of the fact that doubt has been cast on the existence of
an “ idiopathic ” form of this (unquestionably rare) condition even
by those who have described cases, the author reports here at
greater length a case previously briefly recorded by him. The case
was that of a boy of sixteen with all the symptoms well marked
of an extra-medullary tumour pressing on the cord about the level
of the 4-5 cervical segments. At the operation there was found
only a circumscribed accumulation of cerebro-spinal fluid under
high tension. There was nothing to which this congestion could
be said to be secondary. Removal of the fluid resulted in almost
complete recovery from the pressure symptoms. When seen
twenty months later there was no relapse and practically no
sign of the disease remaining. The author is strongly of the
opinion that such an idiopathic condition exists apart from any
disease of the spine, membranes, or cord itself.

J. H. Harvey Pirie.

TWO OASES OF LANDRY’S PARALYSIS. (Zwei FJUle von

(625) Landry’scher Paralyse.) Arth. v. Sarbo, Neurol. Centralbl.,
Nov. 1, 1908, p. 1009.

Two cases are here described as Landry’s paralysis. The first
terminated fatally after a four days’ illness, while the second
recovered.

Case 1. — A boy, aged 12, in the best of health, was suddenly
affected with paralysis of the palate and difficulty in swallowing.
On the second day the weakness was more pronounced, and there
was paralysis of the right side of the face, which was followed
quickly by left facial and right sixth paralysis, while on the same
day weakness of the neck muscles, upper extremities, and thorax
were observed. On the fourth day the left knee-jerk disappeared

ABSTRACTS

711

and the tendon-jerks on the right side were more difficult to elicit
than previously. Death occurred on the fourth day with paralysis
of the intercostals and diaphragm. The only point in the previous
health was a discharge from the one ear, which dated back for five
years. The author lays stress on the absence of sensory symptoms,
and regards the case as a descending Landry's paralysis. He refers
to several similar cases in the literature. Ho autopsy was made.

Case 2.—A woman, aged 19, who had married against the will
of her father, came home after a three weeks’ wedding tour com¬
plaining of subjective sensations and weakness in the feet, which
symptoms were followed by complete paralysis after a stormy
interview with her father. The patella and Achilles reflexes were
found to be absent. She complained of severe pain in the dorsal
region of the spine. Paralysis of the trunk, the arms, the face,
and the soft palate quickly followed, with hyperesthesia of the
extremities and the picture of an ascending motor paralysis.
Improvement began to occur on the tenth day. There was, how¬
ever, muscular atrophy, with reaction of degeneration, but no
sensory disturbances or fibrillary tremors. After fourteen weeks
she was almost well, although the knee-jerks were still absent. No
organisms were found in the blood. Edwin Beam well.

TRAUMATIC AFFECTIONS OF THE OORD. (Zur Kentniss der

(626) traumatischen Ruckenmarksaffectionen.) Winkler und Joch-
MANN, D. Zeitsch.f. Nervenheilk ., 1908, Bd. 35, S. 222.

These authors give a detailed clinical and anatomical account of
two cases of hsematomyelia. The first was in a man of forty-five,
who was struck on the back by a railway signal bar four months
before admission. This produced an extensive intramedullary
haemorrhage in the cervical and upper thoracic portions of the cord.
The second was in a school girl of twelve, who fell a distance of
about two metres from a ladder during gymnastic exercises. No
serious symptoms developed until the following day, when pain
and weakness appeared in the left arm and leg. The patient sur¬
vived eighteen months, and died ultimately from bedsores. The
hsematoma was chiefly in the 3rd, 4th, and 5th cervical segments.

The details of these cases are carefully set forth and well
illustrated by diagrams, but cannot well be condensed in an
abstract. Purves Stewart.

TRAUMATIC CERVICAL MYELOMALACIA. Carl D. Camp,

(627) Joum. Amer. Med. Assoc., Aug. 22, 1908.

The case which is reported in this paper is that of a man who
fell about six feet, striking his back on the frozen ground. After

712

ABSTRACTS

the accident there was a prominence in the cervical region of the
spinal column, but next day there was no deformity of the spine
in any part, and radiograph showed nothing abnormal. The
paralysis was peculiar, inasmuch as it apparently advanced and
receded and was of a peculiar distribution for an organic lesion
of the cord; both forearms and one leg seemed to be the seat
of permanent paralysis, while the paralysis of the other leg ap¬
parently appeared one day to disappear the next There was no
Babinski reflex, but there was a band on the chest of true alio-
chiria and other various and varying disturbances of sensibility,
A month later atrophy of the paralysed parts set in.

The patient died four months after the accident, and the autopsy
revealed a linear fracture in the body of the sixth cervical vertebra,
with an area of softening in both anterior horns from the sixth
cervical down to the first thoracic segment. There was no evi¬
dence of an old haemorrhage, and the author explains the condition
as being due to a slight dislocation of the vertebrae pressing on
the spinal cord sufficiently to block the anterior spinal artery,
setting up a thrombosis which caused areas of softening in the
anterior horns and to some extent the adjacent white matter.

The diagnosis from traumatic hysteria is discussed, and the
inadvisability of surgical interference is emphasized.

W. K elman Macdonald.

THE OEBEBBO-SPINAL FLUID m DIPHTHERITIC PSEUDO-
(628) TABES. (Zur Klinik postdiphtherischer LMunungan. Liqnor-
befnnde bei postdiphtherischer Pseudo-tabes.) Romhkld,
Neurol. Ceniralbl., 1908, p, 1007.

At the annual meeting of German neurologists at Heidelberg,
Romheld recorded the first case of diphtheritic paralysis, in which
an examination of the cerebro-spinal fluid has been published.
The patient was an adult who had been treated with antitoxin.
After suffering from paralysis of the palate and accommodation,
three months after the initial attack he presented marked ataxia
of the upper and lower limbs, loss of tendon jerks, tenderness of
the nerve trunks, diminution of electrical excitability and sub¬
jective sensory disturbances. The first lumbar puncture was
performed two and a half months after the onset of diphtheria.
Moderate lymphocytosis was found. A month later there was
hardly any increase in the lymphocytosis, and the amount of
albumin in the fluid was less. No diphtheria toxin nor antitoxin
was present. At the third puncture, performed a month later,
the cellular contents were normal and the albumin was still less.
On his discharge the patient was in a normal condition, except

ABSTRACTS

713

that his tendo Achillis jerks were absent and his knee jerks were
weak. Since no pathological change is present in ordinary
peripheral neuritis, these observations show that in diphtheritic
paralysis of long duration there exists not only peripheral neuritis
hut central anatomical changes. A comparison is made with the
findings in the cerehro-spinal fluid in metasyphilitic processes.
Whereas in the latter the morbid changes once present persist,
in diphtheritic paralysis the diminution in the cellular contents
and amount of albumin goes hand in hand with clinical improve¬
ment J. D. Rolleston.

OYTOLOOIOAL EXAMINATION OF OEREBRO-SPINAL FLUID
(629) AND ITS INTERPRETATION. (Ergebnisse der sytologischen
Untersuchungen der Zerebrospinallltissigkeit und deren Aua-
sichten.) 0. Rehm, Munch, med. WochenscJvr., Aug. 1908,
p. 1636.

Dr Rehm gives a short preliminary account of the history of
lumbar puncture from its therapeutical and diagnostic aspects.
Introduced therapeutically in 1891 by Quincke, its uses, from a
diagnostic point of view, were quickly recognised, and the fluid
was examined to determine the pressure, at which it was ex¬
pelled, its chemical constitution, more particularly the presence
or absence of albumin, the bacteriological examination of the
fluid, the presence of cellular elements and their characters,
whether lymphocytes or leucocytes, in the different pathological
conditions examined. Valuable work was early done by various
French workers in syphilitic, post-syphilitic, and many associated
diseases of the central nervous system.

Nissl was the first in Germany to classify those diseases in
which an increase in the number of lymphocytes is present, and
he also confirmed many of the results of French writers. He
emphasised the fact that both the exact number and the kind of
cell present must be noted. The so-called French method then in
use, consisted in centrifuging a definite amount of the fluid for a
definite time, collecting the sediment in a hair-pipette, and blow¬
ing this out in drops on a slide, which are then fixed and stained.
This method leaves too much room for variations in technique,
slight errors in which will markedly affect the result, and it
diminishes the value of comparison between the results of different
observers. In 1904 Fuchs and Rosenthal used a counting
chamber similar to that used in the enumeration of blood
corpuscles. This is a more exact method than the former, and is
of great value if the cells are numerous, and in comparing results
in the same case from day to day. Alzheimer, in 1907,
introduced a new method of fixing the cells. He saturated the

714

ABSTRACTS

fluid with 96 per cent alcohol, centrifuged the coagulum, hardened,
fixed, and embedded it in celloidin; this he could then cut and stain.
In cases where the albumen is distinctly increased this method is
very valuable, but in others the coagulum is so thin as to render
the process very difficult

Dr Rehm then describes his results after a series of 650
punctures. He classifies them as follows:—From one to five
cells in cubic millimetre is normal, from six to nine he puts in
a sort of neutral zone between normal and pathological. In this
group many of the cases had a syphilitic taint, besides some cases of
fever delirium, and several cases of tabes and progressive paralysis.
He begins the distinct pathological increase with ten cells per
cubic millimetre. Some much higher counts he obtained in
meningitis and meningomyelitis.

Dr Rehm found in syphilitic cases a distinct diminution in the
number of cells after a course of mercurial inunction, thus showing
that the mercury has a distinct influence on the cell production.
He then goes on to describe the kind of cells found in various
diseases, and gives a very full account of their appearance; he
finds the Alzheimer method much the more suitable for exact
differentiation of the cells.

Dr Rehm concludes the article by emphasising the great im¬
portance of lumbar puncture as part of the routine examination of
patients and the careful examination of the kind of cells present,
considering the results to be obtained as valuable as those which
have been got in the blood examination in other cases.

Duncan Lordckr.

ACJUTB ASEPTIC MENINGITIS. (Contribution k U tude dee
(630) reactions mfoingfes aigutis aseptiques.) L. Chabbert, Thhses
de Paris, 1907-1908, No. 159.

Acute aseptic meningitis occurs in syphilis of the nervous centres,
otitis media, herpes zoster, and after injection into the pia-
arachnoid cavity of stovaine or cocaine. The symptoms are the
same as in the other varieties of meningitis. Diagnosis can only
be made after lumbar puncture. The cerebro-spinal fluid in these
cases has two principal characteristics—(1) It is aseptic, or, at
least, the present laboratory methods show no micro-organisms;
(2) it contains polymorphonuclears which are remarkable for their
perfect state of preservation. Recovery is the rule, but certain
symptoms may persist, such as headache, apathy, inequality of the
pupils, and dissociation of the pulse and temperature. The treat¬
ment is the same as in septic meningitis, except that one should
abstain from injecting substances into the pia-arachnoid cavity
which might increase the intensity of the reaction.

J. D. Rolleston

ABSTRACTS

715

TUBERCULOUS MENINGITIS m PREGNANCY. (De la mtfningite
(631) tuberculeuse an conrs de la grossesae.) H. Plivard, Thtees de
Paris, 1907-1908, No. 342.

Tuberculous meningitis is exceptional during pregnancy. It
may occur at any stage, unlike eclampsia, which is rare before
the sixth month. It may assume either an epileptiform or a
comatose character, and therefore closely resembles eclampsia,
from which it is to be distinguished mainly by the character of
the pulse. Examination of the urine is of little help, since
albuminuria may be present in tuberculous meningitis. Since
tuberculous meningitis usually forms part of a more or less
generalised tuberculosis, search must be made for evidence of the
disease in other organs, especially the lungs and choroid. Lumbar
puncture and the ophthalmo-reaction will also be of assistance.
The thesis contains the histories of seven cases, two of which have
hitherto been unpublished. In three cases the disease was
manifested by both convulsions and coma. In four coma was
present, but the convulsions were ill-marked or absent.

J. D. Rolleston.

TREATMENT OF OEREBRO-SPINAL MENINGITIS WITH
(632) FLEXNER’S SERUM. C. B. Ker, Edin. Med. Journ., Oct.

1908.

Before the serum prepared by Flexner and Jobling was used, the
death-rate of the cerebro-spinal cases at the Edinburgh City
Hospital was not less than 80 per cent At first the treatment
adopted was chiefly expectant in character, but most of the serums
obtainable were given a trial. In all, thirty-three patients were
treated with Flexner’s serum, the mortality being 42’3 per cent.,
or about half that of the cases treated otherwise. Several of the
patients injected were moribund or quite hopeless on admission.
If these are deducted the death-rate falls to 33 per cent. These
figures, while perhaps not so satisfactory as those reported by
other observers, are extremely encouraging.

The serum was invariably injected into the spinal canal, and an
average adult dose was 30 c.c. As much spinal fluid as would
readily escape was withdrawn before each injection. The best
results were obtained by giving daily injections for the first three
days the patient was under observation, and if improvement was
not noted within that time the serum was pushed, doses being
given at intervals, as long as the symptoms remained acute and
meningococci were present in the spinal fluid. The largest amount

716

ABSTRACTS

of serum given in any one case was 360 c.c. In favourable cases
the injections were followed by improvement in the general condi¬
tion of the patient. The rigidity and headache rapidly dis¬
appeared. Occasionally a fairly definite crisis occurred, a mode of
termination which had not been observed in untreated cases. The
spinal fluid rapidly became less turbid and the extra-cellular
micro-organisms disappeared early, all the cocci becoming intra¬
cellular. The staining properties altered, the organisms appeared
disintegrated, and after a few days' treatment it often became
difficult to get cultures to grow. Ker does not lay any stress on
the opsonic and agglutinative reactions as aids in prognosis, but
believes that both are of considerable value in diagnosis.

A great feature in the cases, which ended in recovery, was the
complete absence of chronic symptoms. Previously the patients
who survived had for the most part a long and tedious illness, and
frequently became quite deaf. Much wasting had also been
observed. The patients, however, who were treated with Flexner’s
serum made rapid recoveries, and, with two exceptions, left hospital
perfectly well. The serum was also most effective in checking the
relapses so often met with in cerebro-spinal meningitis. The small
mortality of children of under ten years of age, only 20 per cent.,
was another very striking feature. To obtain success it is veiy
necessary to inject early, and, provided this is done, there is hope
even for patients with pus in the spinal canal.

Ker also treated fourteen patients with Kolle’s serum. Of
these, eight died. The injections, however, in this series were
almost entirely subcutaneous, and he concludes that, whatever
the merits of this particular serum may be when used in large
doses intraspinally, there is little to be gained by subcutaneous
injections. On the other hand this serum is recommended as
worthy of a trial in large intraspinal doses. Jochmann s serum
was also tried and given much on the same lines as Flexner’s, but
with very poor results Author’s Abstract.

THE SEBUM TREATMENT OF CEREBRO-SPINAL FEVER IN
(633) THE CITY OF GLASGOW FEVER HOSPITAL, BELVEDERE,
BETWEEN MAT 1906 AND MAT 1908. J. R. CURRIE and
A S. M. Macgregor, Lined, Oct 10, 1908.

Within the periods quoted Belvidere Hospital received 330 cases
of cerebro-spinal fever. Of these, 105 were treated with anti¬
meningococcic serum, while 225 were not so treated. The results
of administration were checked throughout by control cases of a
similar type, and the fallacy avoided of comparing the treated
cases of one stage of the epidemic with the untreated cases of

ABSTRACTS

717

another. The four sera employed were Professor Wassermann’s,
Professor Ruppel’s, Professor Kolle’s, and Messrs Burroughs,
Wellcome & Co.'s. An account is given of the clinical features of
the epidemic, and a comparison of the mortality rate with that
obtaining in other and previous epidemics brings out the fact that
the Glasgow type was one of great severity (mortality=74*8 per
cent.).

The authors' experience is discussed from (a) the clinical, (ft)
the statistical aspects. Clinically it was found that the adminis¬
tration of serum was followed in individuals by no consistent
modification of the natural course of the disease. A tabular
inquiry was conducted into (a) total case mortality among treated
and untreated cases; (ft) duration of illnesses ending in death;
(c) duration of illnesses ending in recovery; (d) relative mortality
among cases that survived the first ten days of illness. Briefly,
the authors are unable to report that total case mortality was
reduced, or that fatal issues were delayed, or favourable illnesses
curtailed. But it was found that when serum-treated survivors
of the first ten days were compared with untreated survivors in
respect of case mortality, the treated cases recovered in greater
number, sufficiently so to allow the inference that serum-treated
cases which survived the first ten days had a better chance of life.
This result suggests that treatment in these cases, though failing
to arrest the disease out of hand, was yet able to hamper its
progress, aiding the natural defences of the body and hindering,
-possibly, the formation of exudates which would stand in the way
of recovery.

It is pointed out that treatment directed against the infective
process is limited on the one hand by the extreme severity of the
infection during epidemic periods, and on the other, in the later
stages of the case, by the occurrence of gross pathological changes
which prejudice recovery. Authors’ Abstract.

THE CORTICAL LOCALISATION OF ASYMBOLY. (Die kortikale
(634) Legalisation der Asymbolie.) E. Poooio, Neurol. Centralbl .,
Sept. 1, 1908, S. 817.

A case of Jacksonian epilepsy. Some of the attacks began with
contractions in the last three fingers of the left band, others with
rotation of the head and eyes to the left. Two localised cortical
lesions were diagnosed. Nothing objective was detected on
examination, in particular there was no motor weakness and no
astereognosis. An operation was performed, and two hydatid
cysts about the size of a cherry-stone were found lying on the
surface of the brain and removed. Twenty-two days after the

718

ABSTRACTS

operation, apart from a very slight tactile loss in the tips of the
fingers, asymboly in the left hand was the only sign of disease.
Thus, when an object was placed in the patient’s left hand, his
eyes being closed, although he could describe accurate ly i ts form
end properties, he was unable to say what it was. When the
object was placed in the right hand he named it at once. The
case is analogous to those reported in which an object cannot be
named at sight although it is recognised when handled.

Edwin Bsamwell.

ON THE SYMPTOMATOLOGY OF CEREBELLAR AND EXTRA-
(635) CEREBELLAR TUMOURS. (Zur Symptomatology der
Tumoren dee Kleinhirns and dee Kleinhirabriickenwinkels.)

Gixrlich, Deutsche Medizinisehe Wochenschrift, No. 42, p. 1800,
Oct. 1908,

Thr author gives a detailed account of two interesting cases.

Case L—The case of a boy, aged 7, suffering from a sarcoma
growing from the inferior vermis of cerebellum into the fourth
ventricle. The following is a brief account of the case and post¬
mortem findings.

The patient, aged 7, in whose previous history nothing note¬
worthy had occurred, in December 1906 had suffered for about
two months with frontal headache, nausea, and giddiness. Vision
was gradually becoming impaired. An acute attack of vomiting
and giddiness brought him under medical supervision. Gait—
drunken type, unsteadiness on standing, increased by closing the
eyes. No muscular weakness. Tremor in arms and legs increased
on voluntary movements. No true ataxy of arms. Increase of
deep reflexes, ankle clonus, and extensor responses. Definite
spasticity in legs. No sensory loss. Nystagmus on lateral
deviation of the eyes. Double optic neuritis.

A diagnosis of cerebellar tumour, or possibly meningitis serosa,
was made.

The patient grew steadily worse—all symptoms becoming more
marked. In addition, definite ataxy and adiodococinesia were ob¬
served on the right side. An operation was performed, the whole
cerebellum exposed and a tumour mass seen projecting into the
posterior fissure of cerebellum. The patient died shortly after
•operation.

Post-mortem ,.—Great hydrocephalus internus. Frontal section
through the cerebellum showed a tumour growing from the
inferior vermis, and projecting into the fourth ventricle. It was
easily removed from its surroundings, and proved to be a round-
celled sarcoma. The author points out that extreme ataxy is often
met with in lesions of the inferior vermis, and especially, as in this

ABSTRACTS

718

-case, of its posterior part A lesion in this position will interfere
with fibres from the cerebellum to Deiter’s nucleus, and also with
the spino-cerebellar tracts.

Case II.—Extra cerebellar tumour(neurofibroma) growing from
the ninth cranial nerve.

The time from onset of symptoms to the patient’s death was
four years. The first symptoms noted of any localising value were
loss of smell and primary optic atrophy. Subsequently unsteadi¬
ness in walking developed, with loss of taste on right side of the
tongue and evidence of implication of the right fifth, seventh, and
•eighth nerves. The palate moved very little, and the palate reflex
was lost Late in the disease difficulty in swallowing fluids and
solids developed, and the patient died during a tonic convulsion,
which at the end were of almost daily occurrence. The interest
of the case lies in the fact that the first symptoms of localising
value were not, as was supposed, due to a growth in the anterior
fossa, but were simply evidence of hydrocephalus internus caused
by an extra-cerebellar tumour growing from the ninth cranial nerve.
The cerebellar symptoms and cranial nerve palsies were supposed
to be due to a second tumour, and on this account no operative
interference was undertaken. C. M. Hinds Howell.

THROMBOSIS OF SUPERIOR LONGITUDINAL AND LATERAL
(636) SINUSES, COMPLICATED BY PREGNANCY. TREATED

BY OPENING THE TOROULAR HEROPHILI. Deane, Joum.

Amer. Med. Assoc., Sept. 19, 1908, p. 997.

The author believes this to be the first case of sinus thrombosis on
record treated by opening the torcular Herophili. The patient was
a married woman, aged 18 years, who for eleven years previously
had had a discharge from the right ear. She was admitted to
hospital with urgent symptoms. Operation revealed mastoid
suppuration and gangrene of the wall of the lateral sinus, with
absence of bleeding on incision. Probing downwards resulted in
some haemorrhage, probing upwards produced hardly any. Five
days later the internal jugular was ligatured; and after three
days more the jugular was excised. Cultural examination of the
blood revealed the presence of the staphylococcus pyogenes aureus.
Severe symptoms of septicaemia still continued. The absence of
eye symptoms seemed to exclude cavernous sinus thrombosis, and
there were no signs of cerebral or epidural abscess. Sixteen days
after the first operation the cerebellum was explored without any
abscess being discovered. The right lateral sinus and the torcular
Herophili were exposed and incised, no bleeding resulting. Septic
material was removed with a curette from the superior longi¬
tudinal sinus, and curetting of the left lateral sinus was followed

720

ABSTRACTS

by free hemorrhage. The thrombosis had clearly affected the
entire right lateral, and parts of the superior longitudinal, torcular
Herophili, straight, occipital, and inferior petrosal sinuses, not less
than fourteen inches of venous channel being obliterated. After
the fourth operation the patient made a good recovery. The
radical mastoid operation was completed later on. The patient
was five months pregnant at the onset of the illness, but the
course of gestation was not interrupted, and at full term she gave
birth to a healthy infant. Henby J. Dunbar.

THE CAUSES AND SYMPTOMS OF THROMBOSIS OF THE

(637) CAVERNOUS SINUS. St Clair Thomson, Ophthalmic Review,
Oct. 1908, p. 293.

The author contends that disease of the sphenoidal sinus is the
most common cause of thrombosis of the cavernous sinus. He
has elsewhere reported sixteen cases collected from the literature,
with post-mortem confirmation. The present short paper contains
a number of diagrams illustrating the intimate anatomical relation¬
ship which exists between the cavernous sinus and the accessory
sinuses of the nose. Edwin Bramwell.

CERTAIN ANEURYSMS OF CEREBRAL VESSELS. JOHN Rose

(638) Bradford, Lancet , Sept. 5, 1908.

After commenting upon the comparative frequency of aneurysm
of the cerebral vessels, the author classifies the cases into four
groups. In the first group of cases there are no symptoms, and
the aneurysm is found accidentally at the autopsy when the
patient dies of something else. The second group is made up of
those which are merely cases of cerebral haemorrhage, while cases
which produce symptoms of cerebral tumour fall into the third
group. The fourth is very important, and consists of a very
definite group of cases characterised by these phenomena: (1)
That there is an early seizure, followed by (2) a period in which
there are no marked symptoms of any kind, perhaps with the
exception of some stiffness of the neck; and (3) subsequently
there is a fatal seizure. The opinion is expressed that the first
seizure is due to a slight rupture and the fatal seizure is due to a
second rupture, and great emphasis is laid upon the practical
importance of clinically recognising the true prognostic significance
of the first seizure. W. K elm an Macdonald.

CEREBRAL ABSCESS. Emil Amberg, Joum. Amer. Med. Assoc.,

(639) Aug. 22, 1908.

This is an account of a case of a girl of 12 years who was operated
on on the day of admission to hospital for middle ear disease, and a

ABSTRACTS

721

thrombus of the lateral sinus removed. Nine days later the middle
cranial fossa was opened and two drachms of yellowish-green pus
evacuated. One week later the patient died, and at the autopsy,
in addition to a chronic suppurative tympano - mastoiditis, an
abscess in the region of the dura of the roof of the antrum and
an extended lateral sinus thrombosis, an old deep-seated brain
abscess was found in the left cerebrum adjacent to the ventricle.
Examination of pus smears showed the diplococcus pneumoniae
and the colon bacillus. W. Kklman Macdonald.

▲ CONTRIBUTION TO THE ETIOLOGY OF EPILEPSY. (Zur

(640) Aetiologie der Epilepsie.) Bratz, Neurol. Ceniralbl., Nov. 16,
1908, S. 1063.

Statistical observations by Sichel indicate that although many
neuroses are more common among the Jewish race than among
the general population, the reverse holds good for alcoholism and
epilepsy. The author brings forward further statistics, and raises
the question, is the rarity of epilepsy related to the infrequency
of alcoholism ? He has observed 1262 cases of idiopathic epilepsy
at the Anstalt Wuhlgarten, of which 28 (2£ per cent.) were Jews
(the Hebrew population of Berlin is estimated at 10 per cent, of
the whole). Since, however, the Jews of Berlin are generally sup¬
posed to live in better circumstances than the general population
of that city, there is a possible fallacy in connection with figures
drawn from the material of a public institution. No instance of
parental alcoholism was present among the 28 cases of epilepsy
above referred to, although in every case there was a neuropathic
taint. On the other hand, among the remaining 1234 cases a
neuropathic heredity was present in 391, and a history of
alcoholism in the parents in 254. Although some authorities
assert that alcoholism in the parents acts as a special pre¬
disposing cause of epilepsy, it has always to be remembered that
in almost all cases of alcoholism there is a neuropathic taint, and
the epilepsy in the offspring may be merely the expression of a
neuropathic heredity rather than a direct consequence of the toxic
effect of alcohol upon the unborn child.

Edwin Bramwell.

THE BLOOD IN EXOPHTHALMIC GOITRE AND IN THYROID-

(641) ISM. (Blutbefunde bei Morbus Basedowii und bei Thyreoid-
ismus.) L. Caro, Berl. lclin. Wochnschr ., No. 39, 1908.

The writer had full blood examinations carried out in fourteen
cases of exophthalmic goitre, in twenty cases of thyroidism without

722

ABSTRACTS

thyroid enlargement, in six cases of goitre without symptoms of
thyroidism, and in eight normal cases after the administration of
thyroid tablets. He comes to the following conclusions:—

(1) Well-marked cases of exophthalmic goitre show a striking
reduction of the polymorph leucocytes (to 50 per cent), along,
with a marked increase of lymphocytes (up to 50 per cent), the
increase being chiefly in the small lymphocytes.

(2) Relative lymphocytosis is found in the fruste forms of
exophthalmic goitre, i.e. cases of thyroidism.

(3) In cases of simple thyroidism the large mononuclear cells
are increased more than are the small lymphocytes, a relative
increase of the latter being typical of a fully developed case of
exophthalmic goitre.

(4) In cases where clinically the exophthalmic goitre appears
to be cured, the blood picture approaches the normal standard, but
a slight relative increase in the large mononuclear cells is often
found in such cases, and indicates that a slight degree of thyroidism
is still present.

(5) In normal cases fed with thyroid tablets a relative
lymphocytosis is invariably found, the large mononuclears being
chiefly involved.

The writer considers that in cases of cardiac disturbance the
presence of a lymphocytosis is strong evidence in favour of thyroid
intoxication being the cause. D. P. D. Wilkie.

ON THE PSYCHICAL NATURE OF BLEPHAROSPASM. (Sulla
(642) n&tura psicogena del blefarospasm.) Gerolamo Mirte, Ann.
di Neurol ., An. 26, Fasc. 1, 1908.

The author quotes the definition of Bianchi of tic and epilepsy as
being both “motor disorders of irrational and inefficient type
which are propagated by areas of cortex not under control of the
general laws of co-ordination, of subordination, and of association.”

Encouraged by the results published by Dr Valude of Paris,
he attempted the treatment of two of his cases by injection of
alcohol into the seventh nerve at its point of emegcncer. In
each case the injection was followed by paralysis of the facial
muscles, but as the paralysis passed off after a duration of three
to four months, the blepharospasm returned and regained its
former intensity.

In one case after failure of the injection treatment, and as the
patient had persistent photophobia, the ophthalmic division of
the fifth was resected on one side, but without any effect. Treat¬
ment by galvanism proved useless. Instillation of atropine re¬
lieves the symptoms for a few hours, but has no curative effect.

ABSTRACTS

723

The author then proceeds to discuss the pathogenesis of
blepharospasm. He considers that an organic excitatory cause
can only be found in a small number of cases. In one of his cases
photophobia might be looked upon as an excitatory cause, but in¬
asmuch as section of the trigeminal failed to relieve it, this view
cannot be maintained.

The author concludes with Oppenheim that facial spasm is a
psychogenic phenomenon that constantly repeats its original
cause; that is, a strong emotion or the continual mental disturbance
to be found in such cases, and that the spasm chiefly affects indi¬
viduals with a strong hereditary neuropathic tendency.

He considers that the symptoms of blepharospasm afford no
support to the attempt of Brissaud to differentiate spasm as a
purely subcortical reflex phenomenon from tic as an automatic
cortical discharge. F. Golla.

THE ATTENTION NEUROSIS. (Die Erwartungsneurose.) M.

(643) IssBLlN (of Munich), Mimch. med. Woehenschr ., July 7, 1908.

The neurosis of attention or expectation discussed by the author
consists in the disturbance of various more or less automatic
activities by the anxious direction of the attention to their execu¬
tion. Instead of normal functioning there is hesitation, and
defective action even to the extent of paralysis, the individual act
being preceded by pronounced distress and a feeling of tension.
The neurosis usually remains limited to one special form of
activity, e.g. writing, reading, sleeping (insomnia), speaking,
swallowing, micturition (“ stuttering micturition ”), walking
(astasia-abasia), etc. The neurosis usually develops on the
basis of a psychopathic constitution, with a natural tendency
to indecision and worry. The function affected is usually de¬
termined by some actual difficulty or disorder. The disorder
arises when for some reason or another the attention of the
individual is specially directed to an otherwise automatic activity;
thus a “ stuttering ” gait may ensue after prolonged rest in bed.
Inability to write may be caused by temporary over-fatigue; in¬
ability to swallow easily may result from the attention paid to the
act during a tonsillitis. The patients do not present the hysterical
constitution; the symptoms remain of very limited range in each
individual case.

There is only one satisfactory mode of treatment, namely,
psychotherapy, and especially hypnosis.

C. Macfie Campbell.

724

ABSTRACTS

POSTSOARLATINAL CONVULSIVE URJSHIA. (Oonfddfr&tions
(644) snr on c&a d’ur4mie ecl&mptiqne postscarlatineiue.) P.

Nob6coubt and P. Harvier, Bull et rrUm. de la Soc. mid. det

Hdp. de Paris, 1908, p. 383; LfioN Bernard, ibid., p. 409.

A boy, aged 12 years, had a slight sore throat, not followed by an
eruption. A month later, while in apparently good health, he
was seized with epileptiform convulsions. The urine was scanty
and smoky, and contained a large quantity of albumin. The
diagnosis was made of convulsive uraemia in the course of acute
nephritis, probably of scarlatinal origin. The convulsions dis-
appeared on the fourth day, and complete recovery took plaoe.
During the attacks there was exaggeration of the left knee-jerk
and Babinski’s sign on the same side. The attacks were followed
by stiffness of the neck, Kemig’s sign, and complete abolition of
both knee-jerks for a month. Kernig’s sign was not due to a
meningeal reaction, since no cells were present in the cerebro¬
spinal fluid, but was probably the result of uraemic intoxication of
the cerebral cells. The writers do not attempt to explain the
temporary abolition of the knee-jerks. At the subsequent meeting
Bernard stated that the existence of scarlet fever was by no means
proved in this case. There was too great a tendency, he thought,
especially among paediatrists, to attribute every acute nephritis of
obscure origin to scarlet fever. Acute nephritis following tonsillitis
had been shown to exist by Bouchard and Landouzy, and Bernard
himself had seen such cases. J. D. Rolleston.

TREATMENT.

SOMETHING ABOUT PUNOTUBE OF THE BRAIN. (Brit.
(645) Med. Assoc.) TlLLMANNS, Brit. Med. Joum,, Oct. 3, 1908,
p. 983.

Puncture of the brain has not received the attention that it
deserves, and, like lumbar puncture, it will certainly come to be
more and more universally practised both as a diagnostic and as a
therapeutic measure. Diagnostic puncture is indicated when there
are signs of cerebral pressure, where abscess, haemorrhage, and the
like are suspected, and for the localisation of cysts, tumours, and
foreign bodies. Therapeutic puncture has been principally made
use of in hydrocephalus and for the injection of tetanus anti¬
toxin. In performing the puncture the head is prepared as for
trephining, local or general anaesthesia is employed according to

ABSTRACTS

725

circumstances, and a brace and drill are used either with or with¬
out preliminary reflection of the scalp and periosteum. Care is to
be exercised in going through the inner table. A fine needle fitted
with a syringe is then inserted through the opening for purposes
of exploration. The puncture may be repeated frequently on the
same patient. Puncture of the lateral ventricle may be performed
from the front (Von Bergmann), the side (Keen), from behind, or,
as recommended by the author, and by Kocher, Neisser, and
Pollack, from above—2 cm. from the middle line and 3 cm. from
the pre-central fissure. The needle is pushed downwards and
backwards, the ventricle being at a depth of 5 to 6 cm. Sub¬
cutaneous drainage of the ventricles may follow this proceeding.

Henry J. Dunbar.

SECTION OF THE POSTERIOR PRIMARY DIVISIONS OF THE
(646) UPPER CERVICAL NERVES IN SPASMODIO TORTI¬
COLLIS. Robert Kennedy, Brit. Med. Joum., Oct. 3, 1908.

Section and excision of a portion of the spinal accessory nerve is
not successful as a means of treating severe cases of spasmodic
torticollis, because in such cases the spasm is not produced merely
by the muscles supplied by the spinal accessory, but also by
certain muscles of the back of the neck of the opposite side
acting along with the sterno-mastoid. The only certain means of
abolishing the spasm is to destroy the spinal accessory which
supplies the affected sterno-mastoid, and also the posterior primary
divisions of the upper cervical nerves which supply the affected
muscles of the back of the neck on the opposite side.

This procedure was first done by Gardner and by Keen in
1888, but the methods of exposure of the posterior primary
divisions which have been described are unsatisfactory, the work
being difficult to perform with precision. As the operation is
not successful unless carried out completely, viz., by destruction
of the upper four posterior primary divisions, it is important to
have a free access to the nerves. The author has practised ex¬
posure by means of a longitudinal incision running midway
between the external occipital protuberance and the external ear.
Cutting in the same line the splenius capitis is divided and the
outer edge of the complex us exposed. One or two of the
slips of origin of the complexus are then detached and the
complexus folded inwards. Free access is thus obtained to the
posterior primary divisions from the first to the fifth. In an
ordinary severe case the nerves are then freely excised, and the
result is that the spasm is at once abolished and does nob
return.

3 F

726

ABSTRACTS

The disadvantage of the operation is its destructive character;
for while it removes a severe spasmodic condition, it replaces this
by paralysed groups of muscles and by an area of anaesthesia.
These defects are welcome substitutes for the condition from
which a patient badly affected has suffered, but at the same time
they are defects of the treatment which it would be desirable to
avoid. In the ordinary severe case which is of long standing, any
attempt to suture the nerves after division would result in a
recurrence of the spasm after regeneration had occurred. In a
case in which the spasm had lasted only three months, which had
been under medical treatment without avail from the commence¬
ment, and in which the severity of the spasm was so extreme that
surgical intervention was decided upon, the author sectioned and
immediately sutured the posterior primary divisions of the upper
five cervical nerves and dealt with the spinal accessory in the
same way. At the time of publication (three and a half years)
no recurrence had taken place. The advantage is that there is no
paralysis of muscles or cutaneous anaesthesia. The rationale of
this operation is that the abolition of the spasm permits the
medical treatment of the case to be effectively carried out, so that
by the time that the function returns in the muscles the cause of
the spasm has been overcome. Obviously this modification of the
method is only applicable to those cases of short duration and
great severity in which there is hope of overcoming the cause of
the spasm by further treatment, which is more effective after the
spasm has been abolished by nerve section. There will, of course,
always be the possibility of recurrence, even in specially selected
cases, in which case, however, the operation can be repeated and
the nerves destroyed. Author’s Abstract.

A OASE OF SEVERE TRIGEMINAL NEURALGIA SUOCES8-
(647) FULLY TREATED BY EXCISION OF THE GASSERIAN
GANGLION. E. W. Hey Groves, Bristol Med. Chir. Joum.,
Sept. 1908.

A married woman of forty had had one previous attack of
neuralgia on the right side of her face, lasting six months. The
last attack had lasted for ten months. She had had thirteen teeth
extracted and had been treated by many drugs without any benefit.
Latterly the pain had been almost constant and the paroxysms
very severe. Each began in the chin and spread to the cheeks,
jaws, and tongue; they lasted from one to five minutes, and when
under observation they recurred every five minutes to quarter of
an hour. On the affected (right) side of the face the skin was

ABSTRACTS

727

rough and excoriated and all the hair lost from the constant
rubbing during the paroxysms. On February 27, 1907, the opera¬
tion was performed. The right common carotid was clamped to
lessen haemorrhage and the eyelids on the right side stitched
together. The usual Hartley-Krause operation was performed, the
bone being removed with a trephine. The blood was removed
from the depth of the wound by the use of a constant suction
apparatus. After the third and second divisions had been cut and an
attempt was being made to free the ganglion, such furious bleeding
occurred from the cavernous sinus that the latter had to be
plugged and the patient put back to bed. On March 4th the
operation was completed, and proved so easy that it would suggest
that the routine performance of the operation in two stages is a
better method of overcoming the difficulties due to bleeding than
clamping the carotid artery. A year later she was in excellent
health, with no return of the pain. Over the right cheek and
lips there was an area of anaesthesia to light touch (epicritic
sensation), which ended at the tragus of the ear in an abrupt
right angle. The corneal sensation was dulled but not lost, and
there was no loss of sensation in the forehead or eyelids, showing
that the ophthalmic division had escaped removal. Within the
anaesthetic area she could still feel deep pressure or the prick of a
pin (protopath ic sensation). The mucous surface of the cheek,
gums, and half the tongue had lost all sensation to touch or pain.
Microscopical examination of the ganglion by Professor Michell
Clarke showed no abnormality. Author’s Abstract.

CONTRIBUTION TO THE STUDY OF THE ELECTRIC AND
(648) OPERATIVE TREATMENT OF PERIPHERAL FACIAL
PARALYSIS. (Contributo alio studio della cura elletrica e
chirurgica delle paralise perifiche del facciale.) Fumarola,
Riv. di Patel, nerv. e merit., July 1908, p. 289.

The author has observed forty cases of peripheral facial palsy in
the past two years.

The cases treated electrically were subjected to currents of 2-4
inilliamperes for about ten minutes three times a week. In cases
where there was pain in the facial nerve, both spontaneous and on
pressure, the treatment was not commenced till such pain had dis¬
appeared. Cases which showed reaction of degeneration only
improved relatively, and no complete cures were effected. In
young persons and those in whom the paralysis was incomplete,
cures were generally obtained after from two to three months of
treatment Electrical treatment was found to be useless in com*
bating secondary contracture.

728

ABSTRACTS

A case of facial palsy which had lasted a year, following on a
revolver wound in the right ear, was submitted to surgical inter¬
ference after electrical treatment had failed, and Professor
Bastianelli performed a facial spinal accessory anastomosis. The
electrical examination of the facial muscles before operation
showed a complete loss of faradic excitability in all the affected
muscles, with a notable galvanic diminution of excitability and
polar change.

After about five months from the date of the operation the
faradic excitability had returned. There was, however, a per¬
manent atrophy of the upper portion of the right trapezius and
the sternocleidomastoid. The muscles continued to act synergic-
ally with the facial muscles at the time of writing—a year after
the operation. The only indisputable good result was a certain re¬
covery of tonicity of the right facial muscles in repose, but there
was practically no independent voluntary motion of the right face,
apart from the sternomastoid and trapezius contraction. No
benefit was obtained from an attempt at muscular re-education.

The author considers that we are still seriously in need of
evidence as to the relative efficacy of the operations of facial
hypoglossal and facial spinal accessory anastomosis.

F. Golla.

DIPHTHERITIC PARALYSIS AND ITS TREATMENT. (Usber
(649) diphtherische L&hmnngen and ihre Behandlung.) Korns,
Therap. Monatsh., 1908, p. 329.

After a sketch of the phenomena of diphtheritic paralysis, the
author states that, inspired by Comby, he has employed large
doses of antitoxin for this condition. Illustrative cases are given,
but are too fragmentary to be of any value.

J. D. Rolleston.

8BRUMTHERAPY IN DIPHTHERITIC PARALYSIS. (Contribution
(650) h l’dtude de la sdrumthdrapie des paralyses poetdiphthlriques.)

Schneider et Vandeuvre, Progrh Mtdical , 1908, p. 421.

A soldier, aged 22, had an attack of severe diphtheria in May
1907, for which he received antitoxin. Forty days later palatal
palsy, palpitation, and various sensory disturbances ensued. On
admission to hospital on June 27 he showed generalised paralysis
and amyotrophy, with hypoa&thesia for all modes of sensibility.

ABSTRACTS

729

The heart sounds were muffled and intermittent, with a tendency
to embryocardia. The skin and tendon reflexes were completely
absent. In the course of the following week he received five
injections of antitoxin. Rapid improvement followed. By July 6
he was able to walk round his bed, and on August 6, when he was
discharged, the paralysis had disappeared, but the knee and ankle
jerks were still absent.

(Was the improvement in this case due to antitoxin, or, as
recently suggested by the reviewer on commenting on a similar
case, the effect of suggestion ? ( v. Lancet, July 25, 1908, p. 261).
—J. D. R.) J. D. Rolleston.

SURGICAL TREATMENT OF TUMOURS OF THE SPINAL CORO.

(651) (Beitrag zu chirurgischer Behandlung der Rfickenmarks-
tumoren.) Flatau and Zylberlast, Zeitsch. /. Nervenheilk .,
1890, Bd. 35, S. 334.

The case was one of extramedullary tumour in the cervical
region of the cord in a woman aged forty years. Fourteen weeks
before admission she had sudden pain in the left foot. The pain
gradually increased in intensity, and within a day it extended up
the left lower limb and included the left half of the trunk (the
face and upper limb being unaffected). On the third day there
was pain in the right leg and in the sacral region. The pain was
followed by weakness of the legs, so that after a fortnight the
patient was bedridden. Four weeks before admission trembling of
the legs was noticed on slight voluntary movement. Then cramp
appeared, also paraesthesia in the legs. On examination the
cranial nerves were normal. The vertebral spaces were tender
on pressure from the lower cervical down to the upper
lumbar region. The upper limbs were normal, the lower limbs
were weak, especially the left leg. There was considerable
rigidity of the muscles of both legs. There was knee-clonus and
ankle-clonus with extensive plantar reflex on both sides. Sensory
disturbances were somewhat difficult to elicit, owing to patient's
deficient attention, but distinct loss was present to touch, tempera¬
ture, and pain on the left side, below the third intercostal space.
These changes were marked on the front of the body, but on the
posterior aspect they were reversed, affecting the right lower
limb and right side of the trunk from the shoulder downward.
This phenomenon was suggestive of a hysterical element, but after¬
wards it was found to be apparently of organic origin. Sense of
position was lost in the left lower limb. Incontinence of urine
was occasionally present. Gradually, in the course of three or four

730

ABSTRACTS

months’ hospital treatment, the pains became more marked on the
right side. The cerebrospinal fluid was under increased pressure,
but free from lymphocytes. The sensory loss became practically
symmetrical from the third rib downward. Ultimately par¬
alysis of the lower limbs became complete, with total retention
of urine, girdle pains around the thorax, and anaesthesia below the
level of the -first thoracic space posteriorly, and from the fourth
intercostal space anteriorly, extending on the right side an inter¬
space higher. The left pupil and left palpebral fissure were dimin¬
ished. Operation was undertaken, and an extramedullary tumour
was removed from the left side at the level of the sixth and
seventh cervical vertebrae, measuring 2*3 cm. long, 1*8 broad, and
0*9 thick. Microscopically the growth was a spindle-celled sarcoma.
On the day after operation there was blunting of sensibility in
the left little finger and ulnar edge of the left forearm, but the
sensation of the feet and of the left leg had improved. TVo days
after operation feeble voluntary movements reappeared in the
right foot, right knee, and left foot, and the sensibility returned
on the right side of the trunk. Gradual return of motor power
occurred in the legs, the right recovering faster than the left.
The anaesthesia disappeared from above downwards on the right
side of the body, the left side clearing up much faster. After
2| months the patient was again able to walk without support,
and six months after operation the gait was practically normal.
The plantar reflexes were still extensor in type.

Purves Stewart.

DIVISION OF THE AUDITORY NERVE FOR PAINFUL TIN-
(652) NITU8, Charles A. Ballance, Lancet , Oct. 10, 1908.

The operation was performed in January 1908 by Mr Ballance,
the patient having been under Dr Ferrier’s care. The illness com¬
menced suddenly in November 1906 with deafness of the right
ear, associated with vertigo, nausea, and tinnitus. The tinnitus
was of a whistling or steaming character, and at its height became
actually painful. The semi-circular canals were removed in
November 1907, with relief to the vertigo, but without relief to
the tinnitus. For many weeks after the operation the patient’s
condition was very grave. Dr Purves Stewart made a note on
October 18, 1908, which appears in full in the Lancet of October
24. She still has slight intermittent buzzing tinnitus, but what
she complains of now is a painful dragging sensation on the same
side of the head. Author’s Abstract.

REVIEW

731

IRevfew

“MANUAL OF PSYCHIATRY.’’ By J. Roques de Fursac, M.D.
Translated by A J. Rosanoff, M J). New York: John Wiley
& Sons. London: Chapman & Hall, Limited, 1908. Price
10a. 6d. nett.

This manual is the authorised second American edition from a
revised and enlarged second French edition. It is a compact
book, obviously intended for students preparing for final examina¬
tions for degrees where psychological medicine is a subject, and
for those it can be recommended as a careful compendium of the
essentials of psychiatry. In such a book brevity is a necessary
feature, but the authors have brought the book well up to
date, and there are numerous references to the recent works of
psychiatrists throughout the pages.

The book is divided into two parts. In Part I. the general
principles of psychiatry are treated on conventional lines. The
chapters on symptomatology are particularly well written. There
is a chapter devoted to the examination of the insane, with an
excellent plan of the method used by the authors in history
taking, while the latter portion of the same chapter gives a short
summary of psycho-therapeutics.

In the second part of the book the clinical varieties of insanity
are succinctly dealt with in turn, the main etiological, symptomatic,
and therapeutic features of each being briefly discussed. The
classification followed is that of Kraepelin, with some slight
modifications. C. J. Robertson Milne.

BOOKS AND PAMPHLETS RECEIVED.

Max Nonne. “ Syphilis und Nervensystem. Neunzehn Vorlesungen fiir
praktische Aerzte, Neurologen und Syphilidologen.” Zweite, vermehrte und
erweiterte Auflage. Karger, Berlin, 1909.

Oppenbeim. “Lehrbuch der Nervenkrankheiten fiir Arzte und
Studiernde.” Fiinfte, vermehrte und verbeeserte Auflage. Karger, Berlin,
1908.

Otto Veraguth. “Dae psychogalvaniecbe Reflexphanomen.” Karger,
Berlin, 1909.

Ludwig Bach. “ Pupillenlehre. Anatomie, Physiologic und Pathologie,
Metbodik der Untersuchung.” Karger, Berlin, 1908.

732

BOOKS AND PAMPHLETS RECEIVED

Ioteyko et Stefanowska. “ Psycho-Physiologic de la Doaleur.” F61ix
Alcan, Paris, 1909.

“ Arbeiten aos dem Neurologischen Institute ander Wiener Univeraitat."
Herausgegeben von Prof. Dr Heinrich Obersteiner. Bd. 14, 1908, M. 25 ;
und Bd. 17, H. 1, 1908, M. 10.

Hermann Oppenheim. “ Zur Gehirnchirurgie.” Offener Brief an Fedor
Krause ( Berl.. klin. JVchnschr., No. 28, 1908).

H. Oppenheim. “Zur Psychopathologie und Nosologie der russisch-
judischen Bevolkerung ” (Joum. /. Psychol. «. Nenrol., 1908).

P. Camus. “ Etude de Neuropathologie sur les Radiculites.” Bailliere
et fils, Paris, 1908.

Mme. Dejerine Klumpke. “ Paralysie radiculaire totale du plexus totals,
etc.” (Rev. Neurol., juillet 1908).

“ La Localisation de l’Aphasie Motrice.” 2e Discussion sur l’Aphasie k la
SocidtA de Neurologic de Paris.

Malynicz. “ Ueber die Haufigkeit der postdiphterischen Lahmungen vor
und nach Serumbehandlung.” Speidel, Zurich, 1908, M. 1.20.

Bloch. “The Sexual Life of our Time in its Relation to Modern Civilisa¬
tion.” Translated from the 6th German edition by M. Eden Paul. Rebman
Limited, London, 1908, 21s.

Jnbices

Page references to Original Articles are indicated by heavy type figures .

SUBJECT INDEX.

Abasia : or Dysbasia, 113
Abdomen : Segmental Paralysis of, 247
Abdacens: Isolated Paralysis of, 305;
Paralysis of, after Spinal Anaesthesia,
350

Abscess: of Brain, 720; Anosmia in
Temporo-8phenoidal Abscess, 654 ;
Bronchiectasis and, 356, 424; Otitic,
40; Fatal, 180; Due to Typhoid
Bacillus, 249 ; Frontal, 492
Aconitine: Action on Nerve-Fibres, 94
Acromegaly : and Syringomyelia, 108 ;
with Osteo-Arthropathies and Para¬
plegia, 256; Osseous Plaques of Pia
Arachnoid and Pain in, 661; Tabes
Associated with Trophic Changes sug¬
gesting, 607

Adiposis Dolorosa: 431; in Dementia
Praecox, 315

Adrenalin : Action on Central Nervous
System of Rabbit, 474
Agraphia: vide Aphasia
Alcohol: Central Nervous System in
Alcoholised Rabbits, 28; Delirium
Tremens after Withdrawal of, 47,
200 ; in Etiology of Insanity, 48, 511 ;
Deep Injections of, for Trifacial Neur¬
algia, 131 ; Injections for Trigeminal
Neuralgia,202; Influence of, on Fatigue,
446; Korsakow’s Disease, 371, 441,
627 ; and Mental Disease, 626
Alcoholism : Neuroflbrils in Chronic, 97 ;
Alcoholic Neuritis, 98; Insanities, 123 ;
Delirium Tremens, 200 ; Alcoholic
Epilepsy, 258 ; Post-Delirious Stupor
in, 259; Complications of, 260 ; and
Insanity, 268 ; Asylum Treatment in,
319; Cerebral Cortex in, 346 ; Chronic,
in a Child, 366; Chronic Non-moral
Alcoholics, 512
Alexia : vide Aphasia
Allochiria, 294

Amaurotic Family Idiocy, 186
Amblyopia: Toxic, 307 ; after Accessory
Sinus Suppuration, 437
Amyotonia Congenita, 481
3 O

Amyotrophic Lateral Sclerosis in Boy
of 16, 99

Anaesthesia: Spinal, 204, 350; Total,
500

Anchylostomiasis: Mental Disorders of,
268

Aneurism: of Larger Cerebral Arteries,
36 ; of Anterior Cerebral Artery, 449 ;
of Internal Carotid Artery aud Cavern¬
ous Sinus, 462 ; of Sylvian Artery,
496 ; of Cerebral Vessels, 720
Ankle Clonus : vide Reflexes
Anorexia Nervosa in Children, 115
Anosmia in Temporo-Sphenoidal Ab¬
scess, 654

Aphasia : 654 ; with Integrity of Left
Third Frontal Convolution, 36 ; Aphe-
mia, 655 ; Alleged Word Deafness in
Motor, 505; Symptoms aud Basis of
Word Deafness, 619 ; Pure Word Deaf¬
ness in Hysteria, 113; Congenital
Word Blindness, 510; Word Blindness
with Agraphia, 509 ; Paraphasia, 621 ;
Conduction Aphasias, 507; and Uraemia
Hemiplegia, 560 ; in Functional
Psychoses, 428: vide Apraxia and
Asymboly

Aphemia: Case of Pure, 655
Aphonia: Organic and Functional, 113
Apoplexy : Tremor following, 180
Appendicitis, Hysterical, 661
Apraxia: 658 ; Motor, 357; Bilateral
Motor, with Apraxia of Eye Muscles,
etc., 657 ; and Dementia Prcecox, 666 ;
in Juvenile General Paralysis, 666 ;
and Aphasia, 508 ; and Left Hemi¬
plegia, 511, 560; Eupraxia, 622
Arsenic: In Treatment of Chorea Minor,
204

| Arteries : Occlusion of Posterior Inferior
( Cerebellar, 557 : vide Aneurism
S Arterio-sclerosis: 119; Symptoms due
to Coronary, 46; Atrophy of Cere¬
brum, 54 ; Nervous Manifestations of,
262

Arthropathy: in Acromegaly, 256;

734

INDICES

Lesions in Anterior Horn Cells in
Nervous, 594

Arthrodesis and Tendon Transplantation
in Paralytic Conditions, 317
Articulation of Consonantal Sounds in
School Children, 243
Ascending Paralysis: 246, 710; Acute,
of Syphilitic Origin, 375
Astereognosis, 502 ; in Disease of Post-
Central Gyrus, 379
Asthenia: Constitutional, 113
Asymboly : Cortical Localisation of, 717 ;
and Aphasia, 107

Ataxia: Acute, 111; Marie’s Hereditary
Cerebellar, 420

Atropin : Action of, on Autonomic Ner¬
vous System, 590
Auditory Tracts, 402

Babinski, Sign of: vide Reflexes
Barium Chloride : Action of, on Fowl's
Muscle, 705

Basedow's Disease: vide Exophthalmic
Goitre

Bell’s Phenomenon, 619
Beri-Beri : Nissl's Stain in, 406
Blepharospasm: Psychical Nature of,
722

Blood : Changes in Mental Diseases
(Review), 205; in Exophthalmic Goitre
and ThyroidUm, 721
Brachial Plexus : Complete Radicular
Paralysis of, with Oculo-pupillary
Phenomena, 624

Brain: Anatomy: Perivascular Corpus¬
cles in Substance of, 20 ; New Origin
of Peduncular Bundle of Tiirek, 91 ;
Induseum Griseum Corporis Callosi,
159; Nucleus Ruber Tcgmenti, 159;
Origin of Superior Facial, 162 ; Floor
of Fourth Ventricle, 235 ; Structure of
Grey Matter, 283 ; Arcuate Nuclei and
External Anterior Arciform Fibres of
Medulla Oblongata, 471 ; Mechanism
and Function (Review), 519; Cerebello-
Olivary Fibres, 544 ; Origin of Facial
Nerve, 685; Three Chinese Brains,
697 ; Brain Matter, 697 ; Projection
Fibres of Occipital Lobe, 698
Physiology: Relation between Labyrinth
and Eye, 92 ; Afferent Impulses and
Fatigue of Vasomotor Centre, 94 ;
Functions of Corpora Striata, 254 ;
Reflex Excitability after Cerebral An¬
aemia, 344; Supranuclear Auditory
Tracts, 402 ; Pons and Corpora Quad-
rigemina, 585 ; Centre for Submaxil¬
lary Gland, 588

Pathology: Postcentral Cortex in Tabes,
5 ; Traumatic Lesion of Pons and Teg¬

mentum, etc., 26; Lenticular Nucleus,
26 ; Medullary Sheaths in Cortex of
General Paralytics, 96 ; Heterotopia of
Nucleus Arcuatus, 168 ; Cell Findings
in Soft Brains, 168 ; Cortical Changea
in Tumours, 169; Experimental Lesions
at Base, 169 ; Cortex in Alcoholics,
346; Senile Cerebellum, 346 ; Contri¬
butions to, 404 ; Forced Movements in
Central Lesions, 549 ; Sequel to Asep¬
tic Lesions of, 642 ; Areas of Disease
in Cortex in Multiple Sclerosis, 706 ;
Cortical Localisation of Asymboly,
717

Clinical: Aneurisms of Larger Cerebral
Arteries, 36; Otitic Brain Abscess,
40; Traumatic Softening of Corpus
Callosum, 51; Treatment of Arterio¬
sclerotic Atrophy of Cerebrum, 54 ;
Symptoms of Atrophy of Occipital
Lobe, 106 ; Fatal Abscess of, 180;
Gliotic Cyst of Right Superior Parietal
Lobule, 182 ; Intracranial Abscess from
Typhoid Bacillus, 249 ; Haemorrhage
into Pons Varolii in Eclampsia, 250 ;
Dissociation of Colour-Sense in Focal
Disease, 291 ; Pontile Haemorrhage,
295; Eye-Movements in Cerebellar Irri¬
tation, 304 ; Cerebellar Abscess, 356
Bronchiectasis and Cerebral Abscess,
356, 424 ; Focal Symptoms in Diffuse
Disorders, 359 ; Cerebellar Atrophy,
359 ; Disease of Post-central Gyrus,
with Astereognosis, 379 ; Traumatic
Abscess of Frontal Lobe, 492; Integrity
of Sensation with Lesion of Left Pari¬
etal Lobe, 501; Cerebral Complications
of Nasal Origin, 645; Anosmia in
Temporo-sphenoidal Abscess, 654 ;
Bulbo-pontine Softening, 612: vide
Abscess, Aneurism, Tumour, etc.

Bromide: Large Doses of, in Nocturnal
Petit Mai, 202

Bronchiectasis and Cerebral Abscess, 356

Bulbar Paralysis: Acute, 421; in Syrin¬
gomyelia, 172, 555, 652

Caffeine : Action of, 640
Caisson Disease : Lesions of Spinal Cord
in Experimental, 479
Calmette Reaction, 117
Cardiac Mechanism after Isolation from
Extrinsic Nerve Impulses, 93
Catatonia: Syringomyelic Lesion in
Stupor, 26 ; in Dementia Prseeox, 198
Cauda Equina : Tumour of, 287; Uni¬
lateral Cauda Equina Syndrome, 611 :
vide Cornus Medullaria
Cavernous Sinus: Aneurism of, 463;
Thrombosis of, 720

INDICES

735

Cerebellum : Senile, 346 ; Classification
of Diseases of, 420 ; Occlusion of Pos¬
terior Interior Cerebellar Artery, 557 ;
Abscess of, 356; Eye-Movements in
Irritation of, 304 ; Atrophy of, 359 :
vide Tumoure
Cerebellar Ataxia, 420
Oerebro-spinal Fluid: in Tubercular Men¬
ingitis, 39; in Paresis, 121; Cyto-
logical Study of, and Diagnostic Value
in Psychiatry, 207; Cytological Study
of, 297 ; Lymphocytosis of, in Lues
Hereditaria Tarda, 297 ; Cholin in,
298 ; Typhoid Bacilli in, 491, 597 ; in
General Paralysis, 635; in Anterior
Poliomyelitis, 651; in Diphtheritic
Pseudo-Tabes, 712; Cytological Ex¬
amination of, 713

Cervical Ribs: and Atrophy of Intrinsic
Hand Muscles, 191; Symptoms due
to, 312

Chateaubriand : Medical Study of, 573
Cheiromegaly and Syringomyelia, 172
Cholesterin : Power to Neutralise Haemo¬
lytic Action of Lecithin and Specific
Serum8, 480

Cholesterol Fluid Crystals, 638
Cholin in Cerebro-spinal Fluid, 298
Chorea: With Double Optic Neuritis,
etc., 44 ; Treatment of Chorea Minor,
132; Psychical Disturbances in Syden¬
ham’s, 188; Certain Pupillary Signs
in, 191; Treatment by Arsenic, 204 ;
Chronic Progressive, 498; Motor
Phenomena of, 499; Mental State in,
563

Circumflex Nerve in Diphtheria, 170
Cocaine : Affinity of Spinal Cord for, 94
Colour-sense: Dissociation of, in Focal
Brain Disease, 291; Splitting off of,
561

Congress of Alienists and Neurologists of
France, 624

Consciousness: Post-traumatic Transi¬
tory Disturbances of, 427
Conus Medullaris: Diseases of, 653;
Epiconus Symptom-complex in Cerebro¬
spinal Syphilis, 77
Corpora Striata ; Functions of, 254
Corpus Callosum : Traumatic Softening
of, 51

Crime : and Insanity, 125,126, 127, 313,
316 ; New Classification of Criminals
(Review), 444

Cyanide of Potassium: Disease of Primary
Motor Neurones from Poisoning by,
555

Cytodiagnosis: in Practical Medicine, 264

De Quinoey : Psychological Study of
(Review), 273

Defectives: Co-operation of Alienist in
Case of, 373

Degenerates: Paranoid Symptom-com¬
plexes in. 196

Delirium Tremens: 200; after with¬
drawal of Alcohol, 47
Dementia Paralytica: vide General
Paralysis

Dementia Prsecox: Catatonic Form of,
198 ; Adiposis Dolorosa in, 315 ; Com¬
plexes and Etiology in, 367 ; Idiocy
and, 368 ; Cases, 569 ; in India, 569 ;
Final Stages of, 570 ; Eye Syndrome
of, 570 ; Bulbo-Cavernous Reflex in,
665 ; Case of Paranoid Form, with
Autopsy, 665; Apraxia and, 666 ;
Neurofibrils in Senile, 97
Dengue: Spondylitis Infectiosa after,
115

Dercum’s Disease: vide Adiposis Dolorosa
Diphtheria: Experimental, 29 ; Patho¬
genesis of Paralysis and Heart Failure
in, 116; Paralysis in, 170; Neuritis of
Left Circumflex Nerve in, 170 ; High
Incidence of Nervous Complications in,
664 ; Treatment of Diphtheritic Paraly¬
sis, 728 (2) ; Cerebro-spinal Fluid in
Diphtheritic Pseudotabes, 712
Disseminated Sclerosis : 31 ; Sacral Type
of, 32; Acute or Disseminated Myelitis,
83 ; or Cerebro-spinal Syphilis, 34;
Acute Retrobulbar Neuritis and, 300;
commencing with Failure of Vision,
424 ; Course and Progress in, 521 ;
Pathological Anatomy of, 706
Double Personality after Haemorrhage,
296

Dysbasia, 113
Dyspraxia: vide Apraxia

Ears : Associated Movement of Eyes
and, 331

Eclampsia: Treatment of, 53 ; Haemor¬
rhage into Pons Varolii as Cause of
Death in, 250

Electrical Treatment: of FaciaL Tic-
Douloureux, 52

Encephalomyelitis : Acute, 354 ; Polio¬
myelitis in Boy of Three, 492

Epiconus Symptom-complex in Cerebro¬
spinal Syphilis, 77

Epilepsy: Etiology of, 721; Heredity
in, 29 ; Epileptoid Convulsions in
Typhoid, 37 ; Borderland of (Review),
134 ; Nocturnal Petit Mai curable by
Large Doses of Bromide, 202 ; Alob-
holic, 258; Operation as Therapeutic
Measure in, 271; Paralysis Agitans in,
315 ; Corpuscular Resistance of Serum
in, 365 ; Jacksonian, 425 ; Mechanism

736

INDICES

of Gliosis in, 497 ; so-called Idiopathic
Form, 498; and Chronic Delusional
Insanity, 513; Colony and Bromide
Treatment of, 563
Eupraxia, 622

Exophthalmic Goitre: 363 ; with Myas¬
thenia Gravis, 239 ; Treatment of (Re¬
view) 327 ; treated by Thyroidectomy,
362 ; Heart Failure in, 566; X-Ray
Treatment of, 566 ; Antithyroid Treat¬
ment of, 659; Blood in, 660, 721 ;
Surgical Treatment of, 669
Exophthalmos: Intermittent, 435
Eyes : Action of X-Rays during Develop¬
ment of, 242 ; Conjugate Deviation of
Head and, 306 ; Associated Movement
of Ears and, 331 ; Headache and Eye-
strain, 428 ; in General Paralysis, 441 ;
in Dementia Prsecox, 570 ; Apraxia of
Eye Muscles, 657 ; Movements of, in
Irritation of Cerebellum, 304
Eyelids: Synchronous Movements of,
with Tongue and Lower Jaw, in certain
Diseases, 35 ; Partial Ptosis with
Exaggerated Involuntary Movement
of Affected, 337

Facial Nerve: Electrical Treatment of
Tic-Douloureux, 52 ; Pathological Ana¬
tomy of Peripheral Paralysis and
Hemispasm, 167; Peripheral Palsy,
171; Theory of Paralysis of, 362 ;
Difference between Central and Peri¬
pheral Paralysis of, 484, 545 ; Origin
of, 162, 685 ; Otalgia as Sensory Affec¬
tion of Seventh Cranial Nerve, 187 ;
Electric and Operative Treatment
of Peripheral Facial Paralysis, 727 ;
Bell’s Phenomenon, 619
Family Diseases : Relation to Premature
Physiological Senescence, 595
Family Spastic Paraplegia, 352
Fatigue: Measurements in 64 School
Children, 20 ; in Frog’s Nerve, 166 ;
Measurement of Intellectual, by the
jEsthesiometer, 407 ; Influence of
Alcohol, etc., on (Review), 445 ; of
Nerves, 472; Action of Active Supra¬
renal Principle on Muscular, 547
Freud’s Psycho-Analytic Treatment of
Insanity, 192, 193, 572

Galvanic Phenomenon in Normal and
Insane, 122

Ganglia: Plasticity and Amoeboidism of
Cells of Sensory, 28; Hypospinal
Micro-Sympathetic, 234 : Structure of
Spinal, 468; Poliomyelitis Posterior
of Geniculate, 485 ; Herpetic Inflam¬

mations of Geniculate, etc., 648; Ex¬
cision of Gasserian in Trigeminal
Neuralgia, 726

Gangrene : Multiple Relapsing, in Arms
and Foot, 567

Gasserian Ganglion: Excision of, in
Trigeminal Neuralgia, 726

Gastric Juice in Psychopathological Con¬
ditions, 51

General Paralysis: with Cerebral
Syphilis, 46; Patchy Atrophy of
Medullary Sheaths in Cortex in, 96 ;
Nerve Fibrils in, 97; Progressive
(Review), 13 4 ; Changes in Spinal
Cord in, 168; Statistical Study of,
196 ; Clinical Course of, 196 ; in Chil¬
dren, 266, 625, 666; Three Years
after Syphilitic Infection (2), 267 ; in
Senile Period, 268; Syphilitic, 293;
Peripheral Nerves in, 345 ; Eye
Findings in, 441; Serum Reaction of
Syphilis in, 572; Frontal Tumour
Simulating, 560 ; Cerebro-spinal Fluid
in, 121, 635

Geniculate Ganglion: Poliomyelitis Pos¬
terior of, 485 ; Herpetic Inflammations
of, 648

Glands: Polyglandular Syndromes and
Opotherapy, 669

Gonorrhoea : Meningitis following, 174 ;
Acute Gonorrhoeal Inflammation of
Labyrinth, 647 ; Gonorrhoeal Neuritis
of Auditory, 649; Optic and Oculo¬
motor Neuritis following, 485; Spon¬
dylitis in, 193

Graves’ Disease: vide Exophthalmic
Goitre

Hemorrhage : vide Brain and Spinal
Cord

Headache: from Pathological Condi¬
tions of Nose, etc., 366; and Eye-
Strain, 428

Hemicrania: Urinary Constituents in,
35: vide Megrim

Hemiplegia: in Typhoid, 87,177; Muscu¬
lar Strength in, 253 ; Pseudo-Hysteri¬
cal, 253; Side affected by Hysterical,
293; Hysterical, 357; Pala to-Laryngeal,
493; with Unilateral Optic Atrophy,
494; Word-Blindness with Agraphia
in Left-Handed Hemiplegic, 509;
Dyspraxia with Left-Sided, 511, 560;
Relative Eupraxia in Right, 622;
following Scarlet Fever, 530 ; Uraemic,
and Aphasia, 560; Precocious, in
Secondary Syphilis, 669

Heredity : 120 ; in Diseases of Nervous
System, 29

Herpes : Gluteal, after Lumbar Puncture j

INDICES

737

38; in Epidemic Cerebro-spinal Men*
ingitis, 38, 103; Neuritis secondary
to, 350; and Mumps, 560; Herpetic
Inflammations of Geniculate Ganglia,
485, 648; of Membrane Tympani,
due to Zo9teroid Affection of Petrosal
Ganglion, 619

Hiccough: in Syringomyelia, 652
Homosexuality: Grouping of, 372;
Diagnosis of, 373

Hydrooephalus, Meningococcal, 418
Hypnosis: State of Brain during, 592
Hypotonia, 409

Hysteria: Definition of, 41; and Liti¬
gious Insanity, 48 ; Pure Word Deaf¬
ness, 113; Severe Briquet Attack,
114; with Periodic Melancholia, 124;
Pseudo-Tetany and Peculiar Vaso-
Motor Disturbances, 192; Freud’s
Psyoho-Analytic Treatment of, 193;
Pseudo-Hysterical Hemiplegia, 253 ;
Ankle Clonus in, 263; Psycholeptio
Attacks in, 264 ; Diagnosis of Organic
from Functional Disease, 284 ; Hemi¬
plegia in, 293, 357 ; in Children, 297 ;
Immobility of Pupils, 303; Major
Symptoms of (Review), 374, Trophic
Disorders in, 426; Dissociation of
Reflexes in, 426 ; Freud s Theory of,
427 ; Hysterical Mutism, 504; Pseudo-
Appendicitis Hysterica, 661; Aphonia,
113; Sign for Detecting Functional
Paresis in Lower Extremities, 662;
Non-traumatic Pseudopastic Paresis,
112; Revision of, 616; Torticollis
Mentalis (Hystericus), 618

Idiocy: Neurofibrils in Microcephalic,
97; Amaurotic Family, 186; and
Dementia Praecox, 368 ; Secondary to
Diseases of Cerebral Vessels, 371
Indoxyluria: in Mental Diseases, 50
Infantile Paralysis, 245 ; Scoliosis in,
286; Resembling Meningitis, 413;
Use of Silk Ligaments in, 515 : vide
Poliomyelitis

Influenza : Psychoses of, 439
Insanity: Alcohol in Etiology of, 48,
511 ; Hysteria and Litigious, 48;
Galvanic Phenomena and Respiration
in, 122; Alcoholic, 123; Hysteria
with Periodic, 124 ; Criminal Respon¬
sibility in, 125; and the Penal Law,
127 ; Alcoholism and, 268 ; Pains in
Manic-Depressive, 268 ; Opsonic Index
to Various Organisms in, 270 ; Paralysis
Agitans in, 315; Forced Speech in
Manic-Depressive, 369 ; Term 44 Manic-
Depressive Insanity,” 869; Simulation
of, 373; Adolescent, 440; Chronic

Delusional, and Epilepsy, 518 ; Modern
Care and Treatment of, 514 ; Pupillary
Phenomena in, 568 ; of Maupassant,
574 ; Thyroid Gland in, 664 ; Simula¬
tion of (Review), 671, 313

Jaw: “ Jaw-winking Phenomenon,”
337; Synchronous Movements of
Tongue and Lower Jaw, 35
Jews : Mental Diseases among, 443

Keratitis : Bacteriology of Neuro¬
pathic, 185
Kernig’s Sign, 40
Korsakow’s Disease, 371, 441, 627

Labyrinth : Destruction of, 646; Acute
Gonorrhoeal Inflammation of, 647;
Relation between Eye and, 92
Landry’s Paralysis, 246 (2), 375 , 710
Larynx ; Parathyreogenic Larvngoapasm,
438; Laryngeal Crisis in Tabes, 652 ;
Palato - laryngeal Hemiplegia, 493 ;
Sensory Fibres in Recurrent Laryngeal
Nerve, 238 ; Recurrent Paralysis, 365
Lenticular Nucleus, 26
Leptothrix Infections, 631
Locomotor Ataxia : vide Tabes Dorsalis
Lumbar Puncture: Gluteal Herpes fol¬
lowing; 38 ; in Cerebro-spinal Menin¬
gitis, 53 ; in Tuberculous Meningitis,
175 : Technique of, in Children, 177 ;
in Optic Neuritis, 205 ; in Meningeal
Forms of Typhoid, 557 ; Paralysis
after Rachistovainisation, 351
Lunatic Asylums: Construction of, 316

Malingering: Sign for Detection of,
662

Maupassant: Insanity of, 574

Melancholia: and Manic-depressive In¬
sanity (Review), 61 ; Recognition and
Treatment of (Review), 64 ; Periodic,
with Hysteria, etc., 124; Homicidal,
440

Meningitis: Serous Spinal, 650, 710;
Acute Aseptic, 714 ; Acute, of Convex¬
ity, 416 ; Pyaemia and, 631; Cerebral
and Cerebro-spinal during Puerperium,
599 ; in Infantile Paralysis Simulating,
413: Systematic Lumbar Puncture in,
53; Surgery of Otogenic, 668 ; in
Mumps, 249 (2) ; in Typhoid, 597 (2);
Gonorrhoeal, 174, 598 ; Acute Syphi¬
litic, 174, 290, 419, 599 ; Tuberculous,
39, 175, 291, 598, 715 ; Epidemic Cere-
bro-spinal, 39, 53, 103, 104, 288, 289,

738

INDICES

353, 417, 418, 489 ; Seram Treatment
of, 852, 417, 600, 715, 716 : vide Cere-
bro-spiual Fluid

Meningococcus Infections, 100; Hydro¬
cephalus from, 418

Mental Diseases: Indoxyluria in, 50;
Obstruction in Nose and Throat as
Cause of, 117; and Crime, 125, 126,
127; Prognosis in Cases showing
Feeling of Unreality, 199 ; Changes of
Blood in (Review), 205 ; Alcohol in
Etiology of, 511, 626: Mental Defec¬
tive in Prison, 575 ; Calvin s Disease,
437; Medical Study of Chateaubriand,
573; De Quincey, 273; in Jews,
443

Mental Disturbances: in Vasomotor
Neuroses, 296; Cranial Trauma and,
369; in Anchylostomiasis, 268 ; in
Unilateral Nasal Obstruction, 627
Menthol Poisoning, 567
Meralgia : Anterior Panesthetic, 245
Mercury Treatment of Metasyphilis of
Nervous System, 127
Methods: New Selective Stain for
Nervous System, 91 ; Simplification of
Nissl’s Stain, 406 ; Principles under¬
lying Weigert’s, 638 ; for Staining
Myeline in Nerve Fibres of Brain ana
Cord, 682 ; for Demonstration of In*
ternal Reticular Apj^aratus of Nerve
Cells, 700

Microcephaly: Neurofibrils in, 97
Middle Ear Disease: Chronic Suppura¬
tion, complicated by Tumour of Pons,
558

Migraine : with Melancholia, 124 ; and
Treatment of the Eyes, 565 ; an Occu¬
pation Neurosis, 618 ; Urinary Con¬
stituents in, 35
Monoplegia : Crural, 358
Movements : of Eyelids, Tongue, and
Lower Jaw in Certain Diseases, 35
Multiple Sclerosis: vide Disseminate
Sclerosis

Mumps : Meningitis in (2), 249 ; Herpes
Zoster and, 660

Muscles: Inhibition, from Excitation of
Ninth Spinal Nerve of Frog, 24;
Strychnine and Reflex Inhibition of
Skeletal, 24 ; End-Plates of, after Sec¬
tion of Nerves, 95 ; Growth in Effici¬
ency after Age of Fifty, 132 ; Contrac¬
tion of, 166 ; Internal, in Oculo-Motor
Paralysis, 184 ; Atrophy of Intrinsic
Hand, and Cervical Ribs, 191 : Re¬
ciprocal Innervation of Antagonistic,
403; Contraction in Strychnine Poison¬
ing, 473 ; Action of Barium Chloride
on, 705

Muscular Dystrophy: Spinal Changes in,

137; Are there 4 ‘Formes Frustea " of ?,
483 ; Case of Old Myopathy, 349
Muscular Movements: Co-ordinationo£
in Central Nervous System, 702
Myasthenia Gravis, 708; Pathology o£
408 ; with Exophthalmic Goitre, 329
Myasthenia : Pseudo-, of Toxic Origin, 1;
Experimental Myasthenic Reaction in
Frog, 150

Myelitis : Disseminated, or Acute Mul¬
tiple Sclerosis, 33
Myeline Forms, 638

Myelomalacia : Traumatic Cervical, 711
Myopathy : Case of Old, 349 : vide Mus¬
cular Dystrophy

Myositis: Progressive Ossifying, in Boy
®t. Eleven, 348
Myxcedema: Incomplete, 565

Nerves : Muscular Inhibition from Ex¬
citation of Ninth Spinal, 24 ; Physical,
Chemical and Electrical Properties of,
25; End-Plates of Muscle after Section
of, 95 ; Freezing of Frog’s, and their
Fatiguability, 166; Regeneration in
Peripheral Segment of, 283 ; Otalgia,
as Sensory Affection of Seventh Cranial,
187 ; Cochlear, in Internal Auditory
Meatus, 236 ; Sensory Fibres in Re¬
current Laryngeal, 238, 365 ; Neuritis
of Circumflex in Diphtheria, 170;
Neuritis of Auditory, 255 ; Stretching
of Median in Spasmodic Contraction of
Finger, 271 ; Regeneration in Peri¬
pheral Segment of, 283 ; Galvanic
Reactions of Auditory, 308 ; Peri¬
pheral, in General Paralysis, etc., 345 ;
Axon Bifurcation in Regenerated, 402;
Injuries of Vagus, 434 ; Fatiguability
of, 472 ; Conductivity of, at Increased
Temperatures, 472; Degenerations fol¬
lowing Injuries to Posterior Roots of
7th Cervical, 643 ; Cliuical Appear¬
ances in Lesions of Vagus Recurrent
and Oculomotor, 645; Gonorrhoeal
Neuritis of Auditory, 649; Rate of
Transmission in Human Medull&ted,
704 ; Neuritis of Deep Palmar Branch
of Ulnar, 709 ; Section of Posterior
Primary Divisions of Upper Cervical,
in Spasmodic Torticollis, 725 ; Divirion
of Auditory, for Painful Tinnitus,
730 ; Inhibitory Fibres in Peripheral,
588; Supposed Existence of Vaso-con-
strictor Fibres in Chorda Tympani
Nerve, 589 ; Origin of Facial, 685;
Cutaneous Branches of Posterior Pri¬
mary Divisions of Spinal, 699
Nerve Cells: Reticular Apparatus of
Golgi-Holmgren, 90; Fibrils and Fib-

INDICES

739

rillogenous Substance in Ganglion, 160;
Studies in, 283 ; Neurofibrils of Motor
Ganglion, 343 ; of Electric Lobe of
Torpedo Oceliata, 471 ; Method for
Demonstration of Internal Reticular
Apparatus of, 700; of Locus Ccerulu9
ana Substantia Nigra, 701

Nerve Centres : Cere bro-spinal (Review),
56 ; Functions of (Review), 327 ; First
Phases of Development of, in Verte¬
brates, 698

Nerve Endings: in Electric Organ of
Torpedo Oceliata, 471

Nerve Fibres : Action of Aconitine on,
94; Living Developing, 241; Course
of Cerebello-Olivary, 544 ; Inhibitory,
in Peripheral Nerves, 688 » Vasocon¬
strictor, in Chorda Tympani Nerve,
589; Vaso-Dilator, in Depressor Re¬
flexes, 589; Primary Lesions of, in
Uremia, 707

Nerve Fibrils : in Dementia Paralytica,
Chronic Alcoholism, etc., 97; in
Ganglion Cells of Vertebrates, 160 ;
Conducting Function of, 242 ; in Pro¬
cesses and Cell-Body of Motor Ganglion
Cells, 343

Nervous Diseases: Obstruction in Nose
or Throat as Cause of, 117 ; Trauma in
Etiology, 117 ; Favourable Influence
of Occupation in, 201 ; Diagnosis of
Organic from Functional, 284

Nervous System: Central, in Alco-
holised Rabbits, 28 ; Central, in Ex¬
perimental Diphtheria, 29 ; Report on
Anatomy of (Review), 57 ; Tumours of
(Review) 321 ; Action of Adrenalin
on, 474; Diseases of (Review), 519;
Structure and Function of Autonomic,
544 ; Diseases of the (Review), 675 ;
Changes in, after Stovaine Anaesthesia,
705 ; Action of Nitrites on Autonomic
Nervous System, 690

Nervousness and Nutrition in Child¬
hood, 708

Neuralgia: and Treatment, 52, 54;
Treatment of Trigeminal by Injection
of Osmic Acid, 55 ; Deep Injections of
Alcohol for Trifacial, 131; Alcohol
Injections for Trigeminal, 202; Ex¬
cision of Gasserian Ganglion, in Tri¬
geminal, 726

Neurasthenia : in the Young, 272 ; Diag¬
nosis and Treatment of, 810; Blood
Pressure in, 564 ; Auto-Suggestion in,
564

Neuritis: Alcoholic, 98 ; Diphtheritic,
of Left Circumflex Nerve, 170;
Lumbar Puncture in Optic, 205; Peri¬
pheral, resembling Tabes, 244 ; of
Auditory Nerve, 255; Acute Retro¬

bulbar, and Multiple Sclerosis, 300;
Secondary to Zona, 350; Optic and
Oculomotor, following Gonorrhoea,
486; of Ulnar Nerve from Deformity
of Elbow Joint, 486; Gonorrhoeal, of
Auditory Nerve, 649 ; Amyotrophic
Polyneuritis, 487 ; in Scarlatinal
Rheumatism, 649 ; Double Optic, fol¬
lowing Varicella, 618; Optic, in
Chorea, 44 ; Occupation, of Deep
Palmar Branch of Ulnar Nerve, 709
Neurotibrils : vide Nerve Fibrils
Neuroglia : Functions of, 587
Neurone Theory : Present Position of,
234

Neurones : Vaso-motor in Shock, 163
Neuroses: Freud’s Sexual Theory of,
192: Mental Disturbances in Vaso¬
motor, 296 ; Migraine, an Occupation
Neurosis, 618 ; Attention Neurosis, 723
Nitrites: Action of on Autonomic Ner¬
vous System, 590

Nose: Disturbance of Psychic Functions
in Unilateral Obstruction of, 627 ;
Cerebral Complications of Nasal Origin,
645; Obstruction in, causing Nervous
and Mental Disease, 117
Nutrition and Nervousness in Child¬
hood, 708

Nystagmus: Influence of Rotatory Move¬
ments on, 306; Mechanism of, 359;
Reflex, in Diagnosis of Condition of
Vestibular Apparatus, 436

Occupation : Favourable Influence in
Nervous Disorders, 201; Neuritis of
Ulnar Nerve, 709

Ocular Movements : Paralysis of Upward
Associated, 361; Partial Ptosis with
Exaggerated Involuntary Movement of
Affected Eyelids, 337; Conjugate, of
Eyes and Head, 306

Oculo-motor Paralysis : without Involve¬
ment of Internal Muscles, 184, 805 ;
Clinical Appearances in, 645; following
Gonorrhoea, 485

Ocular Nerves: Paralysis of Abduoens,
305, 350 : vide Eyes, ocular movements
and oculo motor paralysis
(Edema: of Optio Disc in Angioneurotic,
257 ; Persistent Hereditary, of Lower
Extremities, 663
Ophthalmia: Sympathetic, 436
Ophthalmo Reaction: to Tuberculin, 117
Opsonic Index : to Various Organisms in
Control and Insane Cases, 270
Optic Atrophy: Unilateral, with Hemi¬
plegia, 494 ; and Tower-shaped Skull,
550

Optic Neuritis: in Chorea, 44; Lumbar

*740

INDICES

Puncture in, 205; after Gonorrhoea,
485 ; after Varicella, 618
Orientation : Disorders of, 112
Otalgia : Sensor}” Affection of Seventh
Cranial Nerve, 187

Otitis: Sinus Thrombosis after Purulent,
181

Pain : Subcutaneous Injections of Air
for Belief of, 52

Palato-Laryngeal Hemiplegia, 498
Paralysis: Arthrodesis and Tendon
Transplantation in, 203, 317; after
Rachistovainisation, 351
Paralysis Agitans : Parathyroid Gland
for, 131 ; in Insane Epileptic, 315;
Symptomatology of, 615
Paralytic Dementia: vide General
Paralysis

Paranoia: in Degenerates, 196
Paraplegia: due to Intra-medullary
Lesion, 173; with Acromegaly, 256 ;
Family Spastic, 352; Acute, after
Anti-Rabic Inoculation, 415
Parathyroid Gland: for Paralysis Agitans,
131 ; and Laryngeal Spasm, 433
Paresis: Non-traumatic Pseudo-spastic,
112 : vide General Paralysis
Parkinson’s Disease: vide Paralysis
Agitans

Periarteritis Nodosa, 198
Petrosal Ganglion: Herpes, due to
Zosteroid Affection of, 619
Petrol: Fumes causing Pseudo-Myas¬
thenia, 1

Pituitary : Development of Mammalian,
340; Histological Appearances of
Mammalian, 341 ; Posterior Lobe of,
843 ; Physiological Action of Extracts
of, 344 ; Hypertrophy of, after Ex¬
cision of Thyroid, 546; Physiology of,
641: vide Tumours
Plexus Palsy, 624

Poliomyelitis: Acute Anterior, 80;
Anterior, in Adult, 98, 605; Acute, and
allied Diseases, 99 ; Recent Epidemic,
171 ; Acute, with Diplococcal In¬
fection of Spinal Sac, 245 ; Scoliosis
in, 286; Orthopaedic Therapy of Acute
Anterior, 318; Acute (Review), 324 ;
Epidemic Acute (Review), 326 ; Heine*
Medin Disease (Review), 324 ; Pos¬
terior, of Geniculate Ganglion,
485 ; Silk Ligaments in, 515;
Anterior, of Specific Origin, 554;
76 Cases of Acute Anterior, 554;
Clinical Picture of, caused by
Disease of Primary Motor Neurones,
555 ; Cerebro-spinal Fluid in Anterior,
651; Resembling Meningitis, 418 ;

in Massachusetts in 1907, 604;

Epidemic, 604; Nerve Anastomosis
in, 630 ; Epidemiology of Acute, 602 ;
Acute, following Tonsillitis, 709;
Chronic Anterior, 709
Polioencephalomyelitis, 354, 492
Polyarteritis Acuta Nodosa, 193
Polyneuritis: Amyotrophic, 487
Pons : Haemorrhage into a cause of Death
in Eclampsia, 250; H aemangioma in,
852

Protagon: Chemical Composition, etc.,

164

Pruritus: in Tabes, 100, 607
Pseudo-bulbar Paralysis, 179, 357 ; with
Loss of Voluntary Respiration, 178
Psych asthenia, 269, 310
Psychiatry: Psychopathic Intoxication,
47; Sexual Traumata as Form of
Infantile Sexual Activity, 50; Secre¬
tion of Gastric Juice in Psychopatbo-
logical Conditions, 51 : Freud’s
Theory and its Significance in Kraepe-
lin’s Manic-depressive Insanity (Re¬
view), 59: Obsessional States, 128 ;
Cerebro-spinal Fluid in, 207 ; Outlines
of (Review), 272 ; Insanity, Simula¬
tion and Criminality, 313 ; Expert
Evidence in Criminal Proceedings,
816; Co-operation of Alienist in Case
of Defectives, 373 ; “Zwang” Pheno¬
mena, 438 ; Mental Diseases among
Jews, 443 ; Protection of Society from
Criminal Lunatics, 629 ; Abolition of
Use of Tobacco in Lucca Asylum, 629 ;
Manual of (Review), 731
Psychology: of Neurotic Symptoms
(Review), 58 ; Study of Thomas de
Quincey (Review), 273; Elements of
(Review), 319; A Mind that found
Itself (Review), 328 ; Alfred de Musset
(Review), 329 ; Crowd Suggestion and
Psychical Epidemics (Review), 380;
The Moltke Case (Review), 880;
Bismarck im Lichts der Naturwissen-
schaft (Review), 376; Co-conscious
Ideation, 406; Coloured Thinking,
475 ; Psycho-Galvanic Reactions from
Co-conscious Ideas in Multiple Per¬
sonality, 478 ; Articulatory Capacity
for Consonantal Sounds in Children,
243, 548; Ideas of Children, 549;
Classification of Methods, 549; Calvin,
437; Rousseau, 437 ; Chateaubriand,
573

Psychopoly neuritis: Chronic, 371
Psychoses : Climacteric, 123 ; Classifica¬
tion of, 195; Acute Traumatic, 201 ;
Peripheral Nerves in, 345; Speech
Disturbances in Functional, 428; of
Influenza, 489 ; Combined, 513;

INDICES

741

Psycho-Analytic Method and “Ab-
wenrneuropsychosen ” of Freud, 572 ;
Hypnoidization in Treatment of
Functional, 629

Psychotherapy : Various Forms of, 55
Ptosis: vide Ocular Movements
Puncture of Brain, 724
Pupils : in Chorea, 191 ; Sensitiveness to
Light and Size of, 239; Diagnostic
Meaning of Symptoms in, 265 ; Physi¬
ology and Pathology of Movements of,
301 ; Eserin in Disorders of, 303;
Peculiar Phenomenon and Hysterical
Immobility of, 303; Eye-Movements
in Cerebellar Irritation, 304; Diag¬
nostic Value of Immobility and Slug¬
gishness, 362 ; in Insanity, 568;
Convergence Reaction with Reflex
Immobility of, 644 ; Spinal Cord in
Absence of Pupillary Light Reflex, 307
Pyaemia: with Meningitis, 631

Rachistovainisation : Paralysis after,
351

Recklinghausen’s Disease, 623
Reflexes: Course of Afferent Portion of
Arcs, 161 ; Inhibition and Excitation,
163 ; Time taken in Transmission of
Impulses, 164 ; in Scarlet Fever, 183 ;
Foot-Clonus, 183; in Infancy, 237;
Ankle-Clonus in Hysteria, 263; “Fly-
catching” in Frog, 401 ; Dissociation
of, in Hysteria, 426 ; Toe Reflex, 432;
Unilateral Loss of Knee Jerk in Tabes,
487 ; Mechanism of Babinski’s Sign,
502; Significance of Tendo Achillis
Jerk, 504; Bui bo-cavernous Reflex in
Dementia Prsecox, 665; Excitation of
Vaao-DilatorNerveFibres iuDepressor,
589 ; Abdominal, 622 ; Transmission
of, in Spinal Cord, 164
Regeneration : in Peripheral Segment of
Nerve, 283

Reap iration : in Normal and Insane, 122 ;
Mechanism, after Isolation from Ex¬
trinsic Nerve Impulses, 93; Changes
in, of Central Origin, 364 ; Loss of, in
Pseudo-bulbar Paralysis, 178
Retrobulbar Neuritis in Disseminated
Sclerosis, 300

Reviews: Centres Nerveux Clrlbro-
sniuaux (Van Gehuchten), 56; Bericht
iiber die Leistungen auf dem Gebiete
der Anatomie des Centralnerven-
systems (Edingerund Wallenberg), 57 ;
Psychology and Treatment of Neurotic
Symptoms(Muthmann),58; Freud’sche
Iaeogenitatsmoment, etc. (Cross), 59;
Die Melancholic, etc. (Dreyfus), 61;
Erkennungund Behandlung der Melan¬

cholic (Ziehen), 64; Arbeiten ans dem
neurologischen Institute (Marburg),
133; Arbeiten aus der deutschen
psychiatrischen Universitats-Klinik in
Prag (Pick), 138; Progressive Allge-
raeine Paralyse (Krafft-Ebing), 134;
Borderland of Epilepsy (Gowers), 184 ;
Notwendige Reformen der Unfall-
versicherungsgesetze (Hoche), 135 ;
Mouvement Mystique Comtemporain
(de Fursac), 135; Aerztliches liber
Sprechen und Denken (Anton), 136;
Blood Changes in Mental Diseases
(Galdi), 205 ; Outlines of Psychiatry
(White), 272; £tude M6dico-psycho-
logique sur Thomas de Quincey
(Guerrier), 273; Elements of Psycho¬
logy (Mellone and Drummond), 319 ;
Tumours of Nervous System (Bruns),
321 ; Acute Poliomyelitis (Wickman),
324 ; Heine-Medin Disease (Wickman),
324 ; Norwegian Epidemics of Polio¬
myelitis (Harbitz and Scheel), 326;
Functions of Nerve Centres (Bechterew),
327; Treatment of Exophthalmic
Goitre (Sainton and Delhermo), 327 ;
A Mind that Found Itself (Beers), 328 ;
Medico-Psychological Study of Alfred
de Musset (Odinot), 329 ; Crowd Sug¬
gestion (Gudden), 330 ; Psychology of
the Moltke Case (Merzbach), 330;
Major Symptoms of Hysteria (Janet),
374 ; Bismarck im Lichte der Natur-
wissenschaft (Lomer), 376; Titres et
Travaux Scientifiques du Docteur
Pierre Marie, 377 ; University of
Pennsylvania, Contributions from
Department of Neuropathology, 377 ;
Archiv fur Geschichte der Medirin
(Sudhoff), 377 ; Classification of
Criminals (Ingegnieros), 444 ; Influ¬
ence of Alcohol, etc., on Fatigue
(Rivers), 445; Nuclei of Spinal Cord
(Jacobsohn), 446 ; Structure of Ner¬
vous Central Organs (Edinger), 516;
Anatomy of Brain and Cord (Harris
Santee), 518 ; Modern Clinical Medi¬
cine—Diseases of Nervous System, 519;
Psychology and Psychiatry in Hesse
(Balser, Aull, and Waldschmidt), 519;
Simulation of Insanity (Mairet), 671;
Diseases of Spinal Cord (Williamson),
674; Diseases of Nervous System(Camp-
bell-Thomson), 675; Manual of Psy¬
chiatry (Roques de Fursac), 731
Rheumatism: Neuritis in Scarlatinal,
649

Scarlet Fever : Reflexes in, 183 ; Hemi¬
plegia following, 530; Neuritis in

742

INDICES

Scarlatinal Rheumatism, 649; and
Uraemia, 724

Sciatica, 430; and Disease of Hip-Joint,
313

Sclerosis: Amyotrophic Lateral, 99;
Tuberose, 292 ; Cerebral, of Pseudo-
Bulbar Type in Children, 367
Scoliosis: in Infantile Paralysis, 286
Sea-Sickness : Pathogeny and Treatment
of, 311

Senescence : Relation of Family Diseases
to Premature Physiological, 595
8ensation : Conduction of in Spinal Cord,
703 ; Disturbances of Cerebral Origin
and Spinal Type, 499; Integrity of,
in Lesion of Left Parietal Lobe, 501 ;
Bone, 501 ; Phrictoj>athic, 562 ; Pain
Sensation in Comparison of Spinal
Cord, 414 ; Upright Position main¬
tained by Sensation from Joints (?),
162

Sensibility: Effect of Mental Work on
Auditive, Visual and Tactile, 347
Sera : “ Neurotoxic ” and Lesions in¬
duced by them, 27, 345 ; Serodiag-
nosis in Psychiatry and Neurology,
651 ; Serum Diagnosis of Syphilis,
298; Washermann’s Serum in Diag¬
nosis of, 261, 262 ; Serum Treatment
of Diphtheritic Paralysis, 728 ; Effect
of Cholesterin on, 480
Shock : Vasomotor Neurones in, 163
Sinuses: Acute Suppuration of Sphen-
oidol, 423 ; Amblyopia after Suppura¬
tion of Accessory, 437 ; Operation in
Chronic Inflammations of Frontal,
559 ; Sinus Thrombosis after Purulent
Otitis, 181 ; Thrombosis of Superior
Longitudinal and Lateral, 719 ;
Thrombosis of Cavernous, 720
Skull: Injuries of, 100; Tower-shaped,
550

Sleep, 21 ; Experimental Study of, 408,
477, 592; Recurrent Autohypnotic,
562; Morbid Somnolence, 311
Somnambulism: Spontaneous, 263
Spasmodic Contraction of Finger: cored
by stretching Median Nerve, 271
Speech : Disturbances of, in Functional
Psychoses, 428 : vide Aphasia
Spina Bifida : Treatment by Drainage of
Cerebral Subdural Space, 667
Spinal Cord : Anatomy : Nuclei of
Human (Review), 446 ; Resemblances
between Human and Animal, 470;
Mechanism and Function, etc. (Re¬
view), 518; Middle Cells of Grey
Matter, 584

Spinal Cord : Physiology : Affinity for
Strychnine and Cocaine, 94 ; Time
taken in Transmission of Reflex Im¬

pulses in, 164; Reflex Excitability
after Cerebral Anemia, 344 ; Sensory
Conduction in, 708

Spinal Cord : Pathology : Changes in
Muscular Dystrophy, 137 ; in General
Paralysis, 168; Peripheral Degenera¬
tion Revealed by Longitudinal Section
and Axis-Cylinder Stain, 173; in
Absence of Pupillary Light Reflex. 307;
after Nerve-Crossing and Nerve-Graft¬
ing, 405 ; Lesions in Experimental
Caisson Disease, 479 ; Posterior Colnnm
Degenerations following Injury to
Posterior Roots of Seventh Cervical
Nerves, 643 ; Histology of Lympho¬
genous and Hematogenous Toxic
Lesions of, 593; Lesions in Anterior
Horn Cells in Nervous Arthropathies,
594

Spinal Cord: Clinical : Subacute Com¬
bined Degeneration, 413 ; Pain Sensa¬
tion in Compression of, 414 ; Diseases
of the (Review), 674 ; Disease of
Primary Motor Neurones from Poison¬
ing by Cyanide of Potassium, 555 ;
Pseudo-systemic Disease of, 608 ; Uni¬
lateral Cauda Equina Syndrome, 611;
Idiopathic (< Meningitis Spinalis Serosa
Circumscripta,” 710 ; Traumatic Affec¬
tions of, 711

Spine: Ankylosing Diseases of, 12 , 66 ;
Sprain of, 556

Spondylitis: after Dengue, 115 ; Gonor¬
rhoeal, 193

Stereognosis and Symboly in Lower
Extremities, 502

Stovaine Anaesthesia: Changes in Nervous
System after, 705

Strychnine and Reflex Inhibition of
Skeletal Muscle, 24 ; Affinity of Spinal
Cord for, 94 ; Contraction of Muscle
in Poisoning by, 478; Action of, 640 ;
Antagonistic Action of Parts of Brain
to, 641

Stupor : in Alcoholism, 258

Subacute Combined Degeneration of
Spinal Cord, 413

Syphilis : Cerebro-spinal or Disseminated
Sclerosis, 34 ; General Paralysis and
Cerebral, 46; Epiconus Symptom-
Complex in Cerebro-Spinal, 77 ; Neuro¬
fibrils in Cerebral, 97 ; Syphilogenons
Diseases of Central Nervous System,
104 ; Mercury Treatment and Meta-
sjrohilis of Nervous System, 127;
Wassennann's Serum, Diagnosis of (2),
261, 262, 572; General Paralysis in
Third Year of, 267 ; Ascending Par¬
alysis in, 275; Multiple Lesions, 293 ;
Serum Diagnosis of, 298; Congenital,
300 ; Precocious Hemiplegia in Second-

INDICES

743

ary, 659 ; Nervous Syndrome in
Secondary, 662; Syphilitic Meningitis,
174, 419 ; Syphilitic Spinal Paralysis,
488 ; Cerebro-spinal Fluid in Congeni¬
tal, 297

Syphilomania and Syphilophobia, 442
Syringobulbia, 172, 555, 652
Syringomyelia: Lesion in Catatonic
Stupor, 26; and Acromegaly, 108;
and Cheiromegaly, 172; with Bulbar
Phenomena and Trophic Disturbances,
172; Case of Spasmodic (?), 390 ; with
Syringobulbia, 555 ; Cervico-Bulbar,
commencing with Hiccough, 652 ;
Segmental Hypertrophy of Arm in,

Tabss Dorsalis: Postcentral Cortez in,
6; with Diseases of Heart and Vessels,
85 ; Pruritus in, 100 ; with Periodic
Melancholia, 124 ; Peripheral Neuritis
resembling, 244 ; Some Years after
Infection, 246 ; Osteo-Arthritic Mani¬
festations of, 286; Syphilitic, 298;
Re-educative Treatment of, 851; Gait
in, 409; Juvenile, 412, 418; Unilateral
Loss of Knee-Jerk in, 487 ; Patho¬
genesis of, 551 ; without Lightning
Pains, 553 ; in Mother and Syphilis in
Infant, 553 ; Etiological Treatment of,
554; Laryngeal Crisis and Paresis of
Abductors of Vocal Cord in, 652;
Cerebro-spinal Fluid in Diphtheritic
Pseudo-Tabes, 712; Ocular Manifesta¬
tions of, 605 ; associated with Trophic
Changes suggesting Acromegaly, 607 ;
Pruritus in, 607
Tachycardia: Paroxysmal, 45
Temperature and Excitability, 165
Tendon Operations: in Spinal and
Cerebral Palsies, 203, 817
Tetany: Tetanoid States in Childhood,
44 ; Hysterical Pseudo-, 192
Thrombosis : Sinus, after Chronic Puru¬
lent Otitis, 181 ; of Superior Longi¬
tudinal and Lateral Sinuses, 719; of
Cavernous Sinuses, 720
Thyroid: Vaso-Motor Innervation of,
546; Hypertrophy of Pituitary after
Excision of, 546; in Insanity, 664 ;
Parathyreogenic Laryngospaam, 483
Thyroidism : Blood in, 721
Tic-Doloureux: vide Neuralgia
Tinnitus : and Vertigo, etc., 646 ; Divi¬
sion of Auditory Nerve for, 730
Tongue : Synchronous Movements of
Lower Jaw and, 85

Tonsillitis: Acute Poliomyelitis follow¬
ing, 709

Torticollis : 862 ; Mental, 372, 618 ;

Surgical Treatment in Mental, 372,
725

Trauma: Skull Injuries, 100; in Eti¬
ology of Nervous Diseases, 117 ; Acute
Psychoses in, 201; Cranial and Mental
Disorder, 369; Traumatic Affections
of Spinal Cord, 711

Treatment: of Eclampsia, 53; of
Arteriosclerotic Atrophy of Cerebrum,
54 ; of Neuralgia, 54, 55 ; of Neurotic
Symptoms (Review), 58
Tremor: Post-Apoplectic, 180; Here¬
ditary, 623

Trophcedema: Chronic, 364
Tuberculin : Ophthalmo-Reaction to,

Tuberose Sclerosis, 292
Tumours: Brain: of Pituitary Duct,
110; Cortical Changes in, 169 ; with
Jacksonian Spasm, etc., 178 ; Tubercle,
in Childhood, 181 ; of Nervous System
(Review), 321 ; Haemangioma in Pons
Varolii, 352; Diagnosis of, 422; in
Cerebello-Pontine Angle, 494 ; Symp¬
toms of Pontine, 495 ; Cerebellar, with
Proptosis, 496 ; Papilloma of Choroid
Plexus, 496 ; of Pons, complicated
Middle Ear Suppuration, 558 ; of
Frontal Lobe Simulating Paresis, 560 ;
Case of Intracranial, 677; of Central
Nervous System, 612, 677 ; Localised
and Removed, 614; Cerebellar and
Extra-Cerebellar, 718
Tumours: Spinal; Surgical Treatment
of, 128; of Cauda Equina and Lower
Vertebrae, 287;) of Central Nervous
System, 612, 677; Surgical Treatment
of, 729

Tiirck: Origin of Bundle of, 91
Typhoid: Epileptiform Convulsions and
Hemiplegia in, 87, 177 ; Bacilli in
Cerebro-spinal Fluid in, 491, 597;
Lumbar Puncture in Meningeal Forms
of, 557 ; Intracranial Abscess from
Typhoid Bacillus, 249; Meningitis,
597

Ulnar Nerve: Occupation Neuritis of,
709

Uraemia: Aphasia and Hemiplegia in,
560 ; Primary Lesions of Nerve Fibres
in, 707; Postscarlatinal Convulsive,
724

Vagus Nerve: Injuries of, 434, 645
Vertigo : and Tinnitus, etc., 646 ; Divi¬
sion of Auditory Nerve for, 780
Vestibular Apparatus: Reflex Nystag-

744

INDICES

nmi in ^Diagnosis of Condition of, Wedensky Inhibition, 24
436

Vocal Cords: Paresis of Abductors of,

in Tabes, 652 X-Rays : Action on Eye in Course of

Development, 242

Wasszbmann’s Sernm Diagnosis of
Syphilis, 261 (2), 262, 572 Zona : vide Herpes

INDICES

745

INDEX OF

Abadie and Nogue. Tabes without
Lightning Pains, 553
Abraham, K. Sexual Traumata as
Form of Infantile Sexual Activity, 50
Achard. Gluteal Herpes after Lumbar
Puncture, 38

Ackermann. Skull Injuries, 100
Acuna. Acute Polio-Encephalomyelitis
in Boy of Three, 492
Adam, James. Spasmodic Contraction
of Finger cured by Stretching Median
Nerve, 271

Adamkiewicz. Pseudo-Hysterical Hemi¬
plegia, 253

Alder, S., and Kurt Mendel. Serous
Spinal Meningitis, 650
Alcock and Lynch. Physical, Chemical,
and Electrical Properties of Nerves, 25
Alessi. Lesions of Cortex in Alcoholics,
346

Alexander, G. 8urgery of Otogenic
Meningitis, 668

Alexander and Obsteiner. Cochlear
Nerve in Internal Auditory Meatus,
236

Alger. Migraine and Treatment of Eyes,
565

Alquier and Raymond. Pseudo-Bulbar
Paralysis, 179 ; Rleklinghausen’s Dis¬
ease, 623

Allen. Diagnostic Sign in Recurrent
Laryngeal Paralysis, 365
Amberg, Emil, derebral Abscess, 720
Anglaae and Calmettes. Senile Cere¬
bellum, 346

Anglade and Jacquin. Dementia Pre-
cox, with Autopsy, 665 jj
Anton. Sprechen und Denken (Review),
136; Psychic Disturbances in Uni¬
lateral Nasal Obstruction, 627
Apert, M. E. Amaurotic Family Idiocy,
186 ; Herpes Zoster and Mumps, 560
Archambault, La Salle. Acute Anterior
Poliomyelitis in Adult, 605
Artom and Lhermitte. Syringomyelia,
with Cheiromegaly, 172
Atlee and Mills. Brain Tumour, with
Jacksonian Spasm, etc., 178
Atwood Influence of Occupation in
Nervous Disorders, 201
Audry. Syphilomania and Syphilo-
phobia, 442

AUTHORS.

Aull, Balser, and Waldschmidt. Alco¬
holism, etc. (Review), 519
Austregesilo and Gotuzzo. Mental Dis¬
orders of Auchylostomiasis, 268
Ayer, J. B., and Henrv Cotton. Cyto-
logical Study of Cerebro-Spinal Fluid,
207

Babinski. Alooholic Neuritis, 98
Bachmann. General Paralysis in Chil¬
dren, 266

Bade. Tendon Operations in Spinal
and Cerebral Palsies, 203
Ballet and Barb6. Syphilitic Meningitis,
419

Baldi. Abdominal Reflex, 622
Ballance, Charles A. Division of
Auditory Nerve for Painful Tinnitus,
730

Ballet and Laignel-Lavastine. Old
Myopathv, 349

Balser, Aull, and Waldschmidt Alco¬
holism, etc. (Review), 519
Barbe and Ballet Syphilitic Men¬
ingitis, 419

Barbe and Deny. Syringomyelic Lesion
in Catatonic Stupor, 26
Barie and Lian. Epileptiform Convul¬
sions and Hemiplegia in Typhoid, 37
Barile. Optic ana Oculomotor Neuritis
following Gonorrhoea, 485
Barrett ana Mitchell. Posterior Column
Degenerations following Injuries to
Posterior Roots of Seventh Cervical
Nerves, 643

Barschinger. Sciatica, 430
Barth. Organio and Functional
Aphonia, 113

Bartlett and Holt. Epidemiology of
Acute Poliomyelitis, 602
Basler, Adolf. Contraction of Frog's
Muscle in Strychnine Poisoning, 473
Bayliss, W. M. Vaso-Constrictor Fibres
in Chorda Tympani Nerve, 589; Ex¬
citation of Vaso-Dilator Merve Fibres
in Depressor Reflexes, 589
Beadles. Aneurisms of Larger Cerebral
Arteries, 36

Bechterew. Functions of Nerve Centres
(Review), 327

Beduschi. Acromegaly with Osteo-
Arthropathies and Paraplegia, 256

746

INDICES

Beck, A. Fatiguability of Nerves, 472
Beers. A Mind that found Itself
(Review), 328

Beevor, C. E. Pseudo-Bulbar Paralysis
with Loss of Voluntary Respiration,
178 ; Co-ordination of Single Muscular
Movements in Central Nervous Sys¬
tem, 702

Bellay and Tribondeau. Action of X-
Rays on Eye in Course of Develop¬
ment, 242

Benigni and Ziloochi. Dementia Pre-
oox, 569

Bennecke. Epidemic Cerebro-Spinal
Meningitis, 39

Berger, Hans. Climacteric Psychoses,
123

Berkeley. Parathyroid Gland in Treat¬
ment of Paralysis Agitans, 131
Beru hard, Nobecourt and Harvier.
Post-Scarlatinal Convulsive Uremia,
724

Bernhardt. Facial Paralysis, 362
Bernstein. Value of Lumbar Puncture,
175

Bethe. Conducting Function of Neuro-
fibrils, 242

Biach, Paul. Resemblances between
Human and Animal Spinal Cords, 470
Bianchi. Development of Nerve Centres
in Vertebrates, 698

Biehl. Relation between Labyrinth and
Eye, 92

Bienfait. Torticollis, 362
Bikcles. Spinal Cord after Nerve-Cross¬
ing and Nerve-Grafting, 405
Bikel les and Fromowicz. Afferent Portion
of Reflex Arcs, 161

Bioglio. Urinary Constituents in Hemi-
cranias, 35

Blanchetiere, Claude, and Schmiergeld.

Scrum of Epileptics, 365
Bleuler and Jung. Dementia Pnecox, 367
Bloch, Ernst. Freud’s Sexual Theory of
Neuroses, 192

Bloch and Hechinger. Anosmia in
Temporo-Sphenoidal Abscess, 654
Bokay, von. Lumbar Puncture in
Cerebro-Spinal Meningitis, 53
Bolton, Charles, and S. H. Brown.
Pathological Changes in Experimental
Diphtheria. 29

Bono, A. M. Family Spastic Paraplegia,
352; Trophic Disorders in Hysteria,
426

Booth, J. Arthur. Myasthenia Gravis
Pseudo-Paralytica, 708
B' schi. Nervous Syndrome in Secondary
Syphilis, 662

Boston, L. Napoleon. Delirium Tremens,
200

Bouchaud. Amyotrophic Lateral Scler¬
osis, 99

Bouchut and Mouriquand. Heart Failure
in Exophthalmic Goitre, 566
Boulenger. Chronic Alcoholism in a
Child, 366

Bourilhet. Paralysis Agitans in Insane
Epileptic, 315

Boycott and Damant. Spinal Lesions in
Caisson Disease, 479

Bradford, John Rose. Certain Aneurisms
of Cerebral Vessels, 720
Bramwell, Byrom. Analysis of 76 cases
of Poliomyelitis Anterior Acuta, 554
Bramwell, Edwin. Intracranial Tumour,
577

Bratz. Etiology of Epilepsy, 721
Bregman. Acute Ataxia, 111 ; Total
Anaesthesia, 500

Brissaud and Sicard. Trigeminal
Neuralgia treated by Injections of
Alcohol, 202

Brown, R. Dods. Psychoses of Influenza,
439

Brown, S. H., and Charles Bolton.
Pathological Changes in Experimental
Diphtheria, 29

Browne, J. G. Epidemic Cerebro-spinal
Meningitis, 353

Bruce, Alexander. Spasmodic Syringo¬
myelia (T), 390; Aneurism of Internal
Carotid Artery and Cavernous Sinus,

462

Bruce, Alexander, and J. H. Harvey
Pirie. Origin of Facial Nerve, 685
Bruce, Pirie, and Macdonald. Aneurism
of Anterior Cerebral Artery, 449
Bruce, W. Ironside. Sciatica and Hip-
joint Disease, 313

Bruns. Surgical Treatment of Spinal
Tumours, 128 ; Tumours of the
Nervous System (Review), 321 ;
Idiopathic “Meningitis Spinalis
Serosa Circumscripta,” 710
Buchanan, Florence. Time taken in
Transmission of Reflex Impulses, 164
Bumke. Diagnostic Meaning of Pupil¬
lary Symptoms, 265; Pupillary
Movements, 301

Bumm. Treatment of Eclampsia, 53
Burn and. Unilateral Loss of Knee Jerk
in Tabes, 487

Burr, C. W. Mental State in Chorea,

563

Byschowski. Cutaneous and Tendon
Reflexes in Infancy, 237

Cajal, S. R. Reticular Apparatus of
Golgi-Holmgren, 90

G&lligaris. Cells of Locus Coeruleus and
Substantia Nigra, 701

INDICES

747

Calmettes and Anglade. Senile Cerebel¬
lum, 846

Camp, Carl D. Traumatic Cervical
Myelomalacia, 711

Cantley. Cerebro-spinal Meningitis,
103

Carles and Rocaz. Lumbar Puncture in
Meningeal Forms of Typhoid, 557
Carmichael, E. Scott. Leptothrix In¬
fections, 631

Caro. Blood in Exophthalmic Goitre
and Thyroidism, 721
Carpenter, George. Chorea with Double
Optic Neuritis and Hyperpyrexia, 44
Carr, Harvey. Psycholeptic Attacks of
Hysterical Origin, 264
Carraro and Salviolo. Physiology of
Pituitary Body, 641

Carver and Fairbairn. Haemorrhage
into Pons Varolii in Eclampsia, 250
Cassirer and Loeser. Rotatory Move¬
ments and Nystagmus, 306
Cassirer and Maas. Chronic Anterior
Poliomyelitis, 709

Catola. Amyotrophic Polyneuritis, 487
Cazacon and Parhon. Chronic Troph-
cedema, 364

Celler and Mandelbaum. Pathology of
Myasthenia Gravis, 408
Cerle tti. Perivascular Corpuscles in
Cerebral Substance, 20
Chabbert. Acute Aseptic Meningitis,
714

Champy and Etienne. Cellular Lesions
of Anterior Horns in Nervous Arthro¬
pathies, 594

Chardinal and Guimaraes. Pupillary
Phenomena in Insane, 568
Charpentier and Dupouy. Cranial Trau¬
matism and Mental Disorder, 369
Charpentier and Dupr6. Chronic Psycho-
pofyneuritis, 371

Chartier and Sollier. Cervico-Bulbar
Syringomyelia commencing with Hic¬
cough, 652

Chavernac. Double Optic Neuritis fol¬
lowing Varicella, 618
Ch6n6. Diphtheritic Paralysis, 170
Cimorini. Hypertrophy of Pituitary
after Excision of Thyroid, 546
Claisse and Toltrain. Acute Syphilitic
Meningitis, 290

Claparede. Definition of Hysteria, 41 ;

Psychological Methods, 549
Clark, L. Fierce. Nocturnal Petit Mai
Cured by Large Doses of Bromide, 202
Clark, L. Pierce, and Tyson. Eye
Syndrome of Dementia Prsecox, 570
Claret and Landowski. Polynucleosis of
Cerebro-Spinal Fluid in Tubercular
Meningitis, 89

Claude and Raymond. Pontine Tumours^
495

Claude and Levi-Valeusi. Juvenile
General Paralysis, with Apraxic Symp¬
toms, 666

Claude, Schmiergeld, and Blanchetiire.

Serum of Epileptics, 865
Cllrarobault, G. G. de. Psychopathic
Intoxication with Transformation of
Personality, 47

Clot, R. Tuberculous Meningitis in
Infants, 291

Cocks and MacKenty. Headaches from
Pathological Condition of Nose, etc.,
866

Collier, James, and S. A. K. Wilson.

Amyotonia Congenita, 481
Collins, Joseph. Acute Anterior Polio¬
myelitis, 30 ; Psychasthenia, 310
Collins, Joseph, and H. S. Martland.
Disease of Primary Motor Neurones,
etc., 555

Collins and Southard. Gliotic Cyst
of Right Superior Parietal Lobule,
182

Comby, J. Ophthalmo-Reaction to
Tuberculin, 117

Commandeur. Cerebral and Cerebro-
Spinal Meningitis during Puerperium,
599

Conzen. Tendo Achilles Jerk, 504
Cornell, W. B. Cerebro-Spinal Fluid in
Paresis, 121

! Cottentot and Dufour. Tabes in Mother
and Syphilis in Infant, 553
Cotton, Henry. Alcohol in Etiology of
Mental Disease, 511

Cotton, Henry A., and J. B. Ayer.
Cytological Study of Cerebro-Spinal
Fluid, 207

Coughlin. Cerebral Abscess with Masked
Symptoms, 424

Courtney. Psychasthenia, 269
Coux, R. de. Acute Syphilitic Menin¬
gitis, 599

Cramer. Treatment of Arterio-sclerotic
Atrophy of Cerebrum, 54
Cramer and Wilson. Protagon: its
Chemical Composition, etc., 164
Crawford, Wm. Headache and Eye-
strain, 428

Cristiani. Use of Tobacco in Lucca
Asylum, 629

Crouzon and Doury. Gonorrhoeal Spon-
dylytis, 193

Crouzon and Villaret. Acute Ascend¬
ing Paralysis of Syphilitic Origin *

276

Currie and MacGregor. Serum Treat¬
ment of Cerebro-spinal Fever in Glas¬
gow Fever Hospital, 716

748

INDICES

D’Abundo. Word-Blindness with Agra¬
phia in Left-handed Hemiplegia, 509
Pamant and Boycott Spinal Lesions in
Caisson Disease, 479
Dana, C. L. Functions of Corpora
Striata, 254

Davids, H. Eye Findings in General
Paralytics, 441

Davies, H. Morriston, and G. Hall.

Neuropathic Keratitis, 185
Davis. Meningococcus Infections, 100
DawBon, W. R. Alcohol and Mental
Disease, 626

Deane. Thrombosis of Superior Longi¬
tudinal and Lateral Sinuses, compli¬
cated by Pregnancy, 719
Debove. Multiple Syphilitic Lesions, 298
Debray. Conjugate Deviation of Eyes
and Head, 306

D&jerine-Klumpke, Madame. Complete
Radicular Paralysis of Brachial Plexus
with Oculo-Pupillary Phenomena, 624
Delachanal and Massia. Ocular Mani¬
festations of Tabes, 605
Delherme and Sainton. Treatment of
Exophthalmic Goitre (Review), 327
Delille, Armand, and Giry. Cerebral
Sclerosis of Pseudo-Bulbar Type in
Children, 357

Dench. Otitic Brain Abscess, 40
Deny and Barb£. Syringomyelic Lesion
in Catatonic Stupor, 26
Deny and Maillard. Bilateral Motor
Apraxia, etc., 657

Dercum. Aphasia with Integrity of Left
Third Frontal Convolution, 36; Tumour
of Frontal Lobes, 660 ; Tabes with
Trophic Changes suggesting Acro¬
megaly, 607

Descomps and Sicard. Mental Torti¬
collis of Brissaud, 372
Desplats. Segmental Hypertrophy of
Arm in Springomyelia, 653
Desplats, Ron£. Electrical Treatment
of Facial Tic-Douloureux by Introduc¬
tion of Salicylic Ion, 52
Dickson, W. Carnegie. Polyarteritis
Acuta Nodosa and Periarteritis
Nodosa, 193

Dieulafoy. Multiple Relapsing Gan¬
grene of Arms and Foot, 567
Dighton. Progressive Ossifying Myositis
in Boy of Eleven, 348
Dijon. XVIII* Coogrfes de M&lecins
Alidnistes et Neurologistes de France,
624

Diller. Pontile Hsemorrhage, 295
Dimitresco and Soutzo tils. Chronic
Non-Moral Alcoholics, 512
Dogiel. Anatomy of Spinal Ganglia
(Review), 468

Donley. Hypnoidization in Functional
Psychoses, 629

Dopter. Meningitis in Mumps, 249
Dorado, Pedro. Asylum Treatment for
Inebriates, 319

Doury and Crouzon. Gonorrhoeal Spondy-
litis, 193

Dow, W. Epidemio Cerebro-spinal
Meningitis, 289

Dreyfus, Georges L. Die Melancholic,
etc. (Review), 61

Dromard. Hereditary Tremor, 623
Drummond, Margaret, and S. H.
Mallone. Elements of Psychology
(Review), 319

Du four and Cottentot. Tabes in Mother
and Syphilis in Infant, 553
Dunn. Serum Treatment of Epidemic
Cerebro-spinal Meningitis, 353
Duperie. Uraemic Hemiplegia and
Aphasia, 560

Dupouy and Charpentier. Cranial
Traumatism and Mental Disorder, 369
Duprd and Charpentier. Chronic
Psychopolyneuritis, 371
Dutheil. Precocious Hemiplegia in
Secondary Syphilis, 659

Epinger. Anatomy of Central Nervous
Organs (Review), 516
Edinger and Wallenberg. Report of
Work on Anatomy of Nervous System
(Review), 57

Edmunds and Roth. Action of Barium
Chloride on Fowl’s Muscle, 705
Egger. Bone Sensation, 501.

Elders. General Paralysis Three Years
after Syphilitic Infection, 267
Einhora. Herpes in Cerebro-spinal
Meningitis, 38

Eli6. Alcoholic Epilepsy, 258
Elliott, A. R. Incomplete Myxoedema, 565
Emerson, K. Acute Poliomyelitis fol¬
lowing Tonsillitis, 709
Erb. Syphilogenous Diseases of Central
Nervous System, 104
Erben. Is Upright Position maintained
from Joints ?, 162

Escherich. Tetanoid States in Childr
hood, 44

Esprit. Diphtheritic Paralysis of Left
Circumflex Nerve, 170
Estrada. Peripheral Neuritis resembling
Tabes, 244

Etienne and Champy. Cellular Lesions
of Anterior Horns in Nervous Arthro¬
pathies, 594

Eulenburg. Neuralgias and their Treat¬
ment, 54

Ewald. Scoliosis in Infantile Paralysis,
286

INDICES

749

Ewens. Dementia Procox in India,

509

Fabritius. Sensory Conduction in
Spinal Cord, 703

Fairbairn and Carver. Haemorrhage into
Pons Varolii in Eclampsia, 250
Fayet Dissociation of Reflexes in

Hysteria, 426

Feilchenfeld. Nervous Complications in
Diphtheria, 664

FeU. Clinical Course of General Par-

Olivary Fibres, 544

Fischer. Patchy Atrophy of Medullary
Sheaths in Cortex of General Para¬
lytics, 96; Wassermann’s Reaction in
Syphilis, 261

Flatau and Zylberblast. Surgical Treat¬
ment of Tumours of Cord, 729
Fleischer. Retrobulbar Neuritis and
Multiple Sclerosis, 300
Fletcher. Growth in Muscular Effi¬
ciency after Fifty Years of Life, 132
Flexner and Jobling. Epidemic Menin¬
gitis treated with Antimeningitis
Serum, 600

Forchheimer. Anorexia Nervosa in
Children, 115

Forli. Traumatic Softening of Corpus
Callosum, 51

Forsac, J. Rogues de. Mouvement
Mystique Contemporain (Review), 135
Foulerton, M*Cormack, and Pasteur.
Acute Poliomyelitis with Diplococcal
Infection of Spinal Sac, 245
Fournier. General Paralysis in Third
Year of Syphilis, 267
Fraenkel and Much. Wassermann’s
Serum Diagnosis of Syphilis, 262
Fragnito. Fibrils in Ganglion Cells of
Vertebrates, 160

Francais and Jacques. Bulbo-Pontine
Softening, 612

Francesco. Pathology of Lenticular
Nucleus, 26

Fran^is-Franck and Hallion. Vaso-
Motor Innervation of Thyroid, 546
Frankenheimer. Adiposis Dolorosa, 431
Frazier and Mills. Brain Tumour
Localised and Removed, 614
Freer. Laryngeal Crisis and Paresis of
Abductors of Vocal Cords in Tabes,
652

French and Hope. Persistent Heredi¬
tary CEdema of Lower Extremities, 663
Freacoln. Complications of Alcoholism,
260

Friedel. Formation of Neuroglia Pencils,
etc., in General Paralysis, 168
3 H

Friedlander. Hysteria and Freud’s
Psycho-Analytic Treatment, 193

Frohlich. Inhibitory Fibres in Peri¬

pheral Nerves, 588

Frohlich and Loewi. Action of Nitrates
and Atropin on Autonomic Nervous
System, 590

Fromard. Apraxia and Dementia
Procox, 666

Fromowicz and Bikeles. Afferent Por¬
tion of Reflex Arcs, 161

Frugoni. Respiratory Changes of Central
Origin, 364

Friind and Nonne. Pseudo-Systemic
Disease of Spinal Cord, 608

Fry, F. R. Motor Phenomena of Chorea,
499

Fuchs, Alfred. Peripheral Facial Palsy,
171; Oculo-Motor Paralysis without
Involvement of Internal Muscles, 184

Fuchs, E. Oculo-Motor Paralysis with¬
out Involvement of Internal Muscles,
305

Fuller. Neurofibrils in Dementia Para¬
lytica, etc., 97

Fumarola. Phenomenon of Charles Bell,
619; Electric and Operative Treatment
of Peripheral Facial Paralysis, 727

Fursac, J. Roques de. Manual of Psy¬
chiatry (Review), 731.; Mouvement
mystique contemporain (Review),
135

Fursac and Pascal. Adiposis Dolorosa in
Dementia Procox, 315

Galdi. Blood in Mental Diseases (Re¬
view), 205

Galewsky. Tabes some Years after In¬
fection, 246

Gehuchten, A. Van. Cerebro-spinal
Nerve Centres (Review), 50; Ankle
Clonus in Hysteria, 203; Anterior
Poliomyelitis of Specific Origin, 554

Giacchi. General Paralysis with Cere¬
bral Syphilis, 46

Gibney and Wallace. Epidemio Polio¬
myelitis, 171

Gierlich. Neurofibrils of Motor Ganglion
Cells, 343; Symptomatology of Cere¬
bellar and Extra-cerebellar Tumours,
718

Gioseffi. Herpes in Cerebro-spinal Menin¬
gitis, 103

Giroux and Laubry. Acute Syphilitic
Meningitis, 174

Giry ana Annand Delille. Cerebral
Sclerosis of Pseudo-Bulbar Type in
Children, 357

Goldstein and Parhon. Paralysis of
Abducens after Spinal Anaesthesia,
350

750

INDICES

Golgi. Method for Demonstration of Hamilton, Chronic Progressive Chorea,
Internal Reticular Apparatus of Nerve 498

Cells, 700 Handwerck. Temporary (Edema of

Gordon, A. Alcoholic Insanities, 123 ; Optic Disc in Angioneurotic (Edema,
Acute Bulbar Paralysis, 421; Integrity 257

of Sensation in Lesion of Left Panetal Harbitz and SclieeL Acute Poliomyelitis,
Lobe, 501 etc., 99 ; Epidemic Poliomyelitis in

Gotuzzo and Austregesilo. Mental Dis- Norway (Review), 326

orders of Anchylostomiasis, 268 Harris, D. F. Coloured Thinking, 475

Gowers, Sir William. Pseudo-myasthenia Harrison, Ross G. Living Developing
of Toxic Origin, 1; Borderland of Nerve Fibre, 241
Epilepsy (Review), 134; Mechanism Hartenberg. Auto-Suggestion in Neur*
of Nystagmus, 359 asthenia, 564

Grants. Lunatic Asylums, 316 Harvier, Nob4court, and Bernhard.

Grasset and Rimbaud. Paraphasia, Postscarlatinal Convulsive Uremia,
621 724

Graziani. Effect of Mental Work on Hatschek. Anatomy of Nucleus Ruber
Sensibility, 347 Tegmenti, 159

Gregor, Adalbert. Sense of Time in Hay, John. Aphasia, 654

Korsakoff's Psychosis, 627 Hubert. Acute Gonorrhoeal Inflammation

Grinker. Subacute combined Cord De- of Labyrinth, 647
generation, 413 Hechinger and Bloch. Anosmia in

Gross, O. Das Freud’sche Ideogenitats- Temporo-Sphenoidal Abscess, 654
moment (Review), 59 Hecht, D’Oreay. Deep Alcohol In-

Groves, E. W. Hey. Excision of Gas- jections for Trifacial Neuralgia, 181;

serian Ganglion in Trigeminal Neur- Treatment of Chorea Minor, 132;

algia, 726 Morbid Somnolence, 311

Griinberger. Bronchiectasis and Cerebral Hegener. Toxic and Infectious Neuritis
Abscess, 356 of Auditory Nerve, 255

Gubb, Alfred S. Subcutaneous Injections Heilbronner. Hysteria and Litigious
of Air for Relief of Pain, 52 Insanity, 48

Gudden. Crowd Suggestion (Review), Heiman. Technique of Lumbar Puncture,
330 177

Guerrier. Medico- psychological Study Hemenway. Acute' Meningitis of Con*
on Thomas de Quincey (Review), 273 vexity, 416

Guimaraes and Chardinal. Pupillary Henry and Rosenberger. Purulent
Phenomena in Insane, 568 Cerebro-spinal Meningitis caused ty

Gullan, A. Gordon. Exophthalmic Goitre Typhoid Bacillus, 597

and Antithyroid Treatment, 659 Herring, P. T. Development of Mam-

Gnnn, J. A. Myasthenic Reaction in malian Pituitary, 340 ; Histological
the Frog, 150 ; Fly-catching Reflex in Appearances of Mammalian Pituitary,
Frog, 401 341 ; Physiological Action of Extracts

Giinzburger. Pruritus in Tabes, 100 of Pituitary, 344

Gurd and Nelles. Intracranial Abscess Hildebr&ndt. Dyspraxia with Left-
from Typhoid Bacillus, 249 sided Hemiplegia, 511, 560; Surgical

Guthrie, Pike, and Stewart. Reflex Ex- Treatment of Exophthalmic Goitre,
citability of Brain and Cord after 669

Cerebral Anaemia, 344 Hochaus. Brain Pathology, 404

Hoche. Notwendige Reformen der Un-
Harnel. Tabetic Gait, 409 fallversicherungsgesetze (Review), 135

Hafemann. Loss of Conductivity of Holland, G. Thurstan. X-Ray Treat-
Nerves at Increased Temperatures, 472 ment of Exophthalmic Goitre, 566
Hajek. Operation in Chronic Inflamma- Holmes, Gordon. Postcentral Cortex in

tion of Frontal Sinus, 559 Tabes Dorsalis, 6 ; Spinal Changes in

Hall, George, and Morrison Davies. Muscular Dystrophy, 137; Classifies-
Neuropathic Keratitis, 185 tion of Cerebellar Disease, 420

Hallion and Francois-Franck. Vaso- Holt and Bartlett. Epidemiology of
# motor Innervation of Thyroid, 546 Acute Poliomyelitis, 602

Halphen and Lombard. Reflex Nystag- Hoover. Sign for Detection of Malinger*

raus in Diagnosis of Functional Con- ing and Functional Paresis of Lower
dition of Vestibular Apparatus, 436 Extremities, 662

INDICES

751

Hope and French. Persistent Hereditary
(Edema of Lower Extremities, 663
Hooch. Delirium Tremens after With¬
drawal of Alcohol, 47
Hosfoixl and Parkinson. Cerebellar
Tumour with Proptoeis, 496
Hoakins and Southard. Cell Findings
in Soft Brains, 168

Huber, Francis. Meningococcus Hydro¬
cephalus, 418

Hudovernig. Central and Peripheral
Facial Paralysis, 484, 646
Hunt, J. Ramsay. Otalgia, 187 ; Polio¬
myelitis Posterior of Geniculate Gang¬
lion, 485 ; Herpetic Inflammations of
Geniculate Ganglion, etc., 648; Occupa¬
tion Neuritis of Deep Palmar Branch
of Ulnar Nerve, 709

Inoeoxirros, Jose. Mental Alienation
and Crime, 126; Liberation of Criminal
Lunatics, 126 ; Insane and Penal Law,
127; Insanity, Simulation and Crimin¬
ality, 313; New Classification of
Criminals (Review), 444
Ingraham and Steiner. Epidemic Cere-
bro-Spinal Meningitis m Hartford,
288

Isselin. Attention Neurosis, 723

Jacques and Fran?ai8. Bulbo-Pontine
Softening, 612

Jacquin and Anglade. Dementia Pracox,
with Autopsy, 666

Jacoby. Psychiatric Expert Evidence,
316

Jacobsohn. Nuclei of Human Spinal
Cord (Review), 446
Jahnel. Hysterical Mutism, 504
Jahrmarker. Final Stages of Dementia

Pnecox, 570

Janet, Pierre. Hysteria (Review), 374
Jobling and Flexner. Epidemic Menin¬
gitis treated with Antimeningitis
Serum, 600

Joohmann and Winkler. Traumatic
Affections of Cord, 711
Joffroy. Juvenile General Paralysis, 625
Johnston, Henry M. Cutaneous Branches
of Posterior Primary Divisions of
Spinal Nerves, 699

Johnston, R. H. Obstruction in Nose
or Throat as Cause of Nervous and
Mental Diseases, 117
Jones, Ernest. Mechanism of Severe
Briquet Attack, 114; Articulatory
Capacity for Consonantal Sounds in
Children, 243, 548 ; Side Affected by
Hysterical Hemiplegia, 293; Allo-
chiria, 294 ; Juvenile Tabes, 413;
Phrictopathic Sensation, 662

Jones, H. Lewis. Cervical Ribs and
Atrophy of Intrinsic Muscles of Hand,
191

Jones, Robert Arthrodesis in Paralysis,
317

Jong, De Josselin de. Gonorrhoeal
Meningitis, 598

Joris. Posterior Lobe of Pituitary Gland,
343

Jung. Freud’s Theory of Hysteria, 427
Jung and Bleuler. Dementia Pnecox,
367

Jung and Ricksher. Galvanic Pheno¬
menon and Respiration in Normal and
Insane, 122

Kappas. General Paralysis in Senile
Period, 268

Kappers. Structure and Function of
Autonomic Nervous System, 544
Karplus and Spitzer. Experimental
Lesions at Base of Brain, 169
Kauffmann. Cholin in Cerebro-spinal
Fluid, 298

Kennedy, Robert. Section of Posterior
Primary Divisions of Upper Cervical
Nerves in Spasmodic Torticollis, 725
Ker, C. B. Treatment of Cerebro-spinal
Meningitis with Flexner’s Serum, 715
Kilvington and Osborne. Axon Bifurca¬
tion in Regenerated Nerves, 402
Kleist. Psychical Disturbances in Syden¬
ham’s Chorea, 188

Kluge. Co-operation of Alienist in Care
of Defectives, 373

Knapp, Albert. Hysterical Pure Word
Deafness, 113 ; Sinus Thrombosis, etc.,
181 ; Hypotonia, 409; Diagnosis of
Cerebral Tumours, 422 ; Speech Dis¬
turbances in Functional Psychoses,
428

Knapp, Philip Coombs. Heredity in
Nervous Diseases, 29
Kocher, Theodor. Blood in Exoph¬
thalmic Goitre, 660

Kohts. Diphtheritic Paralysis and its
Treatment, 728

Kollarits. Torticollis Mentalis, 618
Kdllner. Etiology of Abducens Paralysis,
305

Koplik. Treatment of Chorea Minor,
204

Korner. Nuclear and Trunk Lesious
of Vagus Recurrent and Oculomotor
Nerves, 645

Krafft-Ebing. Progressive General Par¬
alysis (Review), 134

Krause. Non-Traumatic Pseudospustir
Paresis with Tremor, 112
Kretschmer. Cerebro-spinal Fluid in
Lues Hereditaria Tarda, 297

752

INDICES

Kroner. Wassermann’s Seram Diagnosis
of Syphilis, 261

Krontnal. Sleep of Another, 21
Krasius. Eserin in Papillary Disorders,
808

Kuckro. Disseminated Sclerosis, or
Cerebro-spinal Syphilis, 34
Kiistner. Chronic Middle Ear Suppura¬
tion with Tumour of Pons, 558
Kuttner and Meyer. Sensory Fibres in
Recurrent Laryngeal Nerve, 288

Lacassagnk. Insanity of Maupassant,
574

Lachmund. Convergence Reactions with
Reflex Immobility of Pupil, 644
Ladame and Von Monaxow. Pure
Aphemia, 655

Laiguel-Lavastine. Epileptiform Con¬
vulsions and Hemiplegia in Typhoid,
37; Acute Encephalomyelitis, 354 ;
Unilateral Cauda Equina Syndrome,
611

Laignel-Lavastine and Ballet. Old
Myopathy, 349

Langfeld. Sensitiveness to Light and
Size of Pupil, 239.

Langmead. Pupillary Signs in Chorea,
191

Landowski and Claret. Polynucleosis of
Cerebro-spin&l Fluid in Tubercular
Meningitis, 39

Langley. Contraction of Muscle, 166
Lasarew. Anterior Paresthetio Meralgia,
245

Laubry and Giroux. Acute Syphilitic
Meningitis, 174

Lavenson. Typhoid Meningitis, 597
Le Breton. Spinal Sprain, 556
Legrain, Alcohol ana Insanity, 268
Lejonne and Raymond. Syringomyelia,
etc., 172

Lemaitre and Rose. Palato-Laryngeal
Hemiplegia, 493

Lenz. Sympathetic Ophthalmia, 436
Leopold. Osseous Plaques of Pia-Arach¬
noid in Acromegaly, 661
L4ri, Andr6. Ankylosing Diseases of
Spinal Column, 12, 65
Leriche and Poncet. Rousseau’s Dis¬
ease, 437 ; Calvin's Disease, 437
Levi, Ettore. Foot-Clonus, 183
Levi-Valeusi and Claude. Juvenile
Genoral Paralysis with Apraxic Symp¬
toms, 666

Lewandowsky. Dissociation of Colour
Sense by Focal Brain Disease, 291 ;
Splitting off of Colour Sense, 561
Lewandowsky and Stadelmann. Acute
Multiple Sclerosis or Disseminated
Myelitis, 33

Lhermitte and Artom. Syringomyelia
with Cheiromegaly, 172
Lian and BariA Epileptiform Convul¬
sions and Hemiplegia in Typhoid, 37
Liepmann. Alleged Word-Deafness in
Motor Aphasia, 505
Lloyd, Warren. Spontaneous Somnam¬
bulism, 263

Looser and Cassirer. Rotatory Move¬
ments and Nystagmus, 306
Loewi and Frohlich. Action of Nitrites
and Atropin on Autonomic Nervous
System, 590

Lomer. Bismarck im Lichte der Natur-
wissenschaft (Review), 376
Lombard and Halphen. Reflex Nystag¬
mus in Diagnosis of Functional Con¬
dition of Vestibular Apparatus, 436
Londe, Paul. Constitutional Asthenia,
113

Long. Crural Monoplegia, 358
Louri£. Eye-movements in Cerebellar
Irritation, 304

Lovett. Infantile Paralysis in Massa¬
chusetts in 1907, 604
Lucas and Mines. Temperature and
Excitability, 165

Ludlum. Peripheral Spinal Degenera¬
tion, 173

Lug&ro. Functions of Neuroglia, 587
Lynch and Aloock. Physical, Chemical,
and Electrical Properties of Nerves, 25

Maas and Cassirer. Chronic Anterior
Poliomyelitis, 709

Maillard and Deny. Bilateral Motor
Apraxia, 657

Maillet. Sea-sickness, 311
Mair, W. f and J. Lorraine Smith. Prin¬
ciples underlying Weigert’s Method,
638

Mairet, A. Simulation of Insanity
(Review), 671

Mandelbaum and Celler. Pathology of
Myasthenia Gravis, 408
Marbd. Stereognosis and Symboly in
Lower Extremities, 502
Marburg, Otto. Arbeiten a. d. Neurol.

Instit. Wien. Univ. (Review), 133
Marchand and R&madier. Thyroid Gland
in Insanity, 664

Margulies. Regeneration of Peripheral
Nerve, 283

Marie, P. Titles of Collected Works of
(Review), 377

Marina. Rudimentary Forms of Muscular
Dystrophy (Erb), 483
Marinesco. Plasticity and Amoeboidism
of Ceils of Sensory Ganglia, 28
Marinesco and Minea. Hypospinal
Microsympathetic Ganglia, 234

INDICES

753

Marks, Swift, and Porter. Afferent
Impulses and Fatigue of Vasomotor
Centre, 94

M&rr, Hamilton C. Cerebro-spinal
Fluid in General Paralysis, 635
Martino. Gonorrhoeal Neuritis of Audi¬
tory Nerve, 649

Martland, E. S., and Joseph Collins.
Disease of Primary Motor Neurones,
etc., 555

Masoin. Medical Study of Chateau¬
briand, 573

Massia and Delachan&l. Ocular Mani¬
festations of Tabes, 605
Mayr. Secretion of Gastric Juice and
Psychopathological Conditions, 51
M‘Callum. Colony and Bromide Treat¬
ment of Epilepsy, 563
MacCormack, Pasteur, and Foulerton.
Acute Poliomyelitis with Diplococcal
Infection of Spinal Sac, 245
Macdonald, Carlos F. Modern Care of
Insane, 514

M ‘Donald, Stuart. Cerebro-spinal Menin¬
gitis, 489

Macdonald, Bruce, and Pirie. Aneurism
of Anterior Cerebral Artery, 449
M'Dougall, William. State of Brain
during Hypnosis, 592
MacGregor and Currie. Serum Treat¬
ment of Cerebro-spinal Fever in Glas¬
gow Fever Hospital, 716
MacKenty and Cocks. Headaches from
Pathological Condition of Nose, etc.,
366

Mackenzie, Alice. Galvanic Reactions of
Auditory Nerve, 808
Macnamara, Eric D. Blood Pressure in
Neurasthenia, 564
Meens. Combined Psychoses, 513
Meige. Mental Torticollis, 372 ; Re¬
vision of Hysteria, 616
Meissner. Intermittent Exophthalmos,
435

Mellone and Margaret Drummond.
Elements of Psychology (Review),
319

Meltzer. Optic Atrophy and “Tower-
Shaped ” Skull, 550

Mendel, Kurt. Trauma in Etiology of
Nervous Diseases, 117
Mendel, Kurt, and S. Adler. Serous
Spinal Meningitis, 650
Merzbach. Psychology of the Moltke
Case (Review), 330

Mey er. Relative Eupraxia in Right

Hemiplegia, 622

Moyer. A. Traumatic Lesion of Pons
and Tegmentum, 26
Meyer ana Kuttner. Sensory Fibres in
Recurrent Laryngeal Nerve, 238

Milhit and Tanon. Meningitis following
Gonorrhoea, 174

Milian. Treatment of Tabes, 554
Mills and Atlee. Brain Tumour with
Jacksonian Spasm, etc., 178
Mills and Frazier. Brain Tumour Local¬
ised and Removed, 614
Minea and Marinesco. Hypospinal
Micro-Sympathetic Ganglia, 234
Minea and Parhon. Original of Superior
Facial, 162

Mineff, Michael. Floor of Fourth Ven¬
tricle, 235

Mines and Lucas. Temperature and Ex¬
citability, 165

Mingazzini. Paralysis after Rachistovain-
isation, 351; Conduction Aphasias,
507

Mirman. Alcoholic Beverages in Etiology
of Insanity, 48

Mirte. Psychical Nature of Blepharo¬
spasm, 722

Mitchell, John K. Landry's Paralysis,
246 ; Neurasthenia, 310
Mitchell and Barrett. Posterior Column
Degenerations following Injury to Pos¬
terior Roots of 7th Cervical Nerves, 643
Miyake. Adolescent Insanity, 440
Monakow, von, and Ladame. Pure
Aphemia, 655

Moncany, Charles. Kernig’s Sign, 40
Monro and Findlay. Course of Cere-
bello-Olivary Fibres, 544
Monserrat and Warrington. Paraplegia
due to Intra-Medullary Lesion, 173
Montesano. Perivascular Infiltration
with Plasma Cells in Central Nervous
System of Alcoholistd Rabbits, 28
Montet, C. de. Tuberose Sclerosis, 292
Mouriquand and Bouchut. Heart
Failure in Exophthalmic Goitre, 566
Much and Fraenkel. Wassermann's
Serum Diagnosis of Syphilis, 262
Muller, Eld. Acute Paraplegia after
Anti-Rabic Inoculation, 415
Muratow. Forced Movements in Central
Lesions, 549

Muthmann, Arthur. Psychology and
Treatment of Neurotic Symptoms
(Review), 58

Nacke. Homosexuality, 372, 373
Nageotte. Rapid Method for Staining
Myeline in Nerve Fibres of Brain and
Cord, 682

Nambu. Haemangioma in Pons Varolii,
352

Nelles and Gurd. Intracranial Abscess
from Tynhoid Bacillus, 249
Nieter. Typhoid Bacilli in Cerebro¬
spinal Fluid, 491

754

INDICES

Nobtaonrt, Harrier, and Bernhard.
Post-scarlatinal Convulsive Uremia,
724

Nogue and Abadie. Tabes without
Lightning Pains, 553
Noica. Mechanism of Babinski’s Sign,
502

Nonne and Friind. Pseudo-systemic
Disease of Spinal Cord, 608
Nutt. Orthopmdio Therapy in Acute
Anterior Poliomyelitis, 318

Obsteixer and Alexander. Cochlear
Nerve in Internal Auditory Meatus,
236

Odinot. Medico-psychological Study of
Alfred de Musset (Review), 329
Oeconomakis. Heterotopia of Nucleus
Arcuatus, 168

Oettinger. Recurrent Autohypnotic
Sleep, 562

Onodi. Cerebral Complications of Nasal
Origin, 645

Oppenheim, H. Sacral Type of Dis¬
seminated Sclerosis, 32; Tumours of
Nervous System, 612
Oppenheim, Gustav. Pathological
Anatomy of Multiple Sclerosis, 706
Orbison. Herpes of Membrana Tympani,
619

Ormerod. Disseminated Sclerosis, 31
Orr and Rows. Histology of Lympho¬
genous and Hematogenous Toxic
Lesions of Cord, 593

Osborne and Kilvington. Axon Bifurca¬
tion in Regenerated Nerves, 402
Osterhaus. Nerve Anastomosis in In¬
fantile Paralysis, 630

Packard. Feeling of Unreality in
Mental Disease, 199

Pailhas. Double Personality following
Haemorrhage, 296

Panella. Action of Suprarenal Principle
on Muscular Fatigue, 547
Pappenheim. Periodic Melancholia,
etc., 124 ; Cerebro-spinal Fluid, 297
Parhon and Cazacon. Chronio Troph-
oedema, 364

Parhon and Goldstein. Paralysis of
Abducen8 after Spinal Anaesthesia,
350

Parhon and Minea. Origin of Superior
Facial, 162

Parkinson and Hosford. Cerebellar
Tumour with Proptosis, 496
Pascal and Fursac. Adiposis Dolorosa
in Dementia Precox, 315
Pasteur, Foulerton, and MacCormack.
Acute Poliomyelitis with Diplococcal
Infection of Spinal Sac, 245

Paterson, Peter. Drainage of Cerebral
Subdural Space in Spina Bifida, 667
Paul and Walton. Arteriosclerosis, 119
Peabody, G. L. Cerebro-spinal Menin¬
gitis of Streptococcus Origin cured by
Subdural Injection of Anti-strepto¬
coccus Serum, 417
Pelz. Paralysis Agitans, 615
Peters. Congenital W ord - Blindness, 510
Peterson, F., and Morton Prince.
Psycho-Galvanic Reactions from Co-
conscious Ideas in Multiple Personality,
478

Petr4n, Karl. Acromegaly and Syringo¬
myelia, 108

Pfersdorff. Forced Speech in Manic-
Depressive Insanity, 369
Pick, A. Atrophy of Occipital Lobe,
106; Asymbolia and Aphasia, 107;
Disorders of Orientation, 112; Ar-
beiten aus der Psychiatrischen Uni-
versitats-Klinik in Prag (Review), 133
Pighini. Nerve Cells of Electric Lobe of
Torpedo Ocellata, 471; Neutralising
Power of Cholesterin, eta, 480
Pike, Guthrie, and Stewart. Reflex Ex¬
citability of Brain and Cord after
Cerebral Anaemia, 344
Pilcz. Heredity, 120
Pineles. Parathyreogenic Laryngospasm,
433

Piper. Rate of Transmission in Medul-
Iated Nerve, 704

Pirie, J. H. H. Middle Cells of Grey
Matter of Cord, 584

Pirie, J. H. Harvey, and Alexander
Bruce. Origin of Facial Nerve, 686
Pirie, Bruce, and Macdonald. Aneurism
of Anterior Cerebral Artery, 449
Plant. Serum Diagnosis of Syphilis,
298

Plivard. Tuberculous Meningitis in
Pregnancy, 715

Poggio, Cortical Localisation of Asytn-
boly, 717

Polimanti, O. Physiology of Pons and
Corpora Quadrigemina, 585
Poncet and Leriche. Rousseau's Disease,
437 ; Calvin's Disease, 437
Porter and Quinby. Yaso-Motor Neu¬
rones in Shock, 163

Porter, Marks, and Swift Afferent
Impulses and Fatigue of Vasomotor
Centre, 94

Potts and Rhein. Poet-Apoplectic
Tremor, 180

Poulard. Toxic Amblyopia, 307
Price. Hysteria in Children, 297
Prince, Morton. Criminal Responsi¬
bility of Insane, 125; Go-conscious
Ideation, 406

INDICES

755

Prince, Morton, and F. Peterson. Psycho-
Gaivanic Reactions from Co-conscious
Ideas in Multiple Personality, 478
Provoteile and Schmiergeld. Psycho-
Analytic Method and u Abwehrneuro-
psychosen ” of Freud, 572
Pnsateri. New Origin of Peduncular
Bundle of Tiirck, 91

Quknsbl. Word-Deafness, 619
Quinby and Porter. Vaso-Motor Neu¬
rones in Shock, 163

Quirsfeld. Fatigue Measurements in 64
School Children, 20

Raimaxn. Homicidal Melancholics,
440

Ramadier and Marchand. Thyroid
Gland in Insanity, 664
Rank£. Idiocy Secondary to Disease of
Cerebral Vessels, 371
Rankin, Guthrie. Infantile Paralysis,
245

Raymond, F. Relationship of Family
Diseases to Premature Physiological
Senescence, 595

Raymond and Alquier. Pseudo-Bulbar
Paralysis, 179; Recklinghausen’s
Disease, 623

Raymond and Claude. Pontine Tumours,
495

Raymond and Lejonne. Syringomyelia,
etc., 172

Rebaud. Pruritus in Tabes, 607
Redlich. Cortical Changes in Cerebral
Tumours, 169; Peculiar Pupillary
Phenomenon, 303

Rehm. Cytological Examination of
Cerebro-spinal Fluid, 713
Reich. Injuries of Vagus Nerve, 434
Reichardt. Brain Matter, 697
Reiss. Paranoid Symptom-Complexes in
Degenerates, 196

Remenar. Spinal Anesthesia, 204
Renner. Localisation of Pain in Com¬
pression of Cord, 414; Syphilitic
Spinal Paralysis, 488
Rennie, George E. Exophthalmic Goitre
with Myasthenia Gravis, 229
Ren on. Polyglandular Syndromes and
Opotherapy, 669

Renterghem, A. W. van. Psychotherapy,
55

R£thi. Amblyopia after Accessory Sinus
Suppuration, 437

Retzlaff. Diagnostic Value of Pupillary
Immobility and Sluggishness, 362
Rhein, John S. W. Syringomyelia, with
Syringobulbia, 555; Apraxia, with
Autopsy, 658

Rhein and Potts. Post • Apoplectic
Tremor, 180

Rhodes, J. Milson. Mentally Defective
in Prison, 575

Ricksher. Statistical Study of General
Paralysis, 196

Ricksher and Jung. Galvanic Pheno¬
menon and Respiration in Normal
and Insane, 122

Riehm. Simulation of Insanity, 373
Rimbaud and Grasset. Paraphasia, 621
Rivers. Influence of Alcohol, etc., on
Fatigue (Review), 445
Robinowitsch. Diseases of Conus Medul-
laris, 653

Robson. Synchronous Movements of
Lower Eyelids with Tongue and Lower
Jaw, 35

Rocaz and Carles. Lumbar Puncture in
Meningeal Forms of Typhoid, 557
Rocenwaldt. Simplification of Nisei's
Stain, 406

Rogera and Smallwood. Studies in
Nerve Cell, 233

Rolleston. Reflexos in Scarlet Fever,
183 ; Hemiplegia following Scarlet
Fever, 530

Romheld. Cerebro-spinal Fluid in
Diphtheritic Pseudo-Tabes, 712
Rose. Neuritis secondary to Zona, etc.,
350

Rose and Lemaitre. Palato-Laryngeal
Hemiplegia, 493

Rosenberger and Henry. Purulent
Cerebro-spinal Meningitis caused by
Typhoid Bacillus, 597
Rosenfeld. Mental Disturbances in Vaso¬
motor Neuroses, 296
Rossi. “ Neurotoxic Sera,” 27, 845
Rossolimo. Toe-Reflex, 432
Roth and Edmunds. Action of Barium
Chloride on Fowl’s Muscle, 705
Rothmann. Supranuclear Auditory
Tracts, 402

Rows and Orr. Histology of Lympho¬
genous and Hematogenous Toxic
Lesions of Cord, 593

Russell, Colin K. Tabes Dorsalis and its
Re-educative Treatment, 351
Russell, J. S. Risien. Diagnosis of Or¬
ganic from Functional Nervous Affec¬
tions, 284

Saevoer, A. Focal Symptoms in
Diffuse Brain Disorders, 359
Sainton and Delherme. Treatment of
Exophthalmic Goitre (Review), 327
Sala. Sequel to Aseptic Lesions of
Brain, 642

Salaris, Sanna, Jackonsian Epilepsy,
425

756

INDICES

Salecker. Segmental Abdominal Par¬
alysis, 247

Salviolo and Carraro. Physiology of
Pituitary Body, 641

Sand, Ren4. New Selective Stain for
Nervous System, 91

Sano. Action of Strychnine and
Caffeine, 640 ; Antagonistic Action
of Particular Parts of Brain to Strych¬
nine, 641 ; Affinity of Spinal Cord for
Strychnine and Cocaine, 94
Santee, Harris E. Anatomy of Brain
and Spinal Cord (Review), 518
Sarbo, Arth. v. Landry’s Paralysis,
710

Sawyer. Cytodiagnosis in Practical
Medicine, 264

Scarpini. Primary Lesions of Nerve
Fibres in Uramia, 707
Schaefer. Dementia Pracox, Catatonic
Form, 198

Scheel and Harbitz. Acute Polio¬
myelitis, etc., 99; Epidemic Polio¬
myelitis in Norway (Review), 326
Schlesinger. Spondylitis Infectiosa after
Dengue, 115; Epidemic Cerebro¬
spinal Meningitis in Adults, 417
Schmiergeld and Provotelle. Psycho-
Analytic Method and “ Abwehrneuro-
psychosen ” of Freud, 572
Schmiergeld, Blanchetiere, and Claude.

Serum of Epileptics, 365
Sell moll. Paroxysmal Tachycardia, 45 ;
Symptoms due to Coronary Arterio¬
sclerosis, 46.

Schneider and Vandeuvre. Serum-
therapy in Diphtheritic Paralysis, 728
Schroeder. Pains in Manic-Depressive
Insanity, 268

Sell rotter. Exophthalmic Goitre, 363
Schulz, Ernst. Hysterical Hemiplegia,
357

Schuster. Three Chinese Brains, 697
Schuster, Paul. Mercurial Treatment
and Metaiypliilis of Nervous System,
127

Schuyten. Measurement of Intellectual
Fatigue in Children. 407
Sehwenkenhecher. Menthol Poisoning,
567.

Serbsky. Korsakow’s Disease, 441
Shaw. Opsonic Index to Various
Organisms in Control and Insane
Cases, 270

Sherren. Neuritis of Ulnar Nerve from
Deformity of Elbow Joint, 486
Sherrington. Strychnine and Reflex
Inhibition of Skeletal Muscle, 24;
Reflex Inhibition and Excitation, 163 ;
Reciprocal Innervation of Antagonistic
Muscles, 403

Shima. Action of Adrenalin on Nervous
System, 474

Sicard and Brissaud. Trigeminal Neur¬
algia treated by Injections of Alcohol,
202

Sicard and Descomps. Mental Torticollis
of Brissaud, 372

Sichel. Mental Diseases among Jews,
443

Sidis, Boris. Sleep, 408, 477, 592
Siegert. Nervousness and Nutrition in
Childhood, 708

Silberberg. Typhoid Bacilli in Cerebro¬
spinal Fluid, 597

Smallwood and Rogers. Studies in
Nerve Cells, 233

Smith, J. Lorrain, and W. Hair. Prin¬
ciples underlying Weigert’s Method,
638

Smithies. Hemiplegia in Typhoid, 177
Sollier and Chartier. Cervico- Bulbar
Syringomyelia commencing with Hic¬
cough, 652

Soloniowicz. Centre for Submaxillary
Gland, 588

Sommer. Acute Traumatic Psychoses,
201

Souques. Aneurism of Sylvian Artery,

496

Southard. Gliosis in Acquired Epilepsy,

497

Southard and Collins. Gliotic Cyst of
Right Superior Parietal Lobule, 182
Southard and Hoskins. Cell Findings
in Soft Brains, 168

Soutter, Robert. Silk Ligaments in
Infantile Paralysis, 515
Soutzo fils. Serum Reaction in General
Paralysis by Wasserm&nn’s Method,
572

Soutzo fils and Dimitresco. Chronic
Non-Moral Alcoholics, 512
Spieler. Diphtheritic Paralysis and
Heart Failure in Diphtheria, 116
Spielmeyer. Nervous System after
Stovaine Anaesthesia, 705
Spiller, VV. G. Epiconus Symptom-Ccm-

K ' ix in Cerebro-spinal Syphilis, 77 ;

mours of Cauda Equina and Lower
Vertebra, 287 ; Paralysis of Upward
Associated Ocular Movements, 361 ;
Occlusion of Posterior Inferior Cere¬
bellar Artery, 557 ; Tumour Malforma¬
tions of the Nervous System, 677
Spitzer and Karplus. Experimental
Lesions at Base of Brain, 169
Stadelmann and Lewaudowaky. Acute
Multiple Sclerosis or Disseminated
Myelitis, 33

Starr, M Allan. Epidemic Infantile
Paralysis, 604

INDICES

757

Stefani. Os teo-arthritic Manifestations
of Tabes, 280

Steiner and Ingraham. Epidemic Cere-
bro-spinal Meningitis in Hartford, 288
Stelzner. Cerebellar Atrophy, 359
Stengel. Nervous Manifestations of
Arteriosclerosis, 262

Stephenson. Lumbar Puncture in Optic
Neuritis, 205 ; Juvenile Tabes Dorsalis,
412

Sternberg. Muscular Strength of Hemi-
plegics, 253

Stertz. Serodiagnosis in Psychiatry and
Neurology, 651

Stewart, G. N. Automatic Respiratory
and Cardiac Mechanisms after Isolation
from Nerve Impulses, 93
Stewart, Purves. Disease of Post-Central
Gyrus, with Astereognosis, 379
Stewart, Pike, and Guthrie. Reflex
Excitability of Brain and Cord after
Cerebral An«mia, 344
Stillman, C. K. Post-Delirious Alcoholic
Stupor, 259

Stransky, E. Peripheral Nerves in
General Paralysis, etc., 345
Straussler. Tumours of Pituitary Duct,
110 ; Disturbances of Sensation, 499
Striimpell. Tabes Dorsalis with Diseases
of Heart and Vessels, 35
Sudhoff. Archiv fiir Geschichte der
Medizin (Review), 377
Swift, Porter, and Marks. Afferent Im-

S lses and Fatigue of Vasomotor
ntre, 94

43ym, W. G. Partial Ptosis with Exag¬
gerated Movement of Affected Eyelid,

337

Tait, John. Freezing of Frog’s Nerve,
166

Tamburini. Protection of Society from
Criminal Lunatics, 629
Tanon and Mil hit. Meningitis following
Gonorrhoea, 174

Taylor. Graves* Diseases treated by
Thyroidectomy, 302

Taylor, F. L. Traumatic Abscess of
Frontal Lobe, 492

Tello. End-Plates of Muscle after
Section of Nerves, 95
Thomas, Andr6. Anatomy of Peripheral
Facial Paralysis and Facial Hemi¬
spasm, 167

Thomsen. 11 Zwang” Phenomena, 438
Thomson. Brain Abscess, 180
Thomson, H. Campbell. Disease of
Nervous System (Review), 675
Thomson, St Clair. Causes and Symp¬
toms of Thrombosis of Cavernous
Sinus, 720

Thorburn, Wm. Symptoms due to
Cervical Ribs, 312
Tillmanns. Puncture of Brain, 724
Tobben. Treatment of Epidemic Cerebro¬
spinal Meningitis, 104
Toltrain and Claisse. Acute Syphilitic
Meningitis, 290

Trautmann. Acute Suppuration of
Sphenoidal Sinuses, 423
Tribondeau and Bellay. Action of
X-Rays on Eye in Course of Develop¬
ment, 242

Trimmer. Abasia or Dysbasia, 113
Trotter. Cerebellar Abscess, 356
Tucker. Epilepsy—So-called Idiopathic,
498

Turner, A. Jefferis. Infantile Paralysis
simulating Meningitis, 413
Turner, John. Structure of Grey Matter,
283

Tyson and Pierce Clark. Eye Syndrome
of Dementia Praecox, 570

Urban. Pseudo-Appendicitis Hysteria,
661

Valkenberg, Van. Projection Fibres
of Occipital Lobe, 698
Vandeuvre and 8chneider. Serum-
therapy in Diphtheritic Paralysis,
728

Varendonck. Ideals of Children, 549
Vennat. Meningitis in Mumps, 249
Verworn, Max. Neurone Theory, 234
Vigouroux. Papilloma of Choroid Plexus,
etc., 496

Villaret and Crouzon. Acute Ascending
Paralysis of Syphilitic Origin, 275
Vincenzo. Bulbo-Cavernous Reflex in
Dementia Praecox, 665
Vining. Acute Ascending Paralysis,
246

Volpi-Ghirardini. Arcuate Nuclei and
External Anterior Arciform Fibres of
Medulla Oblongata, 471

Waldschmidt, Balser, and Aull. Alco¬
holism, etc. (Review), 519
Wallace and Gibney. Epidemic Polio¬
myelitis, 171

Wallenberg and Edinger. Report of
Work on Anatomy of Nervous
System (Review), 57

Waller, A. D. Action of Aconitine on
Nerve Fibres, 94

Walton, G. L. Anterior Poliomyelitis
in Adult, 98 ; Migraine, an Occupation
Neurosis, 618

Walton and Paul. Arteriosclerosis, 119
Warda, Wolfgang. Obsessional States,
123

758

INDICES

Warrington, W. B. Course and Pro¬
gress in Disseminate Sloeroeis, 021

Warrington and Monserrat. Paraplegia
dne to Intra-Medullary Lesion, 173

Weisenburg. Lesions in Cerebello-
Pontile Angle, 494

Wendenburg. Poet-traumatic, Tran¬
sitory Disturbances of Consciousness,
427

Westphal. Hysterical Pseudotetany,
192; Motor Apraxia, 357

Weygandt. Idiocy and Dementia Prae-
cox, 368

White, C. P. Cholesterol Fluid Crystals
and Myelin Forms, 638

White, Wm, A. Outlines of Psychiatry
(Review), 272

Wickman, Ivar. Acute Poliomyelitis

(Review), 824 ; Heine-Med in Disease
(Review), 324

Willerv&l. Tuberculous Meningitis in
Infants, 598

Williams, Tom. Pathogenesis of Tabes
Dorsalis, 551

Williamson, R. T. Disseminated

Sclerosis commencing with Failure of
Vision, 424 ; Hemiplegia with Uni¬
lateral Optic Atrophy, 494; Diseases
of Spinal Cord (Review), 674

Willson. Neurasthenia in the Young,
272

Wilson, S. A. K. Associated Movement
of Eyes and Ears, 831; Apraxia, 508.

Wilson, S. A. K., and James Collier,
Amyotonia Congenita, 481

Wilson and Cramer. Protagon; its
Chemical Composition, etc., 164
Winckler and Jochmann. Traumatic
Affections of Cord, 711
Wixel. Manic-Depressive Insanity, 369
Wiadimiroff. Scarlatinal Rheumatism,
649

Wollstein. Cerebro-Spinal Fluid in
Anterior Poliomyelitis, 651
Woods, M Operative Procedure in
Epilepsy, 271

Woolley. Muscular Inhibition from
Excitation of Ninth Spinal Nerve of
Frog, 24

Wright, G. A. Injection of Osmic Acid
into Gasserian Ganglion in Trigeminal
Neuralgia, 55

Wunderlich. Spinal Cord in Absence of
Pupil Light Reflex, 307
Wynne. Congenital Syphilis, 300

Yearslst, Macleod. Vertigo and Tin¬
nitus, 646

Zappert. Brain Tubercle in Child¬
hood, 181

Ziehen, Th. Recognition and Treatment
of Melancholia (Review), 64 ; Classifi¬
cation of Psychoses, 195
Zilocchi and Benigni. Dementia Pne-
cox, 569

Zuckerkandl. Anatomy of Induseum
G risenm Corporis Calloei, 158
Zylberblast ana Flatau. Surgical Treat¬
ment of Tumours of Cord, 729

BIBLIOGRAPHY

1908

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V. J. WOOLEV. On an apparent Muscular Inhibition produoed by Excitation
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KEITH LUCAS. The Excitable Subetanoee of Amphibian Muscle. Joan.
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KRUNBERG. Zur Kenntnis der Extraktivstoffe dee Muskeln. Soppe-Beyler't
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DRESER. Zur Auswertung deg “ Travail stations ” beim Verat rinmuakoL Arch,
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LEDERER. Zur Frage der doppelten Innervation von Muskeln des Warm-
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JUQULIER. Les experiences de M. Sh. I. Frans an sujet de la physiologic du
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TRIBONDEAU et BELLAY. Action des Rayons sur l’CEil en Toie de Ddveloppe-
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8PALLITTA. Sur la fonction du ganglion du vague ohes la Thcdastochdyt caretta.
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ARTUR SCHtJLLER. Keimdrfisen und Nervensystem. Arb. a. d. NeuroL
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G. F. ALEXANDER. Mechanism of Accommodation and the Function of the
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WOLLFLI. Schemata fur AugenmuskellKhmungen. Bergmann, Wiesbaden,
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BIEHL. Beitrag sur Lehre Ton der Besiehung swischen Labyrinth nnd A age.
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GUTTMANN. Untersuchungen fiber Farbenschwaohe (Forts.). Ztschr. f.
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KGLLNER. Erworbene Violettblindheit und ihre Verhalten gegenfiber epektralen
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NAGEL. Erwiderung an Herm Swdn betreffs Santoninwirkung im Aoga
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WIEDLICH. The Optical Significance of the Accommodative Pupillary Move¬
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KAUFFMANN. Ueber eigentUmliohe Geruohsanomalien einiger ohemischer
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TORATA SANO. Ueber die Entgiftung von Strycknin und Kok&in durch das
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CENT. L’influenoe des centres corticaux sur let ph6nombnee de la g6n6ration et
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COHN. K&lk, Phosphor und Stichstoff im Kindergehirn. Deutsche med.
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KOCH. Zur Kenntnis der Sohwefelverbindung des Nervensystems. Hoppe-
Seylers Ztschr Bd. 53, H. 0, 1907, S. 490.

PORTER, MARKS and SWIFT. The Relation of Afferent Impulses to Fatigue
of the Vasomotor Centres. Amer. Joum. Physiol., Vol. xx., 1907, p. 444.

IOHMANN. Ueber den Sitz der automatischer Erregung im Herzen. Arch,
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G. N. STEWART. Some Observations on the Behaviour of the Automatio Re¬
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PSTOHOLOOT

HENSEL. Von der Seele im gesunden und im kranken Zustande. Borggold,
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VAN G1NNEKEN. Principes de Linguistique Psycbologique. Riviere, Paris,
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BIBLIOGRAPHY

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ARNOLD PICK. Studien but fiimpathologie and Psychologic. Kargor, Berlin,
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A. PICK. Die umschriebene senile Hirnatrophie als Gegenstand klinischer and
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CAJAL. Note sur la d6g6n$reeoence traumatique dee fibres nerveusee da oervelet
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HUGO FREY. Bildungsfehler dee Gehororganes bei der Anencephalie. ArA a.
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CAJAL. Notes microphotographiques. Trav. du Lab. de Rechaxhes Bid. de
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SIEBENMANN und BING. Ueber den Labyrinth- und Himbefund bei einem an
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SAND. Eine neue elektive NervensystemfSrbung. Arb. a. d. Neurol. InstiL a.
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BIBLIOGRAPHY

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DAVID W. FINLAY. Introductory Address on Aloohol in Relation to Medicine.
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SMITH ELY JELIFFEL Dispensary Work in Nerrous and Mental Diseases.
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STRANSKY. BeitrKge sur Kenntnis des Vorkommens von Verfinderungen in
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Poliomyelitis. —HARBITZ und SCHEEL. Akute Poliomyelitis und verwandte
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WALTON. Anterior Poliomyelitis in the Adult. Boston Med. and Sura. Joum.,
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Tabes.— CAMP. Motor Paralysis as an Early Sign of Tabes Dorsalis. Med. Rec.,
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HENRI CLAUDE. Traumatismes et Localisation des Arthropathies TaWtiques.
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ERNEST A. DENT. Locomotor Ataxia: its Early Recognition and General
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SAINTON et FERRAND. Varicosity g6n£ralis6es et sym6triques ohes une
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GIOVANNI SIAZ. Traumatische RUckenmarksblutung bei beginnender Tabes
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Landry's Paralysis. —CARL CAMP. Acute Unilateral Asoending Paralysis.
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Tnmonr.—ARDIN-DELTEIL et DUMOLARD. Myxo-sarcome de la Queue de

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JEMTEL. Les fibromas vertlbraux. Joum de Mid., No. 47, 1907, p. 462.

Amyotrophic Lateral Sclerosis. — BOUCHAUD. Sclerose lattfrale amy-
otrophique, h d£but h6mipl6gique chez un sujet de 16 ans. Joum. de Neurol.,
d5c. 5, 1907, p. 465.

Disseminated Sclerosis.— OPPENHEIM. Zur sakralen Form der Sclerosis
multiplex. Neurol. Centralbl., Dez. 1, 1907, S. 1106.

ORMEROD. Two Cases of Disseminated Sclerosis,with Autopsy. Brain, VoL xxx..
No. 119, 1907, p. 887.

BIBLIOGRAPHY

«*

Mjil filidi—ALQUUBB et MXNDICINL Myflomalaoie bhes on sojet opW
d’un Nyoplasme ulodrl do la verge. ( 800 . de neurol) Rev. NeuroL, dot. 30,1907,
p. 1224.

Piraplefla—CRAIG. Fonotional Spastic Paraplegia. Dublin /own. Med. dk,
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DUPR^l, LHERMITTE et GIROUX. Parapiygie myfflopathiqoe dies un vieiHard.
( 80 c. de neuroL) Rev. NeuroL, nov. 80,19u7, p. 12X4.

MUIRHEAD LITTLE. Infantile Spastic Paralysis and its Treatment. Med.
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1 —tinirlli FftPFPT Traumatic Hematomyelia. Ann. qf Burg., Nov.
1907, p. 678.

Syringomyelia.—DUFOUR. Malformations Cong4nitales. Syringomyelic con-
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1907, p. 1220 .

L’HERMITTE et ARTOM. Un cas de syringomy61ie avec cheiromegalie suivi
d’autopsie. Nouv. Icon, de la SalpHrilrt, sept. -oct. 1907, p. 374.

N. S. IWANOW. Vagu sl&hmung (voreugsweise EehlkopfmuskellAhmung) bet
8 yringbulbie. Neurol. CerUralbl., Dez. 1, 1907, S. 1116.

FELIX ROSE et HENRI FRANCAIS. Amyotrophic dee memhree sup^rieurs et
du thorax aan* troubles de la sensibility. Syringomy61ie probable. Rev. NeuroL ,
d 6 o. 16, 1907, p. 1238.

■erpea.—ALEXANDER BRUCE. Unusual Sequela of Herpes Zoster (I Posterior
Poliomyelitis). Rev. NeuroL and Psychiat., Dec. 1907, p. 886 .

ROLLESTON. Herpes Facialis in Diphtheria. RriL Joum. Dermatol , Nov.
1907, p. 376.

IpUtl Cardes.—SCHLAGENHAUFER. Uber Rlickenmarksllsionen nach osteo-
porotischen Wirbelproseesen. Arb. a. d. NeuroL InstiL a. d. Wien. TJniu.,
Bd. 16, Teil 1, 1907, S. 310.

localisation.—J. H. LLOYD. Spinal Localisation as shown by a case of Acute
Meningomyelitis with Secondary Softening and Cavity Formation. Joum. Amer.
Med. Assoc., Dec. 7, 1907, p. 1886.

Spinal AnsMthesta.—NOICA. itude sur l'aneethtaie m4duUaire. Joum. de

Neurol ., d 6 c. 6 , 1907, p. 469.

mlahv—

Meningitis.— B 6 KAY. Der Wert der systematischen Lumbalpunktion in dor

Behandlung des Cerebrospinalmeningitis. D. med. Wcknsehr ., Nov. 21,1907, 8 .
1947.

CANTLEY. Cerebro-Spinal Meningitis. Brit. Joum. Children's Die., Nov. 1907,
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DAVID DAVIS. Studies in Meningoooocus Infections. Joum. Infectious Die.,
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KttRNER. Die otitischen Erkrankungen des Hims, der Hirnhfiute und der
Blutleiter. Bergmann, Wiesbaden, 1908, M. 3.

SAMBON et V01SIN. Complications dee mlningites oerebro-spinales aiguSs.
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Menlngtsm. —PEYRAZAT. Contribution & l’ 6 tude du myningisme (Bur un cas de
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Encephalitis.—CHARTIER. L’Enoyphalite aigue non suppurye. Jacques, Paris,
1907, 7 fr.

Abscess.—BOENNINGHAUS. Ein atypischer Fall von Sinusthromboee und
Kleinhimabssees. Ztschr.f. OkrenheUk ., Bd. 54, H. 3-4, 1907, S. 246.

BOINET. A beys du Lobe Occipital droit dll h une Infection Puerp 6 rale. ( 80 c-
de neurol.) Rev. Neurol nov. 80, 1907, p. 1228.

Trauma.— ACKERMANN. Beitrag zur Kasuistik der SchSdelverleteung (Beads-
fraktur, Contusio cerebri, traumatisebe Epilepeie und Demenayhasisohe Bymp-
tome). Monatsschr. f. Psychiat. u. Neurol., ErgttnsungBheft, 1907, S. 1.

KURT MENDEL. Der Unfall in der Aetiologie der Nervenkrankheiten (Fork).
Monatsschr. f. Psychiat. u. Neurol., Bd. 22, H. 6,1907, 8. 544.

BIBLIOGRAPHY 7*

g™®- , 52 ?“® 9 ???" of Head In i ul 7- Intercol. Med. Joum. of Auitral., Vol. 12,
No. 10, 1907, p. 641.

■emiptogfo—RAYMOND. L’h4michor£e post-h6mipl6giqae. Joum. da Prat,,

IpkMia. —F. X. DERCUM. A Case of Aphasia, both “ Motor ” and M Sensory,”
with Integrity of the Left Third Frontal Convolution; Lesion in the Lenticular
Zone and Inferior Longitudinal Fasciculus. Joum, Ncrv. and Ment. Die,, Nov.
1907, p. 681. *

LEW AN DOWSE Y. Ueber eine als transkortikal e sensorisohe Aphasie gedeutete
Form aphasischer Sprung. Ztsckr.f. hlin. Med,, Bd. 64, H. 8-4, 1907, S. 268.

M AH A IM. L*aphasie motrice, l’insula et la troisihme circonvolution frontale.
L’BnUpkale, nov. 1907, p. 477.

4r f Uber Asymbolie und Aphasie. Arb. a. d, deutschen. psychiat. Unit u-

KhnxL xn Prog., Kar lin, 1908, S. 80.

Aararlm. —CECIL F. BEADLES. Aneurisms of the Larger Cerebral Arteries.
Brain, Vol. 30, No. 119, 1907, p. 286.

iMfhntile Cerebral Paralysis. —NEURATH. Angeborene Herzfehler und organ-
ische Hirakrankheiten (cerebrale Kinderlahmung). Arb. a . d. Neurol. Instil, a, d,
Wxen. Univ., Bd. 16, Teil 2, 1907, S. 186.

Tmmoar.—MAGER. Zur Kenntnis vasomotorischer Symptome bei Himtumoren.
Arb, a. d, Neurol. Instil . a. d. Wien. Univ., Bd. 16, Teil 2, 1907, S. 340.

H & ma ngiom im Pons Varoli. Neurol. CentralbL, Dez. 10. 1907, S.

IlOA

NONNE. t)ber Falle von benignen Hirnhauttumoren ; liber atypisch verlaufene
ralle von Hiraabszess sowie weitere klinische und anatomiscne Beitr&ge zur
Pseudotumor cerebri.” Deutsche Ztschr.f. Nervenheilk., Bd. 88, H.

SOUQUES. Tumeur c£r6brale de la region des circonvolutions parietales supdr-
leures. Nouv. Icon, de la Salpltritre, sept.-oct. 1907, p. 366.

ERNST STRAUSSLER. Zur Symptomatologie und Anatomie der Hypophysen-
ganggeschwiilste (Erdheim). Arb. a. d. deutschen psychiat. Univ.-Klinxk in Prag..
Karger, Berlin, 1908, S. 88.

REDLICH. tlber diffuse Hirnrindenver&nderungen bei Himtumoren. Arb. a. d.
Neurol. Instil, a. d. Wien. Univ., Bd. 16, Teil 1, 1907, S. 320.

H. CAMPBELL THOMSON. A Clinical Lecture on a Case of Cerebral Tumour
Associated with Subjective Sensations of SmelL Brit. Med. Joum., Dec. 21,1907,
p. 1761.

Acresiegaly. —SCALINCI. De la pathogenic de l’exophtalmoe dans l'acromlgalie.
Germain et Grasset, Angers, 1907.

Pseudo-Bulbar Paralysis. — ARMAND-DELILLE et GIRY. Deux cas de
Scl6roee Cerebrale & type Pseudo-bulbaire chez l’Enfant. (Soc. de neuroL) Rev.
Neurol., nov. 30,1907, p. 1204.

BEEVOR.

A Case of Pseudo-Bulbar Paralysis with Complete Loss of Voluntary
Arb. cl d. Neurol. Instil, a. a. Wien. Univ., Bd. 16, Teil 1, 1907,

RAYMOND et ALQUIER. Sur un cas de paralyse pseudo-bulbaire. Nouv.
Icon, de la SalpStriire, sept. -oct. 1907, p. 371.

Tabereolesls. —MfiRY. Tubercule du cervelet. Joum. da Prat., d6c. 7, 1907,

Insolation. - SILVAGNI. Osservasdoni cliniohe, anatomiche e istologiche sol
oolpo di sole. Riv. crit. di Clin. Med., No. 48. 1907, p. 777.

OEimtlL AND FUNCTIONAL DISEASES—

Epilepsy.—BGKELMAN N. Epilepsieand Epilepeiebehandlung. Kabitsoh. Wtirs-
burg, 1907, M. 0.85.

DONATH. Sind Neorotozine bei der AuelSsung des epileptiauhen Krampfanfalls
anzunehmen? DeuUche Zttchr.f NervenkeUk., Bd. 83, H. 6-6, 1907, S. 450.
GRUNWALD. Zur Frage dee Bromgehaltes im Epileptikergehirn. Arb. a. d.
NeuroL Imtii. a. d. Wien. Univ., Bd. 16, Teil 1, 1907, S. 455.

BIBLIOGRAPHY

MARCHAND at NOUfiT. Du oar&ctfere dit “epfleptique.” Res. de Mid.,
No. 11.1907, p. 1090.

MASSAGLIA et SPARAPINI. Eclampsie experimental© et dclampsie spontanea
dea animaux. Arch. ital. dt Biol., Vol. xxyiiL, 1907, p. 109.

VILLARET et TIXIER. itclampsie puerperal© et leuoocytose du liquid©
o^phalo-rachidien. Gaz. dee H6p., dea 5, 1907, p. 1600.

RODIER et CANS. Lee auras visuellee dee 6pileptiques. Arch, dt Neurol, No.
9,1907, p. 177.

WHARTON SINKLER A Case of Epilepsy of the Family Type. N.T. Med.
Joum Dec. 7, 1907, p. 1067.

GENARO SIXTO. La Epilepsia Infantil y el Tratamiento metatrofioo. Arch,
dt Psiquiat. y Criminal. , sept.-oct. 1907, p. 534.

ERNST VEIT. Kutane Haemorrhagien bei Epileptiachen. MonaUschr.f. PsychiaL
u. Neurol., Erganzungsheft, 1907, S. 146.

Syphilis.— BALLET et VALENSI. Crises Epileptiformes. Sign© d*Argyll*
Lymphocytose. Syphilis remontant h 42 ana. (Soc. de neurol.) Rev. Neurol,
nov. 30, 1907, p. 1213.

ERB. Uber die Diagnose und Friihdiagnose der syphilogenen Erkrankungen dee
zentralen Nervensystems. Deutsche Ztsckr. f. Nervenkeiuc., Bd. 33, H. 5-6, 1907,
S. 425.

8CHUSTER. Hat die Hg. -Behandlung der Syphilis Einfluss auf das Zustande-
kommen metasyphilitischer Nervenkrankhei ten. Deutsche med. Wchnschr., Doc.
12, 1907, S. 2083.

Diabetes.— FRANZ SOETBEER. Epileptiform© Anfalle und SAure-Intoxikation
bei Diabetes mellitus. MonaUschr.f. Psychiat. u. Neurol., Erganzungsheft, 1907,
S. 92.

Cberea. — ORZECHOWSKI. Zur Frag© der pathologisohen Anatomic und
Pathogenese der Chorea minor. Arb. a. d. Neurol. Inst. a. d. Wien. Uni
Bd. 16, Teil 2, 1907, S. 530.

GEORGE CARPENTER A Fatal Case of Chorea, associated with Double Optic
Neuritis and Hyperpyrexia, in a Child aged three and a half years. Lancet , Nor.
30, 1907, p. 1521.

8IEGERT. Die Chorea minor, der Veitstans. Kabitsch, Wiirzburg, 1907,
M. —85.

Double Athetosis.— HAUPT. Ein Beitrag sur Kenntniss der idiopatisohen

Athetose (athltoee double). Deutsche Ztschr. f. Nervenheilk ., Bd. 33, H. 6-6, 1907,
& 464.

Paralysis Agltaas*— PARHON et URECHIE. Note sur les effets de TOpothdrspie
Hypophysaire dans un cas de syndrome de Parkinson. (Soc. de NeuroL) Res.
Neurol., nov. 30, 1907, p. 1280.

Exophthalmic Goitre.— PAUL SAINTON. Rapports da Congrfes de Medicine,
oct 1907. I. Pathog^nie et traitement du goitre exophtbalmique. IL Com¬
munications diverse*. L'EnctphaU, nor. 1907, p. 561.

SWASEY. Exophthalmic Goitre. Boston Med. and Sura. Joum., Dea 5,1907,
p. 754.

■yxoedema* —PIT FIELD. Incomplete and Complete Hypothyroidea or Myxo-
edema. Amer. Joum. Med. Sc., Dec. 1907, p. 859.

Neuralgia*— ACKLAND. Notes on Some Cases of Neuralgia. (Brit. Med. Assoa).
Bril Med. Joum., Nuv. 23, 1907, p. 1499.

Hysteria*— CLAPARtlDE. Quelques mots sur la Definition de THyiterie. Arth*
de Psychol., T. 7, No. 26, 1907, p. 169.

BAB1NSKI. Suggestion et Hysterie. A. propos de l'article de M. Bernheim
intitule: “ Comment je comp rends le mot hysterie.” Durand, Chartres, 1907.
BARTH. Die differentialdiagnostische Bedeutung der organischen und funk-
tionellen Aphonie. Deutsche med. Wchnsckr., Nov. 28, 1907, S. 1999.

BOLDT. Die Bedeutung der Hysterie filr die Armee. MonaUschr.f. Psyckial *•
Neurol ., ErgAnzungsheft, 1907, 8. 25.

BIBLIOGRAPHY

DERCUM. Hysteria. Its Nature and its Position in Nosology. Jour*. Amer.
Med. Assoc., Not. 28, 1907, p. 1729.

FRIEDLANDER. Ueber Hysteria und die Freudsohe psyohoanalytische Behand-
derselben. Monatsechr . /. Psychiat. tt. Neurol ., Erg&nzungsheft, 1907,

ALBERT KNAPP. Ueber hysterische reine Worttaubheit Monatsechr . /.

Psychiat. u. Neuriat., Bd. 22, H. 6, 1907. S. 586.

KOLLARITS. Bemerkung liber Tortioollis hystericus. Deutsche Ztschr. /.
Nervtnheilk ., Bd. 33, H. 5-6, 1907, S. 497.

LEROY. Kleptomania chez une hystlrique ayant presents, h differents 6poques
de son existence, des impulsions systematises de diverses natures. Joum. de
Neurol., nov. 5, 1907, p. 225.

BERNARD MYERS. On the Neoeeaity of Caution in Diagnosing Hysteria.
Practitioner, December 1907, p. 844.

SCHWARZ. Ueber sogen. “ hysterischee Fieber. ” St Peters . med. Wchnschr.,
Nos. 42, 43, 1907, Sn. 405, 414.

WESTPHAL. Ueber hysterische Pseudotetanie mit eigenartigen vasomotorisohen
Stbrungen. Berl. klin. Wchnschr., No. 49, 1907, S. 1567.

Neumsthenla.—ALBERT DESCHAMPS. Les Maladies de l’^nergie. Les
Asth£nies g^nerales. Alcan, Paris, 1908, 8 fr.

DAVID DRUMMOND. A Lecture on the Mental Origin of Neurasthenia and its
Bearing on Treatment. BriL Med . Joum Dec. 28, 1907, p. 1813.

PAUL LONDE. L’asthlnie oonstitutionnelle. Rev. de Mid., No. 11, 1907,
p. 1023.

Acrocyanosis. —BARKER and SLADEN. On Acrocyanosis Chronica Annas*
thetica with Gangrene: Its Relations to other Diseases, especially to Erythrome*
lalgia and Raynaud’s Disease. Joum. Nerv. and Ment. Du., Dec. 1907, p. 745.

Caisson Disease.—F. H. RUDGE. A Case of “Caisson Disease.” Lancet,
Dec. 14, 1907, p. 1675.

Neuroses.—G. D’ABUNDO. Sostitudoni, trasformadoni ed associadoni morboee
nolle nevropatie. Riv. Ital. di Neuropathol.. Psichiat. ed ElettroUr ., VoL i, f.l,
1907, p. 1.

FORCHHEIMER. Anorexia Nervosa in Children. Aixh. qf Pediat., Nov. 1907,

p. 801.

W. v. HOLST. Ueber Herznervodtkt. St Peters, med. Wchnschr ., No. 44, 1907,
S. 421.

ORLOWSKI. Die Phosphaturie eine traumatische Neurose. Ztschr. f. U)oL,
Bd. 1, H. 12,1907. a 1034.

TROMNER. Ueber Abade resp. Dysbade. Monatsechr. f. Psychiat. u. Neurol.,
Ergttnzungsheft, 1907, S. 132.

WARDA. Zur Pathologie und Therapie der Zwangsneurose. Monatsechr. f.
Psychiat. u. Neurol., Ergknzungsheft, 1907, S. 149.

SPECIAL SENSES AND CRANIAL NERVES—

DOPTER. Paralysie faciale au cours d’un erydpMe ambulant. Prog, mid.,
nov. 30, 1907, p. 853.

FUCHS. Ooulomotoriusl&hmung ohne Beteiligung der Binneramuskeln bet
^eripheren Lasionen. Arb. a. d. Neurol. Instit. a. d. Wien. Univ., Bd. 15, Toil 1,

CRADLE. Bilaterality and One-ddedness in Diseases of the Eye. N. T. Med.
Joum., Nov. 23, 1907, p. 968.

JAY KAISER. A Case of Unilateral Third Nerve Paralysis. Med. Rec.,
Nov. 30, 1907, p. 903.

ALFRED FUCHS. Periphere Faoialislahmung. Arb. a. cL Neurol. Instit. a. d.
Wien. Univ., Bd. 16, Toil 2, 1907, S. 245.

MALAISI^. Die Lahmung des Nervus facialis. Ergeb. d. allg. Pathol ., Bd. 2,
Abt. 2, 1907, S. 81.

J. 8TODDART BARR and JOHN ROWAN. An Investigation into the Frequency
and Signification of Optic Neuritis and other Vascular Changes in the Retina of
Patients suffering from Purulent Disease of the Middle Ear. Bint. Med. Joum.,
Nov. 23, 1907, p. 1480.

10*

BIBLIOGRAPHY

MANNING FISH. A Study of Thirty-six Successive Case* of Optic Neuritis.
Joum. Laryngol. Rhinol. and Otol ., Dec. 1907, p. 619.

SARAKOFF. Bin Fall yon Neuritis retrobulbaris als Folge yon Jodoformintoxi-
kation. Wien. klin. Wchnschr., Noy. 28,1907, 8. 1507.

MHCELUHE6V8 SYMPTOMS—

ALQUIER et CIOVINI. MonoplSgie Braohiale droite. Troubles de la parole, etc.
(Soc. de neurol.) Rev. Neurol noy. 80, 1907, p. 1222.

BABIN SKI. Troubles sensitifs dans une lesion bulbaire. Jour a. da PraL , d6a
21, 1907, p. 823.

BAUN. Untersuchungen Uber den Mendel-BechterewBchen Fussriiokenreflex.
MUneh. med. Wchnschr., No. 50, 1907, S. 2468.

W. y. BECHTEREW. t)ber die Hervomifurtg yon Sohmerzen bei Isobias durch
Hyperextension der Extremit&t und Uber die Unfahigkeit beide Beine xu strecken.
Neurol. Centralbl ., Des. 1, 1907, S. 1107.

BREGMAN. (jber akute Ataxie. Deutsche Ztschr, . /. NervenKeUk. , Bd. 38, EL
5-6, 1907, S. 409.

BUMKE. Neuere Untersuchungen Uber die diagnostische Bedeutung der
Pupillensymptome. Munch. med. Wchnschr ., No. 47, 1907, S. 2313.

BLEGVAD. Ueber die Einwirkung des berufsmfissigen Telephonierens auf den
Organismus mit besonderer RUcksicht auf das Gehdrorgan (Schluss). Arch.
Okretiheilk., Bd. 72, H. 8-4, 1907, S. 205.

BREGMAN. t)ber den spontanen AusUuss yon CerebrospinalflUssigkei t duroh
die Nase. Arb. a cL Neurol Instil a. d. Wien. Univ ., Bd. 15, Tefl 1, 1907,
S. 474.

CANTONNET et LAN DOLT. Par&lysie de F616vation dee Globes Oculairee pour
lee mouyements yolontaires aveo integrity des mouyements automatico-r^flexee.
{Soc. de neurol.) Rev. Neurol ., noy. 2®, 1907, p. 1205.

CHALIER. Un cas de nanisme thyroidien. Got. da Htp ., noy. 19, 1907i
p. 1675.

COUGET. Le oaf&sm et le thfcisme. Gaz. da. H6p. % noy. 28 et d£e. 8, 1907.
CORLAT. Some Further Studies on Nocturnal Paralysis. Boston Med. and Surg.
Joum., Dec. 5, 1907, p. 751.

R. H. ELLIOT. On Some Forms of Headache. Indian Med. Goa, Noy. 1907,
p. 409.

ESCHBACH. La plagioo6phalie. Joum. de MSd ., No. 47, 1907, p. 462.
ETIENNE Des ecchymoees zoniformes spontan6es. Nouv. Icon, de la SalptrUre,
eept.-oct 1907, p. 385.

FEHR. Sehnervenerkrankung durch Atoxyl. Deutsche, med. Wchnschr. , Dee. 5,
1907, a 2032.

FRANKEL. Spiegelschrift der linken Hand und Nutzen linkseeitiger Schreib-
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FRIEDEMANN. Ueber passiye Ueberempfindliohkeit. Munch, med . Wchnschr.,
No. 49, 1907, a 2414.

HANDWERCK. Kurzdauemdes Oedem der Sehnervenpapille eines Auges, eine
Localisation des akuten umschriebenen Oedema (Quincke). Munch, med. Wchnschr .,
No. 47, 1907, S. 2332.

THEOPHIL KLINGMAN. Facial Hemiatrophy: Statistical Review of Etio¬
logical Factors and Pathogenesis. Joum. Amer. Med. Assoc., Deo. 7, 1907,

p. 1888.

LUCIEN HAHN et WICKERSHEIMER. Un cas dbypertrophie mammaire
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FRANKL-HOCHWART. Zur Differentialdiagnose der juvenilen Blasenstor-
ungen. Arb. a. d. New'ol. Instil a. cL Wien. Univ., Bd. 16, Teil 2, 1907. S. 1.
ETTORE LEVI. Das gr&phische Studium des Fussklonus und seine Bedeutung
in der Klinik. Arb. a. d. Neurol. Instil, a. d. Wien. Univ., Bd. 16, Teil 2, 1907,

a 26.

LOWENBURG. The Diagnosis and Treatment of Convulsions in Children.
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OHLER. Ueber einem bemerkenswerten Fall von Dyskinesia intermit tens
brachioram. D. Arch./, klin. Med., Bd. 92, H. 1-2,1907, S. 164.

BIBLIOGRAPHY 11*

HERBERT PARSONS. A Clinio&l Lecture on the Diagnostic Value of the
Visual Acuity. Lancet, Nor. 80, 1907, p. 1518.

A. PICK. Zur Sy mptomato)ogie dee atrophisohen Hinterhauptslappens. Arb. a.
& Deutschen Psyckiat., Univ.-Klinik in Prog , Rarger, Berlin, 1908, 8. 42.
SCHLESINGER. Zur Kenntnis der Spondylitis infectiosa (nach Dengue-Fieber).
Arb . a. d . Neurol. Insdt . a. d. Wiea. univ., Bd. 16, Teil 2, 1907, S. 13.

RHEIN and POTTS. Poet-Apoplectic Tremor (Symmetrical Areas of Softening
in Both Lenticular Nuclei and External Capsules). Joum. Nerv. and Ment Die.,
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KRAUSE Ueber pseudoepastische Pareee mit Tremor nicht traumatdscher
Aetiologie. Monatsschr./. Psyckiat. u. Neurol ., Ergttnzungsheft, 1907, S. 54.
RAMOND. Vertiges et dyspepeie. Prog. M$d. t d6c. 7, 1907, p. 865.

RIGLER. Uber die nervdsen Stbrungen bei Schwefelkohlenstoffvergiftung.
Deutsche Ztsckr.f. Newnheilk., Bd. 33, hT 5-6, 1907, S. 477.

HERBERT J. ROBSON. The Synchronous Movements of the Lower Eyelids with
the Tongue and Lower Jaw observed in Certain Diseases. Lancet , Dec. 14, 1907,

p. 1681.

ROSE et LEMAITRE. Apoplexie bulbo-protutarantrielle circonscrite probable i
la suite d’une Emotion provoqu6e par un Traumatisme insignifiant (Soc. de
neurol.). Rev. Neurol ., nov. 30, 190/, p. 1202.

Fl&LIX ROSE. De l’apraxie. L'BndphaU, nov. 1907, p. 510.

SPIELER. Zur Pathogenese der postdiphtherischen Ltthmungen und des
Herztodes bei Diphtherie. Arb. a. <L Neurol Instil, a. d. Wien . univ. , Bd. 15,
Teil 1, 1907, S. 512.

SPILLER. Paralysis of Upward Associated Ocular Movements. Arb. a. d.
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UCHERMANN. Otitisohen Gehienleiden. Arch. /. Ohrenkeilk. , Bd. 72, H. 8-4,
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PST0HIATB7

GENERAL—

J. CROCQ. La situation du m6decin d’asfle en Belgique. L'Informateur des
AliSnistes , nov. 1907, p. 884.

SHUZO KURE. Medizinischer Berioht des Sugamo Hospitales, der Irrenanstalt
der Stadt Tokio flir den Zeitraum, 1889-1901. Arb . a. d. Neurol InstiL a. d.
Wien. Univ., Bd. 16, Teil 2, 1907, S. 279.

MARCH AND et NOUET. Lea syndromes mentaux symptomatiques de la
sd6rose c6r6brale superficielle diffuse. Rev. Neurol, nov. 80, 1907, p. 1164.
NOUET. Documents relatifs h l'histoire de la psychiatrie : Un asile anglais en
1828. Rev. de Psyckiat ., No. 11, 1907, p. 457.

JOSfi S. PICADO. Educacion de los Ninos Retard os. Arch, de Psiquiat y
Criminal., sept.-oet., 1907, p. 511.

STROHMEYER. Ueber den Wert genealogischer Betraohtungsweise in der
psychiatrischen Erblichkeitslehre. Monatsschr. f. Psyckiat. u. Neurol , Erg&nz-
ungsheft, 1907, S. 115.

ZIEHEN. Beitrag zur Methodik der Statistik und der Klaasifikation der
Pay chosen. Monatsschr. f. Psyckiat. u. Neurol., Erg&nxungsheft, 1907, S. 161.
AYARRAGARAY. El suicidio en las Campanas Argentina*. Arch, de Psoquiat.
y Criminol ., sept.-oct., 1907, p. 526.

STEGMANN. Beitrag zur Lehre vom Selbstmord. Monatsschr. f. Psyckiat. u.
Neurol ., Erganzungsheft, 1907, S. 109,

General Paralysis.— RICHARD FELS. Wandlungen im klinischen Verlaufe der
grog-essiven Paralyse. Monatsschr. f. Psyckiat u. Neurol., Erg&nzungsheft, 1907,

OSKAR FISCHER, tlber den fleokweisen Markf&sersohwund in der Himrinde
bei progressiver Paralyse. Arb. a. d. deutechen psyckiat. Univ.-Klinih in Prog,
Karger, Berlin, 1908, S. 63.

ERWIN FRIEDEL. Ueber Gliastiftbildung und Vorderhomatrophie im Rlioken-
marke einen Paralytikers. Monatsschr . /. Psyckiat u. Neurol., Ergtozungsheft,
1907, S. 39.

12*

BIBLIOGRAPHY

MABILLE et DUCOS. Traumatismes craniena et paralysis g^nto-ale. L'Kncepkalt,
nor. 1907, p. 687.

MARANDON de MONTYEL. Alterations isol6es et siinultan6es dot reflex*
mens dans la paralysis gyn&ale. Rev. de MScL, No. 11, 1907, p. 1088.

8 CHMIERGELD. Lee glandee k s&sretion interne dans la paralysis gdndrale.
L'JSnctphale, nov. 1907, p. 601.

WEIL und BRAUN. Ueber AntiktSrperbefunde bei Lues, Tabes und Paralyse.
Berl. kli a. W<An*Ar., No. 49, 1907, R 1670.

iOMMtla Praeeex.—SCHAEFER. Ein Fall von Dementia prsecox katatonischer
Form (Kr»pelin) der nach 15 jahriger Dauer in Genesung auaging. Monaisadur.
f. Psychiat. u. NeuroL, Erganzungsheft, 1907, 8. 72.

RICHE, BARB^, et WICKERSHEIMER Dee ldsions anatomiquee attribofe i
la dtaence prdcoce. Arch, de Neurol No. 9, 1907, p. 186.

■ulcDepmilfe Imsamlty.—ISSERLIN. Piyohologisehe Unterauchungen an
Manisch-Depressiven. Monatsachr. f. Psychiat. a. Neurol., Bd. xxiL, H. 6, 1907,
S. 609.

JiTeiile Imsamlty. —MIKA YE. Jugendirresein. Ark a, <L NeuroL InstiL a. <L
Wien, Univ., Bd. 16, TeU 2, 1907, 8. 315.

I41eej.—H. YOGT. Zur Pathologic und pathologischen Anatomie der verschiedsoen
Idiotie-Formen (Sohluse). Monatsachr. f. Psychiat, a. NeuroL , Bd. 22, EL 6d,
1907, S. 490.

Ceaitttatioaal Abmeimality. — EDUARD REISS. Rasuistischer Beitrag mr
Lehr© von dem Auftreten paranoider Symptomenkomplexe bei Degenierten.
CetUralbl.fNervenheilk. u. Psychiat ., De*. 1, 1907, 8. 893.

Traumatic rsyekose*. — MAX SOMMER. Zur Kenntnia der akuten trau-
matischen Pay chosen. Monatssckr, f. Psychiat u . NeuroL , ErgSnaungaheft, 1907
8 . 100 .

Aleekolftc Fsyckese*.—LA PIERRE Alcoholic Delusional Insanity. Med . Rsc.,
Dec. 7,1907, p. 988.

SERBSKY. Die Korsakowsche Kr&nkheit. Arb . a. cL NeuroL InstiL a. <L Wien*
Untv., Bd. xv., Teil 1, 1907, 8. 889.

Ieill« Dementia.—FRANCESCO FRANCESCHL Le demenze aemDL Gliosi
perivascolare—Lacune da deamtegrasione. Riv. di Patol, nerv. e menL, toL xiL,
f. 9, 1907, p. 445.

DelIrtmm.—SWIFT. Delirium and Delirious States. Boston Med. and Surg.
Joum ., Noy. 21, 1907, p. 687.

Medico-Legal.—BALTASAR BELTRAN. Histerismo y Responsabilidad penal
Arch, de PsiquiaL y Criminol. , sept.-oct. 1907, p. 60L

INGEGNIEROS. La Alienacion Mental y el Delito. Arch, de PsiquiaL y
Criminol ., sept.-oct. 1907, p. 565.

BARRIOS y A VEND AN0. Responsabilidad de loe Actos Praoticadoe par los
Alcoholicos. Arch, de Psiquiat. y Criminal., sept.-oct. 1907, p. 688.

BERNARD LEROY. Escroquerie et Hypnoee. Arch, de PsychoL, T. 7, No. 26,
1907, p. 188.

COSSA. Des modifications k apporter k la Legislation Fran^aise sur les AH^nfe.
L'lnformatcur des Alitnistes, nor. 1907, p. 847.

INGEGNIEROS. Liberadon y Abandono de Alienados delinguentes modelo de
delirio sistematico evolutive. Arch, de PsiquiaL y Criminal, sept.-oct. 1907,
p. 669.

INGEGNIEROS. Los Alienados y la Ley Penal. Arch, de PsiquiaL y CrmiuoL,

sept-oct. 1907, p. 571.

LUCIO V. LOPEX y AGUDO AVILA. Disimulacion en los Delirantes Sistema-
tizados. Arch. PsiquiaL y Criminal., sept.-oct., 1907, p. 578.

TARNO WSKI. Le Suicide et la Criminality au Japon. Arch. dAnthrop. Grim,
ddc. 12, 1907, p. 809.

Miscellaneous Cases—R AIM ANN. Homidde Melancholiker. Arb. a. d. NeuroL
InstiL a. d. Wien. Univ., Bd. 16, Teil 8,1907, S. 167.

HANS BERGER Ueber die Psychosen des Klimakteriums. Montsschr . f-
Psychiat u. NeuroL, Ergfinxungsheft, 1907, S. 18.

BIBLIOGRAPHY

13*

PAPPENHEIM. tJber einen Fall Ton periodischer Melancholia, kombiniert mit
Hysteric und Tabes dorsalis mit eigenartigen Migrkneanfkllen. Arb. a. d.
deutschen Psychiat Unit. -Klinik. tit Prag ., Karger, Berlin, 1908, S, 118.
URBACH. Ueber akute Psychosen nach Operationen am Gallengangsystem.
Wien. Uin. Wchnschr., Nov. 21, 1907, S. I486.

Special Symptoms —FLOURNOY. Automatisme tdldologique anti-suicide. Arch,
de Psychol., T. 7, No. 26, 1907, p. 113

MACDONALD. Physio-Psychology of Hallucinations. Glasgow Med. Jour*
Deo., 1907, p. 498.

MAROULIES. Studien Uber Echographie (Pick). Monaisschr. f. Psychiat. u
Neurol., Bd. 22, H. 6,1907, a 479.

A. PICK. t)ber Stttrungen der Orientierung am eigenen Ktirper. Arb* a. d.
deutschen peychiaL Unit.-Klinik in Prag., Karger, Berlin, 1908, S. 1.

BABINSKI. Utility du traitement mercuriel dans la syphilis du systhme nerreux
et en particular dans le tabes. Clin, de Parts, No. 89, 1907.

BERKELEY. A Brief Report of Further Experiences in the Use of Parathyroid
Gland for Paralysis Agitank N. Y. Med. Journ., Nov. 23, 1907, p. 974.

BUMM. Behandlung der Eklampsie. D.med. Wchnschr., Nov. 21, 1907, a 1945.
CASSIRER. Die Behandlung der Erkrankungen der Cauda equina. Deutsche
Ztschr.f. Ncrvenheilk., Bd. 33, H. 6-6,1907, S. 882.

CROTHERS. The Action of the Radiant Light Bath in Nervous Diseases. Med*
Pec., Nov. 23, 1907, p. 853.

DELHERMet LAQUERRlftRE. L’lonoth&rapiedlectrique. BaiUUreetfils, Paris,

CRAMER Die Behandlung der arteriosklerotisohen Atrophie des Groeshims.
Klinischer Vortrag. D. med. Wchnschr., iL, Nov. 21, 1907, S. 1929.

DAM AYE. Re marques sur l'action clinique de Tiode au cours des 6tats de
stupidity et de confusion mentale. Rev. de Psychiat., No. 11, 1907, p. 448.

RENK DESPLATS. Contribution k T6tude du traitement du tic douloureux de
la face par Tintroduction dlectrolytique de Tion salicylique. Arch. <TElect. Mid .,
nov. 25, 1907, p. 867.

LHERM1TTE et LlfcVY. Injections aous-arachnoidiennes de Fibrolysine dans le
Tabes. (Soc. de neurol) Res. Neurol., nov. 30,1907, p. 1214.

FREUND. Rtintgenbehandlung der Isohias. Wien. Jilin. Wchnschr ., Des. 19,
1907, S. 1611.

PINELES. Zur Behandlung der Tetanie mit EpithelktirperprKparaten. Arb. a*
d. Neurol. Inslit. a. d. Wien. Univ. t Bd. 16, Teil 2, 1907, S. 437.

TOBBEN. Zur Therapie der Meningitis cerebrospinalis epidemics. Munch, mid.
Wchnschr., No. 49, 1907, S. 2420.

ROSENBLITH. Le massage en neuropathologie. Journ. de Mid., No. 46, 1907,
p. 4 49.

SCHUTTE. Therapeutische Erfahrungen mit “Barta” bei Neurasthenic,
Hysterie, Impotent Koster, Aachen, 1907, M. —50.

MAX SIEGE. Erfolge der Flechsigschen Brom-Opium-Kur. Montasschr. f.
PsychicU. u. Neurol., Ekgknzungsheft, 1907, S. 84.

WOLFF. Zu Dr Gustav Heim : Wirkung 'dee Klimas Aegyptens auf Neur-
asthenie. Centralbl.f. Ncrvenheilk. u. Psychiat., Nov. 15,1907, S. 865.

Svrgtcal.—ALESSANDRI. Ulteriori cenni su di un caso operato di laminectomia
per lesione della cauda equina. Riv. di Paid. nerv. e menu, YoL xii, f. 9, 1907,
p. 470.

BABINSKI. Section de la branche exterae du Spinal dans le Tortioolis dit
Mental. (Soc. de neurol.) Rev. Neurol ., nov. 80, 1907, p. 1208.

BAER Operations of the Spinal Column. Ann. qf Surg Nov. 1907, p. 694.
BABCOCK. Nerve Disassociation j a New Method for the Surgical Relief of
oertain Painful or Paralytic Affections of Nerve Trunks. Ann. qf Surg., Nov.
1907, p.686.

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

14 *

BOOKS AND PAMPHLETS RECEIVED

CHARLES A BALLANCE. An Address on Some Experiences of Intracranial
Surgery. Lancet , Deo. 21, 1907, p. 1741.

The Indications for Operation in Cases of Intracranial Tumour. Leading Article.
Brit . Med . Joum., Nov. 30, 1907, p. 1005.

BR1SSAUD et SICARD. Tr&itements des nlrralgies du triiumeau pas lea
injections profondes d’aloooL Rev. NeuroL , nov, 30, 1907, p. 1157.

BRUNS. Die chirurgische Behandlung der RUckenmarksh&utgesohwulgte.
Deutsche Ztschr.f. Nervenheilk ., Bd. 33, EL5-6, 1907, S. 355.

SICARD el DESCOMPS. Torticollis Mental de Brissaud. lichee du traitemeot
chirurgical. (Soc. de neurol.) Rev. Neurol., nov. 30, 1907, p. 1207.

CANNY RYALL. The Value of Spinal Analgesia in protecting the Patient from
Surgical Shock. Med. Press. , Dec. 18, 1907, p. 659.

SCHLESINGER. Operative Behandlung traumatischer Meningitis. BerL klin .
Wchnsckr. , No. 47, 1907, S. 1514.

8 HAMBAUGH. Some Important Surgical Relations of the Temporal Bone.
Joum. Amer. Med. Assoc., Dec. 14, 1907, p. 1991.

SPITZY. Die Anwendung der Lehre von der Regeneration und Heilung durch*
schnittener Nerven in der chirurgischen Praxis. Wien. Min. Wchnsckr Nov. 28,
1907, S. 1493.

SOUTTER. A Brace for Postural Curvature of the Spine. Boston Med* and Sure
Joum., Nov. 28, 1907, p. 726.

G. A. WRIGHT. Note on Treatment of Trigeminal Neuralgia by Injection of
Osmio Add into the Gasserian Ganglion. Lancet, Deo. 7, 1907, p. 1603.

B1&RARD. L’Hypnotisme et la Suggestion en thdrapeutique ooulaire. Germain
et Grasset. Angers, 1907.

LAVRAND. La suggestion et les Gulrisons de Lourdes. Blond et Cie, Paris,
1908.

BOOKS AND PAMPHLETS BEOEIVED

Van Gehuchten. “ Les Centres Nerveux Cdrdbro-epinaux. Anatomie
Normale et filaments de Neoropathologie Gdndrale.” Uystpruyst-Dieudonn^,
Louvain, 1908.

A. Pick. “ Arbeiten aus der dentechen psychiatrischen Universitats-
Klinik in Prag.” Karger, Berlin, 1908, M. 8.

Sydney Herbert Mellone and Margaret Drummond. “ Elements of
Psychology.” Blackwood & Sons, Edinburgh 1907. 5s.

u Studies from the Department of Neurology.” Publications of Cornell
University Medical College.

“Arbeiten aus dem Neurologischen Institute an der Wiener Univeraitat
Bd. xv., u. Bd. xvi. Festschrift zur Feier des 26 jahrigen Bestandesdes
Neurologischen Institutes.” Franz Deuticke, Leipzig u. Wien., 1907, M. 25,
jeder Band.

Albert Deschamps. “Lea Maladies de I’jftnergie. Les Asthdnies
G4n4ralee.” F. Alcan, Paris, 1908. 8 fr.

Bibliography

ANATOMY

DUCKWORTH. The Brains of Aboriginal Natives of Australia in the Anatomy
School, Cambridge University. Part II. Jomm, A not. and Physiol ., Jan. 1908,

p. 176.

FLECHSIG. Bemerkungen liber die Horsph&re des menschlichen Gehirns*
Neurol. Ctnlralbl ., Jan. 2 u. 16, 1908, Sn. 2, 60.

HALLER. Die pbyletische Entfaltung der Grosshirnrinde. Arch, f. mikros.
Ana/., Bd. 71, H. 3, 1908, S. 350.

HERMANN. Gehirn und Sch&del. Fischer, Jena, 1907, M. —60.

BRUNO LOBO. Estructura do cylindro-eixo. Arch, Brasil, de Psychiat. e
Neurol ., Anno 3, Ns. 3 e 4, 1907, p. 297.

ANDREA MANNU. II confluente dei seni della dura mad re, le sue variazioni
e il suo significata. Intemat. Monatschr, f. Anal. u. Physiol., Bd. 24, H. 7-9,
S. 304.

PAULESCO. L’Hypophyse du Cerveau. Recherches Morphologiques et Physio-
logiques. Vigot Freres, Paris, 1908, 4 fr.

PESKER. Zur Lehre von der Histogenese der Neurofibrillen. Arch./, mikros.
Anat, Bd. 71, H. 3, 1908, S. 333.

RAMON Y CAJAL. El Renacimiento de la Doctrina Neuronal. Arch, de
Psiquiat. y Criminol ., Nov.-Die. 1907, p. 646.

ST BERNHEIMER. Zur Kenntnis der Guddenschen Kommissur. Arch. f,
Ophthalmol ., Bd. lxvii. Hft. 1, S. 78.

PHYSIOLOGY

CAILLAUD. Physiologic de l’iria. litat actuel de nos connaissances sur cette
question. Oaz. des H6p., d6c. 21, 1907, p. 1743.

DESFOSSES. Physiologie musculaire. Gymnastique de la region eervicale.
Presse Mid., jan. 1, 1908, p. 2.

KRONE. Das Verhalten des Blutdruckes bei Muskelarbeit. Miinch, med.
Wchnschr ., Nr. 2, 1908, S. 69.

J. N. LANGLEY. On the Contraction of Muscle, chiefly in relation to the
Presence of “ Receptive ” Substances. Joium. Physiol., Dec. 31, 1907, p. 347.
KEITH LUCAS and G. R. MINES. Temperature and Excitability. Jotmi.
Physiol ., Dec. 31, 1907, p. 334.

KEITH LUCAS. On the Rate of Variation of the Exciting Current as a
Factor in Electric Excitation. Joum. Physiol ., Dec. 31, 1907, p. 253.

C. CENI. L’influence des centres corticaux sur les phdnomfenes de la g£n6ra-
tion et de la perpetuation de Tesp&ce. Arch. ital. de Biol., T. xlviii., F. 1, p. 49.
PORTER and QUINBY. Further Data regarding the Condition of the Vaso¬
motor Neurons in “ Shock.” Amer. Jour. Physiol ., VoL 20, No. 4, 1908, p. 500.
F. SPALLITTA. Sur la fonction du ganglion du vague ohez la Thalasiochelys
caretta. Arch. Ital. de Biol., T. xlviii., F. 1, p. 33.

PSYCHOLOGY

H. CARR. Apparent Control of the Visual Field. Psychol. Review, Nov. 1907,
p. 367.

J. COHN u. W. GENT. Aussage und Aufmerksaraheit. Zeitschrift f. angewandte
Psychol,, Bd. 1, H. 3, S. 237.

b *5*

16*

BIBLIOGRAPHY

STEPHEN S. COLVIN. The Educational Value of Humour. Pedagog. Seminary,
Dec. 1907, p. 517.

HANCOCK. Mental Depression in Young Women and Children. Pedagog.
Seminary, Dec. 1907, p. 460.

R. HAHN Uber die Beziehungen zwischen Fehlreaktionen und Klangassozia-
tionen. Psychol. Arbeiten, Bd. 5, H. 2, S. 163.

HERBERTZ. Die angeblich falsche Wissenstheorie der Psychologie. Zts-hr. f.
Ptyrkol., Bd. 46, H. 4, 1907, S. 275.

KIESOW. Ueber einige Beruhrungstauschungen. Aixh. t\d. gtsam. P<ychc>l. y Bd.
10, H. 3-4, 1907, S. 311.

O. KRAMER. Zur Untersuchung der Merkfiihrigheit Gesunder. Psychol. .4r-
beiten. Bd. 5, H. 2, S. 253.

RAPHAEL LEVI. Zur Analyse der Empfindungec, insbesondere der Lustemp-
findungen. Arch. f. d. gcsam. Psychol., Bd. 10, H. 3-4, 1907, S. 403.

PAUL LINKE. Die stroboskopischen Tiiuschungen und das Problem des Sehens
▼on Bewegungen. Psychol. Shtdien , Bd. 3, H. 5 u. 6. S. 393.

MARTIN. Zur Begriindung und Andwendung der Suggestionsmethode in der
Normal psychologic. ArrA./. d . gesam. Psychol Bd. 10, H. 3-4, 1907, S. 321.

G. H. MEAD. Concerning Animal Perception. Psychol. Rev., Nov. 1907, p. 333.
MESSER. Bemerkungen zu meinen 44 Experimentell - psychologischen Unter-
suchungen liber das Denken.” Arch. f. d. gesam. Psyc/u>l. y Bd. 10, fl. 3-4, 1907,

S. 409.

MULLER-FREUNFELS. ZurTheorie der Gefiihlstbne der Farbenemphndungen.
Ztschr. t. Psychol., Bd. 46, H. 4, 1907, S. 241.

TALBOT. The Identity of Visual and Colour Sensations. Med. lice., Dec. 21,
1907, p 1023.

VON RENAULD. Ueber reflektive Sympathie mit besonderer Berlicksichtigung
der Verpflichtungsfrage. Arch.f.d. gesam. Psychol Bd. 10, H. 3-4, 1907, S. 264.
E. H. ROWLAND. A Study in Vertical Symmetry. Psychol. Rev., Nov. 1907.

5. von der TORREN. liber das Auffassungs- und Unterscheidungs-vermugen fur
optische Bilder bei Kindem. Ztschr. f. angewandte PsychoL , Bd. 1, H. 3, S. 189.

PATHOLOGY

A. N. COLLINS and E. E. SOUTHARD. Gliotic Cyst of the Right Superior
Parietal Lobule. Amer. Journ . Insan., Vol. 64, No. 2, 1907, p. 271.
HALLIBURTON. The Repair of a Nerve. Science Progress , Jan. 1908, p. 413.
LUDLAM. Peripheral Spinal Degeneration revealed only by Longitudinal Sec¬
tions of the Cord and an Axis-cylinder Stain. X. V. Med. Journ. y Dec. 21, 1907,
p. 1167.

CARLO RICHETTI. Delle alter&zione cellulari nervosa consecutive ad ustioni
circoscritte della cute. Sperimcntale , Anno bd., f. 6, 1907, p. 771.

SOUTHARD and HODSKINS. Note on Cell-Findings in Soft Brains. Amer .
Journ. Insan., VoL 64, No. % 1907, p. 305.

CLINICAL NEUROLOGY

CEXEKAL—

L. A. CLUTTERBUCK. Nerve Diseases. Scientific' Press, London, 1907, 3s.
OPPENHEIM. Zur Lehre von der Period izitat nervdser Krankheitserscheinungen.
.Vff'/o/. Cmtralhl. Jan. 2, 1908, S. 7.

PILCZ. Beitrage zur direkten Herelitut. Wien. merl. DVA«4cAr., Dez. 21, 1907,
S. 2506.

Erste Jahresversammlung der Gesellschaft Deutscher Nerveniirtze in Dresden
am 14. und 15. September 1907. D. Ztschr. f. Xercenheilk., Bd. 34, H. 1, 1907,
S. 1.

M1SCLE8—

RUD. DIETSCHY. Ueber eine oigentiimliche Allgemeinerkrankung mit vor-
wiegender Beteiligung von Muskulatur und Integument Ztschr. f. If in. Med..
Bd. 64, H. 5-6, 1S07, S. 377.

BIBLIOGRAPHY

17*

H. LEWIS JONES. Cervical Ribs and their relation to Atrophy of the Intrinsic
Muscles of the Hand. Quarterly Journ. of Med., Jan. 1908, p. 187.
HERRINGHAM. A Clinical Lecture on a Case of Muscular Atrophy. Clin.
Journ., Jan. 15, 1908, p. 209.

M6RY. La poliomyosite simple. Journ. desPrat ., No. 1, 1908, p. 7.

M^JRY. La paralysie pseudo-hypertrophique. Journ. des Prat., No. 3, 1908,
p. 38.

PKKIPHERAL NERVES—

BRASSERT. Spatl&sion des Ulnaris. Munch, med. Wchnschr., Dez. 31, 1907,
S. 2841.

DUQUE ESTRADA. Urn caso de nervotabes peripherica. Arch. Brasil, de
Psychiat. e Neurol., Anno 3, Ns. 3 e 4,1907, p. 285.

KLIPPEL et LHERMITTE. Des n£vrites au cours des cirrhoses du foie.
Semaine Mid., jan. 2. 1908, p. 13.

SPINAL CORD—

Peliemy el lifts* —HENRY W. BERG. Poliomyelitis Anterior as an Epidemic
Disease. Med. Rec., Jan. 4, 1908, p. 1.

GIBNEY and CHARLTON WALLACE. The Recent Epidemic of Poliomyelitis.
A Preliminary Report. Journ. Amer. Med. Assoc., Dec. 21, 1907, p. 2082.

Paraplegia. —W. B. WARRINGTON. A Case of Paraplegia due to an Intra¬
medullary Lesion and Treated with some Success by the Removal of a Local
Accumulation of Fluid. Lancet , Jan. 11, 1907, p. 94.

Tabes.— GlJNZBURGER. Pruritus bei Tabes. Munch, med. Wchnschr., Dez. 31,

1907, S. 2643.

GORDON HOLMES. A Note on the Condition of the Postcentral Cortex in
Tabes Dorsalis. Rev. Neurol, and Psychiat., Jan. 1908, p. 5.

Syringomyelia. — ARNOLD CLARKSON. Syringomyelia. Canadian Pract.,
Jan. 1908, p. 1.

Spinal Ankylosis. —ANDR6 LERI. Clinical and Anatomical Diagnosis of the
Ankylosing Diseases of the Spinal Column. Rev. Neurol, and Psychiat. , Jan. 1908,

p. 12.

BRAIN—

Meningitis.— DMITRENKO. Uber die Schwierigkeiten der Diagnose der Cerebro-
Spinalcn-Meningitiden. Ally. Wien. med. Zeitung, Dec. 1907, Sn. 553, 565, 577.
PERCY J AKINS. a Case of Meningitis Subsequent to Mastoid Operation.
Journ. Laryngol., Jan. 1908, p. 34.

CLAUDE B. KER. A Review of Recent Work on Epidemic Cerebro-Spinal
Meningitis. Practitioner, Jan. 1908, p. 66.

MEASLIER. Contribution k l’tftude des m6ningites cons6cutives aux fractures de
la base du cr&ne. (Th&se.) Biroche, Nantes, 1907.

RAC'ZYNSKI. Therapeutische Erfahrungen der Behandlong der epidemischer
Zerebrospinalmeningitis mittels Jochmannschon Serums. Wien. klin. Wchnschr.,
Dez. 26, 1907, S. 1641.

SCHULTZ. Erfahrungen mit dem Meningokokkenheilserum bei Genickstarre-
kranken. Berl. klin. Wchnschr., Dez. 30, 1907, 8. 1671.

Menlnglsm. —ORTNER. Meningitis oder Meningismus. Med. Klinik., Nr. 2,

1908, S. 39.

Abscess. —J. J. THOMSON. Report of Two Fatal Cases of Brain Abscess. Arch.
ofOtol., Vol. 36, No. 6, 1907, p. 576.

Slnns Thrombosis. —ARNOLD KNAPP. A Fatal Case of Sinus Thrombosis after
Chronic Purulent Otitis Complicated with Cholesteatoma. Arch* of Otol. , Vol. 36,
No. 6, 1907, p. 573.

Aphaslxt* —WILLIAM M DONALD. Aphasia and Mental Diseases. Amer. Journ.
Jnsan., Vol. 64, No. 2, 1907, P. 231.

MINGAZZINI. Ueber einen Fall von sensorischer transcorticaler Aphasie. Wien,
med. Wchnschr., Nr. 4 1908, S. 146.

18*

BIBLIOGRAPHY

Tumour* —ATLEE and MILLS. Brain Tumour with Jacksonian Spasm and
Unilateral Paralysis of the Vocal Cord and late Hemiparesis and Astereognosis.
Joum. Amer. Med. Assoc., Dec. 28, 1907, p. 2129.

BOEGE. Psychosen mit Herderkrankungen. Allg. Ztsckr. f. PsyckiaL, Bd. 64,
Ht 5, 1907. S. /61.

HIRSCHFELD. Zur Symptomatologie der Hirntumoren. Bert. klin. Wchnschr.,
Dez. 30, 1907. S. 1673.

OTTO MARBURG. Zur Frage der Adipositas unirersalis bei Hirntumoren.
Wien. med. Wchnschr., Dez. 21, 1907, S. 2611.

Acromegaly. —NEUFELD. Ueber Kehlkopfveranderungen bei Akromegalie.

Ztschr.f. klin. Med., Bd. 64, H. 6-6, 1907, S. 400.

Tuberculosis.— MOSS& Neurofibromatosedoriginetuberculeuse. (These.) Impr.
rhinits, Lyon, 1907.

SCHOELER. Zur primaren Tuberkulose der Sehnervenpapille. Klin. J fonatsbl.
f. Augcnheilk ., Dez. 1907, S. 528.

Dptle Meurfttfts. —MANNING FISH. A Study of 36 Successive Cases of Optic
Neuritis (Conclus). Joum. Laryngol. , Jan. 1908, p. 26.

«IXBiiL AND FUNCTIONAL DISEASES—

Epilepsy. —ANGLADE et JACQUIN. Sur la forme dite cardio-vasculaire de
l’lpilepsie. Ann. Mbd.-Ptychol. , ian.-f6v. 1907, p. 27.

BAD IE. De« formes climques de V^pilepsie Saturnine. ( Thise. ) Rey, Lyon,
1907, fr. 2.60.

PAUL BONCOUR. Le “caractfcre Ipileptique ” chez 1’enfant et I’^oolier; sa
valour et sa nature. Prog. Mid., d4c. 21. 1907, p. 889.

FUCHS. Ober Epilepsie und deren Behandlung mit Dr Weil’s antiepileptischen
Pulver. Konegen, Leipzig. 1907, M. 1.

MUNSON. Epilepsy, Tuberculosis, Syphilis. Med. Rec. % Dec. 21, 1907, p. 1015.
PIERCE CLARK. The Curability of a Rare Form of Nocturnal Petit Mai by
the Use of Large Doses of Bromide. Amer. Joum. Med. Sc., Jan. 1908, p. 94.

Tetany. —PINELES. Zur Pathogenese der Kindertetanie. Jahrb.f. Kindn'heilk.,
Dez. 1, 1907, S. 665.

Syphilis.— F. W. MOTT. An Address on Some Recent Developments in our Know¬
ledge of Syphilis in Relation to Diseases of the Nervous System. Brit. Med. Joum.
Jan. 4,1908, p. 10.

PERITZ. Lues, Tabes und Paralyse in ihren atiologischen und therapeutischen
Beziehungen zum Lecithin. Berl. klin Wchnschr., Nr. 2, 1908, S. 53.

PLAUT, HENCK und ROSSI. Gibt es eine spezifische Prazipitatreaktion bei
Lues und Paralyse ? MUnch. med. Wchnsch ., Nr. 2, 1908, S. 66.

WEIL und BRAUN. Ueber AntikOrperbefunde bei Lues, Tabes und Paralyse.
Berl . klin. Wchnschr., Dez. 9, 1907, S. 1570.

BENEDICT. Ueber Peri&rteriitis nodosa. Ztschr.f. klin. Med., Bd. 64, H. 5-6,

1907, S. 405.

Tetanus. —MERRILL. Typhoid Fever and Tetanus. X. Y. Med. Joum., Jan. 4,

1908, p. 21.

P03SELT. Beitr&ge zur Tetanus-Antitoxinbehandlung und zur Statistik des
Starrkrampfes. ZUchr.f. Heilk., Bd. 28, H. 12, 1907, S. 229.

ZUPNIK. Die Symptomatologie, Pathogenese und Therapie des Tetanus.
Fischer, Jena, 1907, M. 8.

Cherea.—KLEIST. Ueber die psychischen Storungen bei der Chorea minor nebst
Bemerkungen zur Symptomatologie der Chorea. Allg. Ztschr.f. Psychiat., Bd. 64,
H. 6 1907, S. 769.

LANGMEAD. A Note on Certain Pupillary Signs in Chorea. Lancet, Jan. 18,
1908, p. 154.

Myastheula* — CHOSTEK. Myasthenia Gravis und EpithelkSrper, Wien. klin.
Wchnschr., Jan. 9, 1908, S. 37.

SIR WILLIAM GOWERS. Pseudo-Myasthenia of Toxic Origin (Petrol Fumes).
Per. Xeut'ol. and Psychiat., Jan. 1908, p. 1.

BIBLIOGRAPHY

19*

TkynldiKMi—U&VI ©t ROTHSCHILD. Tfagfl -i sur 1© norvosisme thyroidien :
formes diniques. Rev. d'Hygiknt et de Mid . Infant ., T. 0, f. 5-0, 1907, p. 417.

Hysteria.—KERN. Leber hysterische Einzelsymptome als Folge von Unf&Uen.
Vierteljahrsschr. f. gericht. Med., Jan. 1908, S. 59.

ROUX. Les vomissemeuts hyst^riques. Journ. du Prat., No. 2, 1908, p. 20.

WESTP H A L. Ueber hysterischo Pseudotetanie mit eigenartigen vasomotorisohen
Storungen. Berl. IIin. Wchnschr., Dez. 9, 1907, S. 1507.

Neurasthenia, —DONLEY. Neurasthenia: its Relation to Personality. N.Y.

Med. Jour a., Dec. 28, 1907, p. 1197.

Alcoholism. — GRUBER und KRAEPELIN. Wandtafeln zur Alkoholfrage.
Lehmann, Munchen, 1907, M. 1.50.

Neuroses.— BLOCK. Ein Beitrag zur Freudschen Sexualtheorie der Neurosen.
Wien. tlin. Wchnschr., Dec. 26, 1907, S. 1047.

CHENEY. The Diagnosis and Treatment of the Gastric Neuroses. Amer.
Journ. Med. Sc., Jan. 1908, p. 25.

ERNEST JONES. Mechanism of a Severe Briquet Attack as contrasted with
that of Psychasthenic Fits. Journ. Abnonn. Psychol., Vol. ii., No. 5, 1907*8,

p. 218.

RAYMOND. La crampe des Scrivains. Journ. du Prat., No. 2, 1908, p. 22.

SPECIAL SENSES AND CKANIAL NEEVES—

GARNIER. Les Surdit6s m&ringitiques particulierement chez les adultes. Rey,
Lyon, 1907, fr. 1.50.

RAMSAY HUNT. Otalgia considered as an Affection of the Sensory States of
the Seventh Cranial Nerve, A rch, of Otol., Vol. xxxvi., No. 0, 1907, p. 4.
KOLLNER. Zur Aetiologie der Abducensliihmung besonders der isolierten
Labmung. D. med. Wchnschr., Nr. 3, 1908, S. 112.

LANDOLT. Diagnoetik der Bewegungsstorungen der Augen. Engelmann,
Leipzig, 1907, M. 3.,60.

VASQUEZ-BARR1ERE. Ueber Ligatur der Carotis communis bei schweren
Fallen intraokularer Blutung, nebst pathologisch-anatomischem Beitrag zur
Retinitis proliferans, Klin. Monatsbl. f. Augenheill., Jan. 1908, S. 43.

PINCUS. Vollige Wiederherstellung der runktion nach Apoplexia sanguines
retinae (Thrombosis venae cerebralis). Klin. Monatsbl. f. A uytnkeilk., Dez. 1907,
S. 508.

WASGUTINSKY. Zur Kasuistik der traumatischen orbitalen Lahmungen der
Augenmuskeln. Klin. Monatsbl. f. A ugenheill. , Dez. 1907, S. 581.

MISCELLANEOUS SYMPTOM*—

BURTON CHANCE. On Coma and the Value of the Ocular Signs observed
therein. Med. Rec., Dec. 14, 1907, p. 979.

COGGESHALL and MACCOY. Headache as a Symptom of Local Disorders*
Journ. Amer. Med. Assoc., Jan. 4, 1908, p. 15.

ALFRED GORDON. The Third Anatomical Proof of the Value of the Para*
doxical Reflex. K. Y. Med. Journ., Dec. 14, 1907, P. 1107.

BABINSKI. Troubles aensitifs dans une lesion bulbaire. Journ. du Prat., d4c.
21, 1907, p. 823.

H. MORRISTON DAVIES. The Bacteriological Aspects of the Problem of
Neuropathic Keratitis. Brit. Med. Journ., Jan. 11. 1908, p. 72.

DRYSDALE and HERRINGHAM. An Unde«cribed Form of Dwarfism associated
with a Spatulate Condition of the Hands. Quarterly Journ. of Med. t Jan. 1908,
p. 193.

J. GRAHAM FORBES. The Pathology of the Cerebro-Spinal Fluid derived from
Lumbar Puncture. Quarterly Journ. of Med., Jan. 1908, p. 109.

ALFRED GORDON. Pathogenesis of Stump Hallucination. N. Y. Med. Journ.,
Jan. 4,1908, p. 17.

GRAUL. Ueber nervoee Superacidit&t und Supersekretion des Magens und ihre
Beziehungen zur kongeoitalen Atonie. Arch. f. Verdauungs-Ki'ani., Bd. 18, H.
0, 19077s. 627.

20*

BIBLIOGRAPHY

GRAUL. Ueber das Zusammentreffen und den Zusammenhang von vaso-
moto rise hen Dennatosen mit Achylic des Magens ala Teilerscheinungen der
Asthenic congenita. L). med. Wchnschr., Nr. 2, 1908, 8. 67.

HARTENBEHG. Le syndrome thalarnique. Press* Mtd ., No. 5, 1908, p. 33.
LINDNER. Zur Diagnose epidureler Hamatome. Munch, med. Wchnschr., Dei.
24, 1907, S. 2599.

M. LINDE. Pupillenuntersuchungen an Epileptischen, Hysterischen und
Psychopathischen. Psychol. Arbeiten, Bd. 5, V. 2, S. 209.

W. C. POSEY. The Significance of Changes in the Optic Nerve in Certain
Affections of the Cerebro-spinal System. Journ. Amer. Med. Assoc.. Jan. 11,
1908, p. 97.

ROLLESTON. A Study of Certain Reflexes in Scarlet Fever. Quarterly Jonriu
of Med., Jan. 1908, p. 117.

SAITO. Ueber einen seltaamen Fall von nervosen Aufstossen. Berl. klin.
Wchnschr., Dez. 23, 1907, S. 1650.

SANTE DE SANCTIS. II Mongolismo. Riv. di Patol. nerv. t ment., Vol xii. T
f. 10, 1907, p. 481.

STOELTZNER. Spasmophilic nnd Calcium-Stoffwechsel. Xeurol. Centralbl .,
Jan. 16, 1908, S. 58.

PARKES WEBER. A Note on Excessive Patellar Reftex of Functional Nervous
Origin, and especially the “Trepidation M or “Spinal Epilepsy” Form. Brit.
Mrd. Journ., Jan. 4, 1908, p. 14.

PSYCHIATRY

GEXERAL—

BRANTHWAITE. Inebriety: Its Causation and Control. Brit. Journ. Inebriety,
Jan. 1908, p. 105.

BLIN. Hospitalisation des debiles dans l'Europe centralo. Rev. de Psychiat.,
d6c. 1907, p. 485.

DESCHAMPS. Les Maladies de l'Snergie (les Asthenies g£n£rales ; Epuisements;
Insuftisances ; Inhibitions). H£rissey et fils, Paris, 1908, 8 fr.

LUIS DUBOIS. Clasificacion de las Impresiones Palmares. Arch, de Psiquiat.
y Criminol ., Nov.-Die. 1907, p. 663.

GU ERRIER. Etude m6dico-psychologique sur Thomas de Quincey. (These.)
Rey, Lyon, 1907, 2 fr.

HOCHE. Moderne Analyse psychischer Erschelnungen. Fischer, Jena, 1907,
M. *40.

H. HOPPE. Simulation und Geistessthrung. Vioieljahrsschr. f. gericht. Med.,
Jan. 190S, S. 38.

C. F. MARSHALL. Alcohol and Syphilis. Brit. Journ. Inebriety, Jan. 1908,
p. 146.

r. W. M‘DONALD. I Look into my Glass. Amer. Journ. Insan., Vol. lxiv.,
No. 2, 1908, p. 271.

MERZBACH. Zur Psychologie des Falles Moltke. Holder, Wien, 1908, M. 80.
ADOLF MEYER. Reception Hospitals, Psychopathic Wards and Psychopathic
Hospitals. Amer. Journ. Insan., Vol. lxiv., No. 2, 1907, p. 221.

PRLSTINARY. La Alienacion Mental en Costa Rica. Aich. de Psiquiat. y
Criminol ., Nov.-Dio. 1907, p. 733.

REZ EN DE PUECH. Gynaecologia e alienacao mental. A rch. Brasil, de Psyd tat.
e Xeurol., Anno 3, Ns. 3 e 4, 1907, p. 352.

QUIRSFELD. Untersuchungsergebnisse des physischen und geistigen Entwick*
lung bei 1014 Kindern von 1 bis 8 Schuljahre. Pray. med. Wchnschr., Des. 12,

1907, S. 653.

ANT. RITTI. Les ali6nes en liberty. Ann. M6d.-Psychol ., jan.-fev. 1908, p. 5.
HENRIQUE ROXO. Dos estados mentaes nas grandes nevroses. ~lrrA. Brasil,
de Psychiat. e Xeuid ., Anno 3, Ns. 3 e 4, p, 247.

HECTOR A. TABORDA. Conferencias sobre el Alcoholismo. Arch, de Psiquiat.
y Criminal., Nov.-Die. 1907, p. 683.

General Paralysis.— JOFFROY et LERI. R&sum6 des donn^es actuelles sur
l’histologie de la paralysie g6n£rale (suite). L’ Encfphale, dec. 1907, p. 632.

F.,W. MOTT. The Diagnosis of General Paralysis. Practitioner, Jan. 1908, p. 1.
PANDY. Die Paralyse der katholischen Geistlichen. Xeurol. Centrnlbl., Jan. 2,

1908, S. 11.

BIBLIOGRAPHY

21*

RAMADIER et MARCHAND. Paralysie g£n6rale et aphasie sensorielle. Ann.
Mid. -Psychol. , jan.-f£v. 1908, p. 19.

CHARLES RiCKSHER. A Comparative Statistical Study of General Paralysis.
Amtr. Journ. Insan., Vol. 64, No. 2, 1907, p. 241.

Z1EMANN. Ueber das Fehlen bzw. die Seltenheit von progressiver Paralyse und
Tabes dorsalis bei unkultivierten, farbigen Rassen. Deutsche rued. Wcknschr .,
Dez. 26, 1907, S. 21 S3.

Dementia Praecox.—U. V. FILHO. A demencia precoce. Arch. Brasil, dt
Psychiat. e Neurol., Anno 3, Ns. 3 e 4, 1907, p. 2SS.

WACHSMUTH. Ein Fall von Selbstverletzung (Ausreissen eines Auges) im kata-
tonischen Raptus. Ally. Ztschr. f. Psychiat ., Bd. 64, H. 5, 1907, S. 856.

Manic* Depressive Insanity. —ISSERLIN. Psychologische Untersuchungen an

Manisch-Depressiven. Karger, Berlin, 1907, M. 5.

SCHROEDER. Ueber Schmerzen beim manisch-depressiven Irresein. CtntralbL
/. Ntrrenheilk. u. Psychiat Dez. 15, 1907, S. 933.

HENRY M. SWIFT. The Prognosis of Recurrent Insanity of the Manic-Depres¬
sive Type. Amer. Journ . Insan ., Vol. 64, No. 2, 1907, p. 311.

Paranoia. —JULIANO MOREIRA. Um caso de paranoia. Arch. Brasil, dt
Psychiat. e Neurol ., Anno 3, Nos. 3 e 4, 1907, p. 377.

Alcoholic Psychoses. —NAPOLEON BOSTON. Delirium Tremens (Mania e Potu),
Lancet , Jan. 4, 1908. p. 18.

0. K. MILLS ana ALFRED R. ALLEN. Two Cases of the Polyneuritic
Psychosis with Necropsies and Microscopical Findings. Amer. Journ. Insan.,
Vol. 64, No. 2, 1907, p. 327.

Infective Psychoses.— FOUQUE. Contribution k l'etude des psychoses cons6-
cutives k la grippe. (These.) Firrain, Montane et Sicardi, Montpellier, 1907.

Miscellaneous Cases.— AUSTREGESILO e GOTUZZO. As desordens mentaes na
ankylostomia.se. Arch. Brasil, de Pychiat. e Neurol., Anno 3, Nos. 3 e 4, 1907,
p. 264.

BOUBILA et LACHAUX. Debilite mentale cong^nitale avec id£es hypocon-
driaques, interpretations delirantes et idees de persecution. Ann. Mid.-Psychol.,
jan.-fev. 1908, p. 48.

CORCHET. Ln cos d’amn&ie retrograde g£n6rale et totale. Ann. Mid.-
Psychol., jan.-f<2v. 1908, p. 37.

PACHECO. Perturbacoes psychicas em algumas affeccocs genito-urinarias.
Arch. Brasil, de Psychiat. e Neurol., Anno 3, Ns. 3 e 4, 1907, p. 324.

FRANCO DA ROCHA. Molestias mentaes em S. Paulo. Arch. Brasil, de
Psychiat. e Neurol., Anno 3, Ns. 3 e 4, 1907, p. 274.

THOM AYER. Zwei Fiille pathologischer Schlafes. Wien, med . Presse, Dez. 22
u. 29, 1907, Sn. 1839, 1879.

Special Symptoms. —DUPRE et CAMUS. Les ctfnesthopathies. LEncinhalc,
d£c. 1907, p. 616.

MEWBORN. Trichopathophobia. Journ. Amer. Med. Assoc., Jan. 4, 1908,
p. 19.

MORAVESIK. Ueber einzelne raotorische Erscheinungcn Geisteskranker. Ally.
Ztschr.f. Psychiat., Bd. 64, H. 5, 1907, S. 733.

FREDERIC II. PACKARD. Prognosis in Cases of Mental Disease, showing the
Feeling of Unreality. Amer. Journ. Insan., Vol. 64, No. 2, 1907, p. 263.
BERNALDO DE QUIROS. Sacher Masoch y el Masoquismo. Arch. de Psiquiat.
y Criminol., Nov.-Die. 1907, p. 639.

CHARLES RICKSHER and C. G. JUNG. Further Investigations on the
Galvanic Phenomenon and Respiration in Normal and Insane Individuals. Journ.
Abnorm. Psychol., Vol. ii., No. 5, 1907-8, p. 189.

Medico-legal. —OR ASSET. Le crime de Monte-Carlo. Une femme couple en
morceaux par un debile du psychisme sup€rieur; respousability att6nu£e.
LEndphale, ddc. 1907, p. 581.

ANTHEAUME. La question de responsabilit£ et le crime de Monte-Carlo
(h propos du rapport du Profosseur Grasset). L End phale, dec. 1907, p. 609.
ARAGON. Delincuencia pasiooal y honor ultrajado. Arch. dt Psiquiat. y
Criminol ., Nov.-Dic. 1907, p. 728.

22*

BIBLIOGRAPHY

ANTONIO BALLIV]£. Procedimiento @n los Delitoe Publicos. ArcA. de
Psiquiat. y Criminal ., Nov.-Die. 1907, p. 671.

ALBERT MOLL. Ueber Heil magnetism us und Heilmagnetiseure in forensischer
Beziehung. Viertejjahrsschr. /. gerickt. Med., Jan. 1908, S. 1.

VICTOR PARANT. Do quelques inconsequence* du nouveau projet do loi sur
le regime dee alilngs. Attn, Mid.-Psyckol., jan.-fdv. 1908, p. 59.

TUATHKirr*—

J. M. WALKER. Potassium Iodide in Mental Diseases. X. V. Med. Joum.,
Jan. 4, 1908, p. 19.

WALLACE. Correction'of the Deformity of Potts' Disease. X. V. Med. Joum.,
Dec. 14, 1907, p. 1115.

ZIEMSSEN. Heilung der Ischias. Wien. med. Wcknschr ., Nr. 2, 1908, a 90.
LANGE. Die Behandlung der Isohias und anderer Neuralgien mit Injektionen
unter hohem Druck. Hirzel, Berlin, 1907, M. 1.

ATWOOD. The Favourable Influence of Occupation in Certain Nervous Dis¬
orders. X. 1". Med. Joum., Dec. 14, 1907, p. 1101.

BAROTTE. Quelques mots sur le traitement de la scoliose ou deviation laterals
de la colonne vert^brale. Tdqui et Guilloneau, Paris, 1907.

DEMMLER. Le choix d’un traitement dans le tdtanos. Prog. Mid., die. 28,
1907, p. 901.

PEDRO DORADO. Afdlos para Bebedores. Arch. Psiquiat y CriminoL , Nov.-
Die. 1907, p. 749.

FREUND. Rontgenbehandlung dee Ischias. Wien. Hi a. Wcknschr., Dez. 19,
1907, S. 1611.

RUDOLPH KUH. Ueber das Kreichverfahren bei Skolioee. Prog. med.
Wcknschr., Dez. 26, 1907, S. 681.

Birglcal.—W. G. SPILLER. Hemicraniosk and Cure of Brain Tumour by Opera¬
tion. Joum. Amer. Med. Assoc., Dec. 21, 1907, p. 2059.

Psychotherapy. —GAUD. De certains processus psychiques de gu&ison. Key,
Lyon. 1907, fr. 1.75.

PUTNAM. The Treatment of Psychasthenia from the Standpoint of the Social
Conscience. Amer. Joum. Med. Sc., Jan. 1908, p. 77.

E. W. TAYLOR The Attitude of the Medical Profession towards the Psycho¬
therapeutic Movement. Boston Med. and Surg. Joum., Dec. 26, 1907, p. 843.

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

Bibliography

ANATOMY

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KAPPERS. Untersuohungen liber das Gehira der Ganoiden Amia calva und
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MARINES CO und MINE A. Uber die mikrosympathischen, hypospinalen

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MINEFF MICHAEL. Le plancher du quatrifeme ventricule. (Etude morpho-
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G. PERUSINI. Alcune proposte inteae ad un' unifazione tecnica nella raocolta
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SCHILLING, tjber das Gehira von Petromyzon fluviatilis. Senckenberg,
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SMALLWOOD and ROGERS. Studies on Nerve Cells. I. The Molluscan Nerve
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PSYCHOLOGY

C. S. BERRY. An Experimental Study of Imitation in Cats. Joum. Comp.
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HARVEY CARR and J. B. WATSON. Orientation in the White Rat, Journ.
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c 2 **

24*

BIBLIOGRAPHY

U EBL. Piychologie et Psychopathologie in Poliieiwecen. Month. mtd. IF chnsckr.,
No. 3, 1908, 8. 122.

WAINWBIGHT. A Psychological Study of Hamlet. Mtd. Htc., Feb. 1,1908,
p. 172.

PHYSIOLOGY

BAOLIONI. Auch di normale aktive Flfigdhaltung der Taube beim Stehen und
Qehen wird einen Reflextonua bewirkt Arch./. Anal. «. Physiol., Pby». Abet.,
Supple. Bd., 1908, S. 71.

BENED1KT. Studie iiber willkiirliche Muskelleistung, iiber Krampf und Krampf -
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BOLLMOW. Ueber die Sehscharfe im farbigen Licht. Zlschr. f. Psychol a.
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BOSWELL. Ueber die xur Erregung dee Sehorgans in der Fovea erforderiichen
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BYCHOWSKI. Reflexstudien. D. Ztschr, f. Ncrvenheilk. , Bd. 84, H. 2, 1908,
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KNGLING. Untersuchungen iiber den peripheren Tonus der Blutgef&se. A txh.
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FEILCHENFELD. Ueber den Blend ungsschmere. Ztschr ./. Psychol, u. Physiol .,
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CARLO FRANCIONI. Le sindromi motorie della prime infanria in rapporto con
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GRASSET. Introduction physiologique h l’Stude de la philosophic. Conferences
sur la physiologic du aystfcme nerveux de I’homme. Alcan, Paris, 1908, 5 fr.

JORDAN. Beitrag zur physiologiscben Technik ftir “ Tonus-muskeln ” yomehm-
lich bei wirbelosen Tieron, nebst Besehreibung eines Mess- und Registrierapparates
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KUTHNER und MEYER. Fiihrt der Rekurrens des Menschen sensible Fasern.
Arch. f. Laryngol. u. Phinol.) Bd. 20, H. 2, 1908, 8. 365.

LANGFELD. Licbtempfindlichkeit und Pupillenweite. Ztschr. f. Psychol, v.
Physiol ., Bd. 42, H. 5, Abt. iL, 1908, S. 349.

MAYDELL. Ueber kontinuierlichen Tetanus. Arch.f. Anal. u. PhysioL , Phys.
Abt., Supple. Bd., 1908, S. 18.

MENDEL and LEAVENWORTH. Notes on the Composition of Embryonic
Muscular and Nervous Tissues. Amer . Joum. Physiol ., No. 1, 1908, p. 99.

NOICA. Sur les Centres Moteurs Reflexes de la MoeUe. (Soc. de neuroL) Per.
Neurol ., d£c. 30, 1907, p. 1318.

NOICA. R6flexe Rotulien, le R6flexe contralateral des Adducteurs et le R£flexe
Onseux de la tuberosity interne du tibia. (Soc. de neurol.) Per. NeuroL, dhc. 30,
1907, p. 1310.

OK1NCZYZ. Considerations sur la physiologic pathologique des muscles creux.
Prog. Med. t No. 5, 1908, p. 47.

ALEXANDRE STCHERBACH. ifctude graphique des ph4nomfenes vibmtoires.
Clonus fonctionnel et organique chess les ammaux. Per. Neurol.) fiv. 15, 1908,

p. 101.

TREVES. Experimcntelle Untersuchungen iiber die Grundlage der Vergleich-
un^gchohener Gewichto. Arch. /, d. ges. Physiol ., Bd. 121, EL 5-6, 1908,

A. VAN GEHUCHTEN. Le m6caniame des mouvements reflexes. NScrm w, Vol.
ix., f. 2, 1908, p. 175.

WIELAND. Ueber den Einfluss ermudender Muskelarbeit auf den Blutxucker
gehalt. Deutsche Atrh. f. kliii. Med.) Bd. 92, H. 8-4,1908, S. 223.

BIBLIOGRAPHY

25*

PATHOLOGY

CATO LA. Ulteriori rioerche sulla istologia delle lacune da disintegrarione

oerebr&le. Riv. di Paid. ncrv. e went., Vol. xii., f. 11, 1907, p. 552.

MARGULI1&. Zur Frag 6 der Regeneration in einem dauernd Yon seinem Zen-
trum abgetrennten peripherischen Nervenstumpf. Virchow $ Arch. f. path. Anal .,
H. 1, 1908, S. 94.

MONRO and HANNAY. Degeneration of the Spinal Cord associated with
Severe Anaemia in the Case of Chronic Gastric Ulcer. Glasgow Mod . Joum.,
Feb. 1908, p. 81.

MOHLMANN. Ueber die Altersverknderungen der Gangliensellen in Gehim.
Virchow*s Atxh./. path. Anal., H. 1, 1908, S. 168.

POROT. Documents anatomiques et cliniques stir la Pathologic des Mlningea.
Rev. de Mid., No. 1, 1908, p. 88.

OTTO SCHtJTZ. Anatomische Befunde an RUckenmark und Nerven bei einer
Morphinistin. Neurol. Centralbl ., Feb. 15, 1908, S. 157.

Sl&GLAS et BARBA Un cas de porencephalic chez un hydroctfphale 6pilep-
tdque. Nouv. Icon, de la Salpthilre, nov.-d€c. 1907, p. 425.

SHIM A. Zur Frage der nach Adrenalinwirkung auftretenden Veriinderungen
des Central nervonsyB terns. Neurol. Centralbl ., Feb. 15, 1908, S. 159.

CARLO TODDE. Ricerche sulle alterazioni del reticolo neurofibrillare endo-
cellular© da trauma sperimentale. Riv. Speriment. di Freniat Vol. xxxiii, F. 4.
1907, p. 751.

CLINICAL NEUROLOGY

GENERAL—

FLESCH. Zur Neurologic der Zunge. Miinch. med. Wchnschr ., No. 3, 1908,
8. 109.

KRONTHAL. Nerven und Seele. Fischer, JenA, 1908, M. 9.

KRU8IUS. tJher ein Binokular-Papillometer. Neurol. Centialbl., Feb. 15, 1908,
8. 154.

REDLICH. Ueber das Heiraten nervoser und psychopathischen Individuen.
Med. Klinik , No. 7,1908, S. 217.

ROSSOLIMO. Le topographe c€rdbral. Nouv. Icon, de la SalpStriIrt, nov.-d^c.
1907, p. 431.

MraciEft—

BENLAY. Chronic Fibrous Myocarditis in Progressive Muscular Dystrophy.
Amer. Joum. Med. Sc. , Feb. 1908, p. 244.

PRKIPHEKAL NERVES—

RAYMOND et ROSE. M^ningo-radiculite purement ant^rieure ot asym£trique
du Plexus Brachial (Soc. de neurol.) Rev. Neurol. , jan. 30, 1908, p. M.

RIEDER et AYNAUD. Ndvrite du Cubital et du Median d’origine traumatique.
(Soc. de neurol.) Rev. Neurol ., jan. 30, 1908, p. 91.

FlslLIX ROSE. Nlvrite sensitive et trophique h la suite d’un Zona. Lesions
trophiques des Os de la main h type de Rhumatisme Chronique. (Soc. de neurol.)
Rev. Neurol ., jan. 30, 1908, p. 90.

SPINAL €#RIS—

ODDO. Maladies de la Moelle et du Bulbe. Octave Doin, Paris, 1908, 5 fr.

ftpflma BMIda.—BENJAMIN CATES. Spina Bifida. Boston Med. and Sur.
Joum. , Jan. 30, 1908, p. 154.

26*

BIBLIOGRAPHY

—BURLEY. Subacute Poliomyelitis, with Report of Three Cases.
Joum. Amer. Mid, Assoc., Jan. 18, 1908, p. 1/7.

McCOMBS. Epidemic Anterior Poliomyelitis in Philadelphia. ArcL of Pediat .,

No. 1. 1908, p. 36.

MEDEA. Beitrag zur Kenntnis der Poliomyelitis anterior subacute adultorum
(Forts:.) Monatsschr, f. Psyckiat. n . Neurol ., Bd. 23, H. 2, 1908, S. 146.
PASTEUR, FOULERTON, and MACOORMAC. On a Case of Acute Polio-
myelitis associated with a Diploooccal Infection of the Spinal Sac. Ixmeet, Fee.
15,1908, p. 484.

GUTHRIE RANKIN. Infantile Paralysis. Practitioner, Feb. 1908, p. 166.

raraplesla.— GILBERT BALLET et ANDRti BARB& Paraplegic flasqu*
abeolue avec conservation dee reflexes ; actinomycoee de la colonne verteoraie,
declaration ascendante de la moelle Ipinifere avec foyer de ramolhaeement
6 tend u de la V® k la VIII® donate. Ret. Neurol., jan. 30, 1908, p. 49.

CRAMER. Deg formes cliniques de la parapllgie spasmodique familiale.
L' Rnclphale, jan. 1908, p. 28.

DELEARDE et M1NET. Le syndrome parapldgie spasmodique familiale (i
suivre). Rev. de Mid., No. 1, 190®, p. 1.

Takes.— BYROM BRAMWELL. Analysis of 263 Cases of Tabes Dorsalis. Cits.
.Studiet, Vol. vi.. Part 2, 1908, p. 120.

FEILCHEN FELD. Ueber dio Venchlimmerung der Tabes und progreesiren

Paralyse durch Unfalle. Bert. klin. Wchutchr., No. 6, 1908, S. 192.

MALAISE. Tabes und Pseudo-Basedow. Monatuckr. /. PtpckiaL u. Neurol.,
Bd. 23, H. 2,1908, 8. 97.

MASSIE et DELACHANEL. L'oeil taWtique. Gaz. de* Sip.. No. 1 et No 4,
1908, pp. 3, 39.

SAINTON et TRONC. Lea crises gastriques des taWtiques. Gaz. de* Sip.,
No. 16 et 19. 1908, pp. 183, 219.

Frledrelek’s Disease.—NOICA. Trouble de la Sensibility objective dans la
Maladie de Friedreich. (Soc. de neuioL) Rev. Neurol. , jan. 30, 1908, p. W.

NOICA. La Contracture dans la Maladie de Friedreich. (Soc. de neurol.) Ret-
NeuroL, jan. 30, 1908, p. 94.

Landry's Paralysis.— J. K. MITCHELL. Landry’s Paralysis ; Recovery; Parfal
Relapse and Complete Recovory. Joum. Amer. Med. Attoc., Feb. 1,1W8, P- 30 •
WILFRED V1NING. A Case of Aoute Ascending Paralysis, with Recovery.
Lancet, Feb. 8, 1908, p. 425.

Syringomyelia.— HARRISON METTLER. Sensory Dissociation as a Symptom,

with report of a case of Syringomyelia. Joum. Amer. Med. Aaoc., ren. o,
1908, p. 434.

ROSE et LEMAlTRE. Deux cas de SyringomyHie avec signe d’ArgyU-Robertson.
(Soc. de neurol.) Rev. Neurol., d£c. 30,1907, p. 1300.

Disseminated Selereais.— CLAUDE et OPPERT. ScUroee en PImum ot
Polyn6vrito Illthylique associ^es. (Soc. de neurol.) Rev. A enrol., dec. 3U, iw/.
p. 1309.

CURSCHMANN. Beitrag sur sakralen Form der multiplen Sklerose und:wr
Dissoziation der Potenzstdrung hierbeL Neurol . Centralbl., Nr. 3, 1908, a® lw.

KURT MENDEL. Zur sakralen Form der multiplen Sklerose. Neurol. CentroM.,
Nr. 3,1908, S. 112.

VOLSCH. Ein Fall von akuter multipler Sklerose. Mowduchr. f. Psychial *■
Newvl., Bd. 23, H. 2, 1908, 8. 111.

Compression_ CLAUDE et TOUCH A RD. Sur un cas de Compression de 1»

Moelle associ^e h. un Syndrome de la Queue de Cheval. (Soc. de neurol.) K ev '
Neui'ol., d&x 80, 1907, p. 1305.

HENRI CLAUDE et FELIX ROSE Syndrome de Compression MSdullsire
chos une Grande HysWrique. Rev. Neurol., jan. 30, 1908, p. 53.

BIBLIOGRAPHY

27*

Cerebre-ftpimal Syphilis.—MARFAN et OPPERT. M6ningo-my61ite h4r4do-
syphilitique chez un enfant de 7 ana. (Soc. de neuroL) Rev. Neurol., jan. 30,
1908, p. 90.

W. G. SPILLER. The Epiconus Symptom-Complex in Cerebro-Spinal Syphilia.
Rev. Neurol, and PsyckiaJL, Feb. 1908, p. 77.

Tvauu.—A. VAN GEHUCHTEN. Coup de oouteau dans la moelle lombaire.
(Eaaai de phyaiologie pathologique.) N&craxe , Vol. Lx., f. 2, 1908, p. 207.

MAUI—

HeniaglUi,—ARZT und BOESE. Ueber Paratyphuameniugitis im Sauglings-
alter. Wien. klin. Wchnsckr., No. 7, 1908, 8. 217.

CLAYTON. The Etiology and Symptomatology of Cerebro-Spinal Meningitis.
Amer. Journ. Med. Sc., Feb. 1908, p. 214.

HENRY and ROSENBERG. Purulent Cerebro-Spinal Meningitis caused by
the Typhoid Bacillus without Fresh Intestinal Lesions of Typhoid Fever. A mer.
Journ. Med. Sc., Feb. 1908, p. 240.

E. LEVY. Erfahrungen mit Kolle-Waasermannachem Meningococoenheilserum.
Deutsche med. Wchnsckr., No. 4, 1908, S. 139.

A. GARDNER ROBB. The Treatment of Epidemic Cerebro-Spinal Fever by
Intraspinal Injections of Flexner and Jobling’s Anti-Meningitis Serum. Brit. Med.
Joum., Feb. 15, 1908, p. 382.

T8CHERNOFF. Zur Diagnose und Behandlung der sporadischen und epi-
demischen Cerebro-spinal meningitis. Jahrb.f. Kxnderheilk., Feb. 1, 1908, S. 161.

VARIOT. Lea mlningites douteuses. Journ. des Prat. , No. 4, 1908, p. 65.

Memi agism. —LAUREL Sur un cas de m&iingiame avec aphaaie au oours et au
d4clin d’une fifevre typhoide, chez un enfant de 10 ana. Rev. Neuivl., t6r. 15,
1908, p. 109.

Tianr, —DEMAYE. Sarcome du lobe frontal gauche chez une syphilitique.
Rer. de PsychiaL , No. 1, 1908, p. 22.

M'CARTHY. Carcinomatosis of the Meninges. N.Y. Med. Journ., Feb. 1,
1908, p. 191.

WISWE. Eine Neubildung des verl&ngerten Markea mit kliniseben und ana-
tomiachen Beaonderheiten. D. Ztschr . /. Nervenheilk., Bd. 34, H. 2, 1908,
S. 87.

■femrrhife. — SCHROEDER. Zur Kasuistik der CerebellarhKmorrhagien.
Neurol. Centralbl., Feb. 16, 1908, S. 160.

Abeeeaa*—GURD and NELLES. Intracranial Abscess due to the Typhoid Bacillus.
Ann. of Surg., Jan. 1908, p. 4.

Hemiplegia*—ADAMKIEWICZ. Hemiplegiapseudohyaterica. Neurol. CenhxUOf.,
Nr. 3, 1908, S. 98.

BOUCHAUD. Hemipl&ie oerebrale spasmodique aurvenue k Page de 12 ans.
Rev. de Mid., No. 1, 1908, p. 20.

STERNBERG. Cher die Kraft der Hemiplegiker. D. Ztschr. f. NenvnheiU.,
Bd. 34, H. 2, 1908, S. 128.

Aphasia*—MINGAZZINI. Lee aphasias de conduction en rapport avec la nouvelle
th6orie de Pierre Marie. L Endphale, jan. 1908, p. 1.

ENRICO ROSSI. Afaaia acuatica e auoi rapporti con l’intelligenza. Nivtxi.ce,
VoL ix., f. 2, 1908, p. 161.

Eeiampeia*—CARVER and FAIRBAIRN. Haemorrhage into the Pons Varolii as
the Immediate Cause of Death in the Eclampsia of Pregnancy, with Illustrative
Cases. Med. Press, Jan. 29, 1908. p. 116.

Aneurism.—SOUQUES. An6vrisme volumineux d’une branche de 1’arthre

Sylvienne ; signea de Tumeur C6r6brale, durle de 66 ana, terminaison par suicide.
(Soc. de neuroL) Rev. Neuix>l. 9 jan. 30, 1908, p. 96.

2b*

BIBLIOGRAPHY

Eacepfcaioecie.— VIANNEY. Qoatre eas d'Endphaloofele. Loire Mid., f£v. 15,
1908, p. 51.

lertaiflale.— BBDUSCHI. 8ur un cas d’acromegalie avec osteo-arthropathies et
paraplegia. Nouv. Icon, de la SalpRribr, nov.-dec. 1907, p. 443.

GIUSEPPE FRANCHINI. Contribute alio studio dell’ acromegalia. Ri*.
Speriment. di Frenial., Vol. xxxiiL, F. 4, 1907, p. 888.

J. U. DOUGLAS WEBSTER. A Case of Unilateral Cerebral Hyperplasia; with
co-existent “ Acromegaly ’’ of the Feet, and a Slight Degree of Unilateral
Gigantism. Journ. Pathol, and Bacterid ., Jan. 1908, p. 306.

Lacallsatloa.— MORTON PRINCE. A Study in Tactual Localisation in a Case
presenting Astereognosis and Asymbolia due to Injury to the Cortex of the Brain.
Journ. 4 V«v. and Mint. Di*. y Jan. 1908, p. 1.

MORTON PRINCE. Tactile Localisation and Symbolia ; have they Localisation
in the Cerebral Cortex? Journ. S'err. and Meat. Dis., Jan. 1908, p. 12.

9EMEBU AND FUNCTIONAL DISEASES -

Spinal AakylesU.—ANDR£ LtRI. Clinical and Anatomical Diagnosis of the
Ankylosing Diseases of the Spinal Column. Part II. Rtc . Xeui'ol. and Psychiat.,
Feb. 1908, p. 65.

Exophthalmic iioltre.—LANDSTROM. tJber Morbus Basedowii Rothacker,
Berlin, 1907. M. 6.50.

Epilepsy*—A. BANKS RAFFLE. Some Notes on Status Epilepticus and its
Treatment. Journ. Ment. Sc ., Jan. 1908, p. 94.

Sleeping SItltneas.—R. KUDICKE. Zur Aetiologie der Schlafkrankheit. Aixkie
f. Sc/uJ'fi- it. Tropen-Hygiene, Jan. 1908, p. 37.

PICARD. Contribution k l’dtude du traitement et de la prophylaxie de la
maladie du somineil. Jacques, Paris, 1907.

Arterio-Seleroals.—CHOLEWA. Schwerhorigkeit, Horschwindel, Ohrensausen in
Folge von GeLisserkrankungen. Verlag. d. drtzl. Rundschau. Munchen, 1908,
M. -75.

STENGEL. Nervous Manifestations of Arterio-aclerosia. Amer. Journ. Med .
Sc., Feb. 1908, p. 187.

Tetaaas.—H ARRASS. Ueber Schling- und Athmungsstdrungen beim Tetanus und
deren Behandlung. Mil. a. d. Oremgebiet. d. Med. u. Ckir. , Bd. 18, H. 3, 1908,
S. 548.

Chorea.—HENRY KOPL1K. Treatment of Chorea Minor, with especial reference
to the Dangers of Arsenic Therapy. Med. Rtc., Jan. IS, 1908, p. 95.

R. W. PHILIP. A Clinical Lecture on Chorea of Aggravated Type with certain
Unusual Phenomena. Brit. Med. Journ., Feb. 15, 1908, p. 365.

.Hyxcedema.—DAVIS. Myxcedema. .1 irk. of Pediat., No. 1, 1908, p. 14.

Paralysis Agltans.—BOU RILHET. Mai de Parkinson survenue chez une ddmente
epileptique. Oclz. dee H6p ., No. 2, 1908, p. 15.

Syphilis.—KRONER. Ueber den ditferentiell-diagnostischen Wert der Wasser*
mann’sehen Seriodiagnostik bei Lues fiir die innere Medizin und die Neurologic.
Bert. klin. WcAnschr No. 4, 1908, S. 149.

Tropheedema.—PARHON et CAZACOU. Sur un nouveau cas de trophcBd^mo
chronique. Considerations sur I’etiologie et la pathogdnie du trophosdeme.
Xour. Icon, de la StUpHrUrt , nov. -dec. 1907, p. 448.

Writers* Cramp.—MORRELL. Writers’ Cramp; what it is and how it can be
treated by a Family Physician. Med. Rec. , Jan. 18, 1908, p. 101.

Hysteria.—AUMAITRE. Fhysiologie pathologique de lliysterie. Journ. de MU.,
No. 5, 1908, p. 17.

BIBLIOGRAPHY

29*

HARVEY CARR. Unusual Illusions occurring in Psyclioleptio Attacks of Hys¬
terical Origin. Al/nomi. Psychol., No. 6, Feb.-March 1908, p. 260.

GRUNEWALD. Ueber hystero-traumatische Lalimungen. Berl. klin. Wchnschr.,
No. 6,1908, S. 190.

TERRIEN. L'hystSrie est-elle curable/ Proy . Mid., No. 3,1908, p. 26.

A. VAN GEHUCHTEN. Un nouveau cos do clonus du pied dans rhvsterie
(Contracture, h&nianesth&ie cutan^e et scnsoriolle). Win-axe., Vol. ix., f. 2,1908,
p. 197.

R. C. WOODMAN. General Considerations os to the Nature and Relationships
of Hysteria. Jovrn. Were. and Meat. fris., Jan. 1908, p. 23.

Neurasthenia. — BING. Bcgriff der Neurasthenic. Med. Klinik , No. 5, 1908,

S. 143.

WILSON. The Pathogenesis and Treatment of Neurasthenia in the Young.
Amer. Jovrn. Med . Sc., Feb. 1908, p. 178.

Migraine.—T. H. B. DOBSON. On Migraine. Brit. Med. Jouni., Feb. 8, 1908,
p. 314.

Pellagra.—CARLO CENT. 1 tossici pellagrogeni in rapporto colie diverse sostanzo
alimentari e colie stagioni dell’ anno. flic. Speriment. di Freniat., Vol. xxxiii.,
f. 4/1907, p. 861.

Alcoholism.—ELIIil. L’epilepsie nlcoolique. Jovrn. de Mid., No. 4, 1908, p. 36.

FRESOOLN. Complications of Alcoholism, with Statistics of 2000 Cases. Jovrn.
Amer. Med. Assoc., Feb. 8, 1908, p. 450.

LEGRAME. Alcoolisms et folie. Press* Mid., No. 9, 1908, p. 66.

Nenroses.—BACHMANN. Die Nervositat. Rohm, Lorch, 1908, M. —20.

BOULENGER. Obsessions et Phobies. Jovrn. de Neurol., jan. 20, 1908.
p. 25. *

DUFOUR et FOIX. Pseudo-torticollis Mental. (Soc. do neurol.) Per. Neurol.,
ddc. 30, 1907, p. 1292.

ALFRED GORDON. Relation of Accidents to Functional Nervous Diseases and
Psychoses. Med. Rec. % Jan. 11, 1908, p. 54.

JOHN PGNTON. Nervousness, its Significance and Treatment. Jovrn. Amer.
Med. Assoc., Feb. 1, 1908, p. 353.

MATHIEU. Dyspepsie, nevropathie et ptoses abdominales. Jovrn. des Prat.,
No. 6, 1908, p. 85.

MEIGE. Les peripeties d’un torticolis mental. None. Icon, de la Salpetriere , nov.-
d6c. 1907, p. 461.

MEJGE. Torticolis Mental. (Soc. de neurol.) Per. Neurol., d^c. 30, 1907,
p. 1319.

LUCIEN NASS. Ixis Xevrosos do 1’Histoire. Lib. Unlcecselle, Paris, 1908,
3 fr. 50.

SICARD et DESCOMPS. Torticolis mental de Brissaud. Insuec&s du tnitement
chirurgical. None. Jeon. de la Salpitriere, nov.-d^c. 1907, p. 459.

ftPECIAL SENSES AND CRANIA I, X ERA' E8—

ALEXANDER und O B E RSTE IN ER. Das Verbal ten des normalen Nervus
cochlearis im Meatus auditorius intemus. Ztschr.f. Ohrenheilk., Bd. 55, H. 1-2,
1908, S. 78.

FINLAY. Remarks on a Case of Recurrent Palsy of the Third Nerve. Arch,
of Ophthal., No. 1, 1908, p. 1.

HEGENER. Klinische Be it rage ZU r Frsge der akuten toxischen und infektiusen
Neuritis des Nervus acusticus. Ztschr.f. Ohrenheilk., Bd. 55, H. 1-2, 1908, S. 92.

ARNOLD KNAPP. Optic Neuritis with Disease of the Posterior Ethmoidal Cells.
Arch, of Ophthal., No. 1, 1908, p. 22.

WYLER A Case of Fleeting Paralysis of Some Ocular Muscles. Arch . of Ophthal .,
No. 1, 1908, p. 16.

30*

BIBLIOGRAPHY

CytedlacMAis.—ALFRED 6UBB. Lumbar Puncture in Affections of the Nervous
System. Med. Press, Jan. 22, 1908, p. 92.

JAMES SAWYER. The Value of Cytodiagnoeb in Practical Medicine. Lancet,
Feb. 1, 1908, p. 283.

SYDNEY STEPHENSON. Lumbar Puncture in Optic Neuritis. Med. Press,
Feb. 12,1908, p. 174.

MISCELLANEOUS SYMPTOMS—

ANTONELLI. Lee suites 61oign6es des paralyses oculo-motrioes. Joum. ds
Neurol. , d4c. 20, 1907, p. 485.

BOCKENHEIMER. Ueber die diffueen Qyperostoeen der Scbadel und Gericht*
knochen und Ostitis deformans fibrosa. Arch. f. klin. Ckir., Bd. 85, H. 2, 1908,
S. 511.

CH&NE. Les paralysies dipht&iques. Oat. des E6p. t No. 7 et 10, 1908,
pp. 75, 111.

FUCHS. Eine bisher nicht beschriebene Form familiarer Nervenerkrankung
nebst einem Falla einer ungewohnliche Motilit&tsneurose. Wien. wed. Wchnsekr.,
No. 5 u. 6, 1908.

HALIPRE et HUBERT. Exostoses ost^ofl^niques. Dystrophie osseuse h6r£di-
taire. Nouo. Icon, de la Salpitri&re. , nov. -a6c. 1907, p. 437.

HAUSHALTER et LUCIEN. Polyurie simple et tubercle de Thypophyse. Per.
Neurol., jan. 15, 1908, p. 1.

HUTMEL. Scolioee et nutrition chez les adolescents. Oat. des H6p., No. 12,
1908, p. 135.

LASAREW. Beitrag zur Kenntnis der Meralgia parastetica anterior. D. Ztsckr .
f. NerrenheilL , Bd. 34, H. 2, 1908, S. 154.

LOURltf. tfber die Augenbewegungen bei Kleinhirnreixung. Neurol. Centralbl.,
Nr. 3, 1908, S. 102.

F. Mt)LLER. Nervous Affections of the Heart. Arch, of Internal. Med., vol. L,
No. 1, 1908, p. 1.

NEUFELD. Zur Kenntnis des Kehlkopfkrampfes der Erwachsenen. Arch. f.
Lai'yrtgol . w. Rhinol., Bd. 20, H. 2, 1908, S. 349.

J. HERBERT PARSONS. Night Blindness. Lancet , Feb. 22, 1908, p. 555.

POLIMANTI. Bur le ph6nomfene de Charles Bell. Nouv. Icon, de la Salpknbt,
nov.-dec. 1907, p. 508.

WIKTOR REIS. Ein Anatomisch untersuchter Fall von Evulsio nervi optici
(Sulzmann) bei Avulsio bulbi. Archiv.f. Optkalmol., Jan. 1908, p. 185.

ROCHON-DIJVIGNEAUD et WEILL. Bl£pharospasme. (Soc. de neurol.) Rev.
Neurol., d6c. 30 1907, p. 1296.

SALECKER. Uber segmentare Bauchmuskellkhmungen. D. Ztsckr. f. Nerce*-
heUL., Bd. 34, H. 2, 1908, S. 160.

SEZARY et DE MONTET. Attaques de sommeil et narcolepsie 6pileptique.
Rev. de Mid., No. 1, 1908, p. 64.

SOUQUES. Le Nystagmus dans l’Apoplexie C6r6brale. (Soc. de neuroL) Rev.
Nevrol., d£c. 80, 1907, p. 1311.

TRABAUD. Des troubles ocalaires neuro-paralytiques (K6ratite neuro-
paralytique). Impi\ rtunics, Lyon, 1908.

VEASEY. A Case of Unilateral Mixed Nystagmus benefited by Treatment
Amer. Joum. Med. Sc., Feb. 1908, p. 269.

VEASEY. The Rhythmical Alterations in the Width of the Palpebral Fissure of
both Eyes, probably produced by Spasms of the Levator Palpebro Muscles.
N. Y. Med. Joum., Jan. 18, 1908, p. 118.

VINCENT, tipilepsie Jacksonienne. Caracthres differentials entre le Spasme
cortical et le Spasme p€riph6rique. (Soc. de neurol.) Rev. Neurol., dfc. 30.
1907, p. 1299.

BIBLIOGRAPHY

31*

PSYCHIATRY

«BNEBAL-

J. SHAW BOLTON. Amentia and Dementia: a dinico-Pathological Study.
Joum. Meat. Sc., Jan. 1908, p. 1.

T. S. CLOUSTON. The Medical Inspector of Schools as a Psychiatrist. Brit.
Med. Joum ., Feb. 1, 1908, p. 262.

W. R. DUNTON. The Nervous and Mental Manifestations incident to School
Life. iV. Y. Med. Joum., Feb. 8, 1908, p. 258.

GAUTER. Intelligonzprufungen bei Epileptiken und Normalen mit der Witz-
methode. Allg. Ztschr. f. Psychiat ., Bd. 46, H. 6, 1908, S. 957.

PAUL GUERRIER. titude M<5dioo-Pgycl hologique sur Thomas de Quincey. A.
Rey, Lyon, 1908.

ALEXANDER MORISON. A Lecture on Sleep and Sleeplessness. Lancet , Feb.
8, 1908, p. 405.

ALFRED PETREN. t)ber Sptttheilung von Psyohosen. Nonl. Med. Arklr .,
Afd. ii., H. 3, 1908.

HALL PLEASANTS. The Nervous and Mental Diseases incident to School Life.
N. Y. Med. Journ., Jan. 18, 1908, p. 111.

J. F. SUTHERLAND. Recidivism regarded from the Environmental and
Psycho-Pathological Standpoints. Part 3. Journ. Ment. Sc., Jan. 1908, p. 68.
TIGGES. Die Abnormalit&ten des Aszendonz in Beziehung zur Deszendenz.
Allg. ZUchr. f. Psychiat., Bd. 46, H. 6, 1908, S. 891.

General Paralysis. — FORMET und SCHERESCHEWSKY. Gibt es eine
spezifische Prazipitatreaktion bei Lues und Paralyse? M'anch. nud. Wchnschr.,
No. 6, 1908, S. 282.

KARPAS. General Paralysis in the Senile Period, with a report of 2 Cases.
N. Y. Med. Joum., Jan. 25,1908, p. 157.

PHILIP COOMBS KNAPP. General Paralysis as a Menace to Public Safety in
Transportation. Boston Med. and Sur. Journ., Feb. 6,1908, p. 187.

Dementia Pneeox. — FITZGERALD. Some Phases of Catatonia. Canad.
Practitioner, Feb. 1908, p. 85.

SMITH ELY JELLIFFE. Some General Reflections on the Psychology of
Dementia Prsecox. Journ. Amer. Med. Assoc., Jan. 18,1908, p. 202.

GIACOMO PICHINI. II ricambio organico nella demenza precoce. Riv. Speri-
ment. di Freniat., Vol. 83, F. 4, 1907, p. 762.

SERGE SOUKHANOFF. Sur la dlmenoe prtfcoce au point de vue clinique ct
biologique. Joum. de Neurol., jan. 20, 1908, p. 21.

Alcefeolic Psychoses.—STILLMANN. Post-delirious Alcoholic Stupor. N. Y. Med.
Journ., Jan. 25, 1908, p. 154.

Senile Dementia*—FRANCHESI. Le demenze senili (cont. e fine). Riv. di Patol.
nerv. e ment., vol. 12, f. 11, 1907, p. 529.

Miscellaneous Cases.—WARREN E. LLOYD. Notes on a Case of Spontaneous
Somnambulism. Joum. Abnorm. Psychol., No. fi, Feb.-March 1908, p. 259.
ENRICO ROSSI. Frenosi sensoria in soggetto frenastenico. Riv. Speiiment. di
Reniat., vol. 33, F. 4, 1907, p. 960.

WILMANNS. ttber Gef&ngnispsychoeen. Marhold, Halle, M. 1.20.

Special Symptoms.— CHARAZAC. Les Tristesses morbides (Thkse). Gimet-
Pisseau, Toulouse, 1907.

LUIGI LUGIATO. Glicosuria e levulosuria alimantaro in alcune forme di
malattia mentale (epilessia, psicosi pellagrosa, paralisi progressiva, demenza pre-
ooce). Riv. Spenmeut. di Frenuet., vol. 33, f. 4, 1907, p. MO.

GIORGIO PARDO. Ulteriori ricerche sull’ indossiluria nei malatti de men to.
Riv. Spei iment. di Freniat., vol. 33, f. 4, 1907, p. 844.

SiRIEUX et CAPGRAS. Diagnostique du dtflire d*interpr6tation. Rev. de
Psychiat., No. 1. 1908, p. 1.

C. J. SHAW. Observations on the Opsonic Index to Various Organisms in
Control and Insane Cases. Joum. Ment. Sc., Jan. 1908, p. 57.

WOLTAR. Ueber das sogenannte “ neurasthenische Vorstadium ” des Psychosen.
Wien. klin. Wchnschr ., No. 4, 1908, S. 111.

32*

BIBLIOGRAPHY

■odleo-Legml.—BE HR. Beitrtige EurgeriobtartElichen Diagnostik an Kopf,
Schkdel und Gehirn. Fischer, Jena, 1902, M. 2.

FOSTERLING. Genese einer sexuellen Abnormitat bei einem Falle von Stehl-
trieb. Allg. Ztschr.f. Psychiat. , Bd. 46, H. 6, 1908, S. 986.

GRASSET. La Responsabilit^ des criminals. Colin, Mayenne, 1908.

KROEMER. Zur Frage der Unterbringung geiateskranker Verbrecher. Allg.
Ztschr. f. PsychiaL, Ba. 46, H. 6, 1908, S. 980.

FRANCESCO PETR6. Sulla delinquent, panda ed inadattabilitikal servino nei
militari e loro ptevensione. Riv. Sperunent. di Freniat vol. 88, r. 4, lw/,
p. 933.

KARL WILMANN8. Der Fall Hartlieb. Zentralbl. f. NenenheiU\ n. Psychiat.,
1908, S. 1, 49, 97.

IRKATMICNT*_

BEAU JOUR et LHERMITTE. Le Tmtement de U Syringomyelia par es
Rayons X. (Soc. de neurol.) Rev. Neurol., d€c. 30, 1907, p. 1312.

GUTZMANN. Sprachstorungen und Sprachheilkunde. Karger, Berlin, 1908.
M 6

JAMESON. The Treatment of the Epileptic. Dublin Jonm. Med. Sc ., Feb.
1908, p. 100.

HAMILTON C. MARR. Five Years’ Experience of a Reception House for Recent
Cases of Insanity. Lancet, Feb. 8, 1908, p. 4|8.

KELLNER. Die Heilerfolge bei der Epilepsia und die Notwendmkeit der Emch-
tung von Heilstatten fur Epileptiker. Manners \ erlag, Hamburg, iwa
M. .60. n

KIL1ANI. Schloeser’s Alcohol Injections for Facial Neuralgia, Med. Rec., Jan.
18, 1908, p. 90.

MURRELL. The Treatment of Lateral Sclerosis. Med. Press , Jan. 29, 1908,

p. 120.

PARHON et GOLDSTEIN, titat peychasthdnique survenu chez une jeune fine
dpileptique soumise au traitement thyroidien, disparaisaant par Ift ^-J^kon du
traitement et r&ppar&iss&nt par sa reprise. Rev. Neurol., jan. 16, 1908, p. o.

SOHLESINGEU. Zur Injektionstherapieder Neuralgien. Deutsche W. Wcknsckr.,
No. 6, 1908, S. 236.

LEO. WEBER. The Favourable Influence of Small Doses of Arsenic and
Bichloride of Mercury in Three Cases of Graves’ Disease. Med. Rec., Feb. 8,
1908, p. 229.

WIGLESWORTH. On the Treatment of Cases of Acute Insanity by Rest in
tied in the Open Air. Jowm. Ment. 8c., Jan. 1908, p. 105.

AUGUSTUS WttRSCHMIDT. The New Hypnotics and Sedatives in the Treat¬
ment of Mental Diseases. Folia Therafxvt ., Jan. 1908, p. 16.

8«rgftcal.— JAMES ADAMS. Severe Spasmodic Contraction of a Finger Cured by
Stretching the Median Nerve. Lancet, Feb. 1, 1908, p. 287.

GOBIET. Beitrage zur Himchirurgie. Wien. Min. Wcknsckr ., No. 4, 1908,
S. 115.

KERMISSON. Le traitement chirurgioal des paralyses infancies. Jour*, des
Prat., No. 4, 1908, p. 54.

PHILIP COOMBS KNAPP. Division of the Posterior Spinal Roots for Amputation
Neuralgia. Boston Med. and Sur. Journ., Jan. 30, 1908, p. 149.

VULPIUS. Ueber die Technik und den Wert der SehneniiberpflaMung bei
der Behandlung der spinalen Kinderliihmung. Deutsche med. Wcknsckr. t N. 4,
1908, S. 142.

Psychotherapy. —JOSEPH COLLINS. Some Fundamental Principles in the Treat¬
ment of Functional Nervous Diseases, with especial Reference to Psychotherapy.
Amer. Journ. Med. Sc., Feb. 1908, p. 168.

PENROSE. The Psychic Treatment of Nervous Diseases from a Practical
Standpoint. N.Y. Aled. % Joum., Jan. 18, 1908, p. 115.

* A number of references to papers on Trestment aie included In the Bibliography under the
Individual Diseases.

Bibliography

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FRUGONI. tlber einige Respirationsveranderungen centralen Ursprungs.
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SAJOUS. Les secretions internes, l’appareil nerveux hypophys6o-surrenal. Oaz.
des H6p. t mars 7, 1908, p. 339.

d 33*

34*

BIBLIOGRAPHY

SYMONS. Wave-like Variations in Muscular Fatigue Curves- Joum. PhysioL,
Vol. xxxvi., No. 6, 1908, p. 885.

J. ARTHUR THOMSON. Heredity. John Murray, London, 1908.

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VARRIER-JONES. Effect of Strychnine on Muscular Work. Joum. Physiol. f
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PSYCHOLOGY

BURNHAM. Attention and Interest- Amer. Joum Psychol., Jan. 1908, p. 14.
CHAMBERLAIN. Notes on Some Aspects of Folk-Psychology of Night. Amer.
Joum. Psychol. , Jan. 1908, p. 19.

CYOX. Das Ohrlabyrinth als Organ der mathematischen Sinne fur Raum und
Zeit. Springer. Borlin, 1908, M. 14.

FERREK. The Intormittenco of Miminal Visual Sensations. Amer. Joum.
Psyrhol.. Jan. 190$, p. 58.

FRISCH KRSEN-KOHLER. Ueber die psychologischen und die logischen
Grundlagcn <les Bowogungsbogriffen. Ztschr. f. Psychol., Abt. 1, Bd. 46, H- 5,
190S, s. :W4.

HEY M ANS and WIERSMA. Beitrage zur speziellen Psychologic auf Grand
einer Ma-vienuntersuchung. Nachtrog zur Psychologic der Geschlechter. Ztschr .
j. Psfh A«»/., Abt. 1, Bd. 46, H. 5, 1908, S. 321.

IOTEYKO. La conception id6o-6nerg6tique et la psychomtfcanique. Joum.de
Xffnd.. No. 4, 1908, p. 161.

LOMBROSO. l T el>er die Entstehungsweise und Eigenart des Genies (Schluss).
Schmidt's JuhrK, H. 2, 1908, S. 132.

MAR HE. Wundt’s Stollung zu meiner Theorie der stroboskopischen Erschein-
ungon und zur systematischen Selbstwahrnehmung. Ztschr. f. Psychol., Abt- 1,
Bd. 46, 11. 5, 1908. S. 345.

A. H. RING. Psychology in Medicine. Boston Med. and Surg. Joum., Feb. 27,
1908, p. 287.

SCHULTZE. Einige Hauptgesichtspunkte der Beschreibung in der Elementar-
psvchologio. Arch./, d . yes. Psychol., Bd. 11, H. 2, 1908, 8. 111.

SCHU > TURE. Exj>oriments on Subconscious Ideas. Joum. Amer. MetL Assoc..
No. 7, 1908, p. 521.

URBANTSCH1TSCH. ttber subioktive Horerscheinungen und subjektive
optische Anschauungsbildor. Deuticke, Wien, 1908, M. 4.

ZIEHEN. Das Gedachtnis. Hirschwald. Berlin, 1908, M. 1.

SUMNER. Psychological Medicine and so-called Christian Science. Indian
Mai. u\ i: M Feb. 1908, p. 46.

PATHOLOGY

BOYER I. Sur uno Lesion particular© et peu oonnue de P^pendyme ventricu-
laire. (Soc, do neurol.) Per. Neurol., No. 4, 1908, p. 182.

CH. DE MONTET. Recherches sur la sclerose tubSreuse. L'Endphale, f4v. 190®,
p. 97.

GORDON HOLMES. A Form of Familial Degeneration of the Cerebellum.
Brain, Vol. xxx., No. 120, 1907, p. 466.

J KNTSi II. Die Mdbius’sche degenerations-moiphologische Sammlmig in Leipzig..
ZtntrwlU. f. Serctnhcilk. «. PsychiaL, H. 5, 190o, S. 1/7.

MA1UNESCO. Lesions des cellules nerveuses produitee par lee variations ex-
plrimontales de la pression osmotiqtie. Ztschr . /. allg. Physiol., Bd. 8, H. 1,1906,
S. 121.

RANKE, Ueber Gehirnveranderungen bei der angeborenen Syphilis. Ztschr.
f. cL Erf or sc h. d.juyend. Schuachsinns, Bd. 2, H. 1, 1908, S. 32.

DOUGLAS WEBSTER. A Case of Unilateral Cerebral Hyperplasia. Joum. of
Pathol.. Jan. 1908, p. 306.

WOLTAR. Zur Pathologie der Cberspanntheit Pray. med. Wchnsckr., Nr. 9,
1907, 8. 110.

BIBLIOGRAPHY

35*

CLINICAL NEUROLOGY

RI3JEN RUSSELL. The Purvis Oration on the Diagnosis of Organic from
Functional Affections of the Nervous System. Brit. Med. J 0111 * 71 ., March 14,1908,

p. 608.

MUSCLES—

GORDON HOLMES. On the Spinal Changes in a Case of Muscular Dystrophy.
Rev. Neurol, and Psychiat ., March 1908, p. 187.

RAYMOND. Le prognostic dans les atrophies musculaires progressives. Journ.
des Prat. , No. 8, 1908, p. 114.

FEMINISEAL NEEVES—

WILFRED HARRIS. A Demonstration of Cases of Brachial Neuritis. Clin.
Journ., March 4, 1908, p. 328.

MICHAEL KOS. Traumatische Lahmung des Musculus obliquus superior.
Wien. med. Wchnechr., No. 11, 1908, S. 562.

QUADFLIEG. Ueber einen Fall von traumatischer Luxation der Nervus ulnaria
dexter. Munch, med. Wchnechr ., No. 9, 1908, S. 467.

SEPPILLI. Un caao di diplegia facdale periferica. Ric. Ital. di Neuropatol.,
Peichiat. ed Klettroter ., Yol. i., f. 3, 1908, p. 118.

ftPIMAL CSBS—

Peliemyel Ills.—ACHARD. Deux cas de Paralysie Infantile avec Paralysie
Faciale. (Soo. de neurol.) Rev. Neurol ., No. 4, 1908, p. 173.

ODDO. Maladies de la moelle et du bulbe (non-syst&natis&s). Poliomy61ites,
Sclerose en plaques, Syringomytflie. Doin, Paris, 1908.

Tabes*—BALLET et BARB& Arthropathia Tab6tique monosymptomatique.
(Soc. de neurol.) Rev. Neurol., No. 4, 1908, p. 178.

BYROM BRAMWELL. An Analysis of 263 Cases of Tabes. Brit. Med. Journ. ,
March 21, 1908, p. 669.

DEROVE. Lesions syphilitiquea multiples, tabes, paralysie g$n6rale, et in-
suffisance aortique. Oaz. dee H6p ., Ur. 20, 1908, p. 243.

RAULT. Des fractures chez les tab£tiques avant la p&iode d'ataxie. (Thist.)
Storck et Cie, Lyon, 1908.

COLIN K. RUSSELL. Tabes dorsalis and its Re-educative Treatment. Montreal
Med. Journ. , Feb. 1908, p. 90.

STEPHAN I. Le tabes ostdo-articulaire precoce, & propos de quelques cas de
manifestations ost6o-articulaires pr6tab6tiquo. Oaz. act H6p., Ur. 25, 1908,
p. 267.

HALLIDAY SUTHERLAND. A Case of Syphilis, Phthisis, and Locomotor
Ataxia. Brit. Med. Journ. , March 21, 1908, p. 6o0.

Iaffcntlle Paralysis.—EWALD. Skoliose bei Kinderltthmung. Ztechr.f. Orlhop.
Chir. , Bd. 19, H. 3-4, 1908, S. 549.

Paraplegia.—DELEARDE et MINET. Le syndrome paraplegic spasmodique
familiale (suite et fin). Rev. de Mid., No. 2, 1908, p. 181.

Syringomyelia.—KLIPPEL et MONIER-VINARD. SyringomySlie frusta avec
manifestations anormales. (Soc. de neurol.) Rev. Neurol., No. 4, 1908, p. 170.

Disseminated Sclerosis.—BENIUNL Un caso di sclerosi a placche tardiva a
localizzazione spinale con reperto istologico. Riv. di Patol. nerc. e ment., Vol. 13,
i. 1, 1908, p. 16.

FLEISCHER. Neuritis retrobulbaris acuta und multiple Sklerose. Klin.
MonaUbl. f. A ugtnkeilk. , Feb. 1908, S. 113.

Tineir.—W. C. KRAUSS. A Case of Cyst within the Spinal Canal. Brain,
Vol. xxx., No. 120, 1907, p. 533.

36*

BIBLIOGRAPHY

SPILLEE. Tumours of the Cauda Equina and Lower Vertebra, with Report of
Nine Cases. Amer. Journ. Med. Sc., March 1908, p. 886.

ftptmal Syphilis.—KLIPPEL et DAINVILLE. M£ningo*my£lite syphilitique h
marche rapide. Rev. Neurol ., No. 4, 1908, p. 141.

LAIGNEL-LAVA8TINE et VERLIAC. Syndrome de 44 rh4mi-queue de choral”
par M6ningo-radiculite syphilitique. (Soc. de neurol.) Rev. NeuroL f No. 4 # 1908,
p. 179.

PLAUT, HEUCK e O. ROSSI. Sulla sierodiagnosi nella sifilide, tabe e paralisi
^rc^ressiva per mezzo della “Precipitaxione.” Riv. di Paid. nerv. emenL, Die*

WYNNE. Manifestations of Congenital Syphilis in the Nervous System. Dudi a
Journ. Med. Sc. , March 1908, p. 191.

Lecallsatlea.— GRAS8ET. Diagnostic des maladies de la moelle. Sifege des
lesions. 3e 6d., revue et modifies. Baillihre et fils, Paris, 1908,1 fr 50.

UA11V—

Encephalitis.—HOLDEN and COLLINS. Polioencephalitis Superior ; its Causa¬
tion, Clinical Course, and Termination, with Report of Six Cases. Journ. Amer.

Med. Assoc., No. 7, 1908, p. 514.

Meningitis.— GEORGE BROWNE. Some Clinical Observations on Epidemic
Cerebro-spinal Meningitis. Monh'eal Med. Journ. , Feb. 1908, p. 98.

DOPTER. M6ningite lymphocytique ourlienne avec atteinte du trijumeau et
zona d’une de ses branches. Prog. mid., fiv. 29, 1908, p. 101.

WILLIAM DOW. The Clinical Symptoms of the Cases of Epidemic Cerebro¬
spinal Meningitis admitted into Belvidere Fever Hospital, Glasgow, during the
Recent Epidemic, with a Short History of the Disease in Scotland. Lancet,
March 14, 1908, p. 768.

MONER. Diagnostic de la m£ningite otogfene par la ponction lombaire. Sa cura¬
bility. ( These.) Rey, Lyon, 1908, 1 fr. 50.

STEINER and INGRAHAM. Epidemic Cerebrospinal Meningitis in Hartford,
Connecticut, during 1904-05. .1 mer. Jonm. Med. Sc., March 1908, p. 351.

Tnmour.— A. J. HALL. A Clinical Lecture on New Growth of Mediastinum
and Brain presenting some Unusual Features. Clin. Journ., March 11, 1908,
p. 344.

RAYMOND et CLAUDE. Tumour de la Protuberance; paralysis des mouve-
ments assoctes des Yeux. (Soc, de neurol.) Rev. Neurol., No. 4, 1908, p. 172.

Hjemorrliagc.— ODOARDO ASCENZI. Una cisti emorragica del corpo calloso.
Riv. di Pato(. nerv. e nient ., Vol. xiii., f. 1, 1908, p. 1.

THEODORE DILLER. A Fatal Case of Pontile Haemorrhage, with Autopsy.
Amer. Journ. Med. Sc., March 1908, p. 408.

PAILHAS. Dydoublement de la personnalitl 4 la suite d’hemorrhagie. IJBncl-
phale, fev. 1908, p. 139.

Abscess.—WILFRED TROTTER. A Clinical Lecture on some of the Commoner
Symptoms of Cerebellar Abscess. Brit. Med. Journ., March 14, 1908, p. 612.

Hemiplegia.— ALFRED FUCHS. Ein weiterer Fall von ungewOhnlicher famiMrer
Norvenerkrankung (Residuen einer Hemiplegia cruciata ?). Wien, med. Wchnschr.,
No. 9, 1908, S. 446.

Aphasia. - FALCETTI. Contribute alio studio della mimica e delle sue
alterazioni negli afasioi motorii. Riv. dipatol. nerv. e meni., Die. 1907, p. 585.
FRANCOIS MOUT1ER. L’Aphasie de Broca. Steinheil, Paris, 1908, 25 fr.
WESTPHAL, Ueber einen Fall von motorischen Apraxie. Med. Klinik, Nr.
9, 1908, S. 283.

Tramnn. — HANWAY R. BEALE Note on a Case of Compound Depressed
Fracture of the Vault of the Skull: Operation and Recovery. Ixmcet, March 14,
1908, p. 786.

LATHROP. Injuries to the Head and Face. They. Go:., Feb. 16, 1908 r
p. 77.

BIBLIOGRAPHY

37*

GENERAL AND FUNCTIONAL DlgEAftEB—

Myxedema. —BENJAMIN und V. REUSS. Ueber den Stoffwechsel bei Myxodem.
Jahrb. f. KinderheilL, Bd. 17, H. 3, 1908, S. 201.

Neuralgia.— BRUNSCHWEIQ. Quelquee considerations sur les n^vralgiee et
n^vrites. Dodivers, Besan^on, 1908.

TREYMANN. Trigeminusneuralgie ala Folge von Zahnretention. D. vied.
Wchnschr ., No. 9, 1908, S. 370.

Neureses. —BLEICHER. Ein Fall von traumatiacher Neuroee. Wien. med.
Wchnschr., Nr. 9, 1908, S. 556.

ROSEN FELD. Paychiaohe Storungen bei der Vaaomotoriachen Neuroee. Zen, -
tralbl.f. Nervenheilk. u. Psychiat ., H. 4, 1908, S. 137.

Mysterta. —ERNEST JONES. Le c6t£ affeetd par rh6mipl£gie hyst£rique. Rev.
Neurol ., No. 5, 1908, p. 193.

J. E. PRICE. Hyateria in Children. Arch . of PediaL, No. 2, 1908, p. 95.

JAS. W. RUSSELL. A Case of Hysterical Somnambulism, showing Abnormal
Acuity of Vision in the Somnambulistic State. Bint. Med. Joum., March 14,
1908, p. 018.

R. C. WOODMAN. General Considerations aa to the Nature and Relationship
of Hysteria. Journ. Nerv. and Ment. Dis. t Feb. 1908, p. 77.

Neurasthenia. —HERZ. Wanderherz und Neurasthenic. Wien . klin. Wchnschr .,
Nr. 9, 1908, S. 291.

J. K. MITCHELL. Diagnosis and Treatment of Neurasthenia. Bull. Johns
Hopkins IIos., Feb. 1908, p. 41.

rsychasthenla.— JOSEPH COLLINS. Psychasthenia. N.Y. Med . Journ., Feb.
15, 1908, p. 297.

COURTNEY. Psychasthenia; its Semeiology and Nosologic Status among
Mental Disorders. Joum. Amer. Med. Assoc., No. 9, 1908, p. 005.

Exophthalmic Goitre. —HANNA THOMSON. Graves' Disease and its Treat¬
ment. Amer. Joum. Med. Sc., March 1908, p. 313.

Torticollis^— BIENFAIT. A propos de torticollis. Joum. de Neurol., i6v. 5,
1908, p. 141.

Tetamas.— JOSEF MENDEL. Beitrag zur Kenntnis des Stoffwechsels bei Tetanus
traumaticus. Ztschr.f. klin. Med., Bd. 05, H. 1-2, 1908, S. 141.

Alcoholism. —ALESSI. Lesioni della Corteccia Cerebrale e Cerebellare in Individui
Alcoolisti. Ann. di Neirol., Anno 25, F. 4-5, 1908, p. 288.

BOULENGER. Alcoolismo chronique chez un enfant. Joum. de Neurol., f6v. 5,
1908, p. 145.

POULARD. Amblyopie toxique par l’alcool et le tabac. Prog, mid., mars 7,
1908, p. 115.

Epilepsy. —HERMAN LUNDBORG. Om epilepsi och sinnessjukedom hos syskon.
Upsals Liikar. For hand., Feb. 28, 1908, p. 211.

JABOULAY. De l’£pilepsie jacksonnienne par porencephalic traumatique. Oaz.
des 116 p ., mars 17, 1908, p. 375.

MUNSON. The Hefirt’s Action preceding an Epileptic Seizure. Joum. Amer.
Med. Assoc., No. 9, 1908, p. 080.

RAYMOND et ROSE. Paralysie post-6pileptique transitoire h type de Paralysie
pseudo-bulbaire. (Soc. de neurol.) Rev. Neurol., No. 4, 1908, p. 108.

bplaal Anaesthesia.—BIRNBAUM. Beitrag zur Kenntnis der Todesf&lle nach
Lumbalanasthesie mit Stovain. Munch, med. Wchnschr., No. 9, 1908, S. 449.
MINGAZZINT. Contribution k l’etude clinique des paralysies consecutivee k la
rachistovainisation. Rev. Neurol., No. 5, 1908, p. 185.

Cerebro-splual Fluid.— KAUFFMANN. Uber den angeblichen Befund von

Cholin in der LumbalfULssigkeit. Neurol. Centmlbl ., Nr. 0, 1908, S. 200.

Acromegale. —OBERNDORFFER. Ueber den Stoffwechsel bei Akromegalie.
Ztschr.f. klin. Med., Bd. 05, H. 1-2, 1908, S. 6.

Sables.—ROUSSET. Accidents nerveux rabiformes oprks morsures. (These.) Rey,
Lyon, 1908, 2 fr.

88*

BIBLIOGRAPHY

APDCIAL SEMSBA AND CRANIAL NERVES—

ALEXANDER und MANASSE. Ueber die Beciehungen der chroniflchen iabyrin-
tharen Schwerighttrigkeit zur Meni&reschen Krankheit. Ztsckr. /. OkrtnkeiUb.,
Bd. 55, H. 3, im, S. 183.

FRENKEL. La Ponction lombaire dans lee nlvrites optiquee par hypertension
cranienne. Toulouse. 1908.

JABOULAY. Paralyaie faoiale d’origine otique ; traitement palliatif de la
lagophtalmie par la section du symp&thique, Gaz. des Hdp., f6r. 27, 1908.
p. 279.

■DCBUANEOIS SYMPTOMS—

BIENFAIT. A propos de la reaction de la d&r£n6reacence. Jour h. dt Neutxd^
f*v. 5, 1908. p. 150.

HEATHER BIGG. Spinal Curvatures. J. A A. Churchill, London, 1908, 5s.
BR1DZINSKI. Ueber die kontr&lateralen Reflexe an den unteren Extremit&ten
bei Kindern. Wien. klin. Wchnschr., No. 8, 1908, S. 255.

CASSIRER und LOESER. tTber den Einfluss von Drehbewegungen urn die
vertikale Korporachse auf den Nystagmus. Em Beitrag zur Funktionsprufung
des Vestibularisapparates. Neurol. CetUralbl., Nr. 6. 1908, S. 252.

D’ORSAY HECHT. Morbid Somnolence. Amer. Joum. Med. Sc., March 1908,
p. 403.

ERNEST JONES. The Precise Diagnostic Value of Allochiria. Bruin, Vol. xxx.,
No. 120, 1907, p. 490.

ALICE MACKENZIE. Zur Klinik der galvanischen Akustikuareaktion. Wien,
klin. Wchnschr., Nr. 11, 1908, S. 580.

POTPESCHNIGG. Zur Kenntnis der kindliche Krampfe und ihrer Folge fiir das
spa tore Alter. Arch. f. Kinderheilk., Bd. 47. H. 4-6,1908, S. 360.

REDLICH. Ueber ein eigenartiges Pupillenphanomen : zugleich ein Beitrag hit
Frage der hysterischen Pupillenstarre. D. mod. Wchnsckr., No. 8, 1908, S. 818.
THORBURN. The Symptoms due to Cervical Ribs. Med. Chron., Dec. 1907,
p. 165.

ARTUR SCHtfLLER. Ueber Rtintgen-untersuchungen bei Krankheiten des
SchKdels und Gehirns. Wien. med. Wchnsckr., No. 10, 1908, S. 502.

PSYCHIATRY

6KIUAL-

ANTONIO BALLVE. Las po nas disciplinarias en los establecimientos pone tend -
arios. Arch, de Psiquiat. y Criminol., Feb. 1908, p. 27.

PEDRO DORADO. Asilos para bebedores. Aixk. de Psiquiat y CriminoL, Feb.
1908, p. 72.

FRAGNITO. I Diaturbi Psichici. Ann. di Neirol., Anno 25, F. 4-5, 1908,
p. 273.

GALCERAN GRANTS. Como deben ser los asilos para alienados. Arc k. de
Psiquiat . y Criminal., Feb. 1908, p. 42.

DEL GRECO. La Sintesi clinica di E. Kraenelin dal punto di vista della storia
della medicina. Manicomio, No. 3, 1908, p. Sol.

LUNDBORG. Essai duplication de la nature intime de la d6g£n$resoenoe.
L'Enciphale, I6v. 1908, p. 109.

T. C. MACKENZIE. The Recognition and Treatment of Incipient Mental
Disease. Scot. Med. and Surg. Journ., March 1907, p. 230.

NAUDASCHER. Syndrome de d6bilit6 motrice dans les d6bilit£s men tales.
(Tkise.) Jacques, Paris, 1908.

PACTET. Enqu&te internationale sur I’aMnation mentale dans pes prisons. Rev.
de Psychtai., No. 2, 1908, p. 45.

PASTORE. II valore vero dell’ opera di Kraepelin. Manicomio, No. 3, 1908,
p. 843.

SALERNI. Dati e Commenti sul XIII. Congresso della Societk Freniatrica
italiana. Manicomio, No. 3,1908, p. 413.

SIGHELE. Eugfene Sue et la psychologic criminelle. Aixk. dAnthropol. Crim.,
Uy. 15, 1908, p. 104.

BIBLIOGRAPHY

39*

Mult*—LEWIS BRUCE. The Symptoms and Etiology of Mania. Edin. Med.
Joum., March 1908, p. 209.

Dementia Prwcox.— ZIVERI. Contributo alio studio della funzionalitA epatica
nella demenza preooce. Manicomio. , No. 3, 1908, p. 821.

Paranoic Conditions. —JOFFROY. De l’interpret&tion delirante dans les ddlires
systematises. L'En&phdle , f£v. 1908, p. 117.

JOFFROY. Ddlires de persecution. Joum. des PraL, fdv. 29, 1908, p. 134.

Special Symptoms.— BARNES. Some Aspects of Memory in the Insane. Amer.
Joum. Psychol. , Jan. 1908, p. 43.

EDMOND CORNU. Sur la cuti-reaction et Tophtalmo-reaction en psychiatrie.
Ann. Mid.-Psychol., mars-avril 1908, p. 177.

DtCLERC. L’Oculo-reaction. La Cutir6action et la Sous-cutir6action en
psychiatrie. Vigot frferes, Paris, 1908.

K LEI ST. Untersueh ungen zur Kenntnis der psychomotorischen Bewegungs-

stttrungen bei Oeisteskranken. Klinkhardt, Leipzig, 1908, M. 4.50.

MIGNARD. Les Satisfaits. Etats de Satisfaction dans la d6mence de l'idiotie.
Rev. de. Psychiat ., No. 2, 1908, p. 67.

LE ROUX. Deux cas dc traumatisme oculaire grave ohez des alienes. Germain
et Grasset, Angers, 1908.

ALBERTO ZIVERI. Sulla presenza di Colina e di Potaasio nel liquido cefalo
rachidea e nel sangue in alcune malattie mentali. Ri r. Ital. di Neuropat ol ., Psichiaf.
ed Elettroter ., VoL i., f. 3, 1908, p. 119.

Miscellaneous Cases. —ALBERT GIRAUD. Revue de medicine legale: Cas de
perversions sexuelles. Ann. Mid.-Psychol., mars-avril 1908, p. 206.

HELLER. Ueber Dementia infantilis. Ztschr.f. d. Erforsch. d.jugend. Schxoach-
sinns, Bd. 2, H. 1, 1908, S. 17.

Ml&RY et ARMAND-DELILLE Syndrome de Debilite Motrice chez deux
enfants atteints de Debilite Mentale. (Soo. de neuroL) Rev. Neurol., No. 4.
1908, p. 177.

J. ROGUES DE FURSAC et C. PASCAL. Adipose douloureuse (maladie de
Dercum) chez une demente precoce. L'Endphale , fdv. 1908, p. 131.

Medico-legal.—BARUK. Expertise psychiatrique. L'Enckphale, fdv. 1908, p. 142*
1NGEGNIEROS. Locura, Simulacion y Cnminalidad. Atrh. de Psiquiat. y
CriminoL , Feb. 1908, p. 3.

G. W. JACOBY. Psychiatric Expert Evidence in Criminal Proceedings; its
Imperfection and Remedy. N. Y. Med. Joum. , March 7, 1908, p. 431.

A. L. MARZO. Diagnostieo medico-legal de las manchas de sangre. Arch, de
Psiquiat. y CriminoL, Feb. 1908, p. 64.

DI MATTEL Note clinico-guidiziarie intorno ad un caso di omicidio colposo.
Manicomio, No. 3, 1908, p. 363.

P1LCZ. Contribution k l'etude du suicide. Ann. Mid.-Psychol., mars-avril
1908, p. 193.

PUNZI. 11 delinquente pazzo morale di fronte al Codice Penale vigente.
Manicomio, No. 3, 1908, p. 289.

TREATMENT*—

ABA DIE. Diagnostique et traitement du goitre exophtalmique an Congr^s de
Medicine de 1907. Gaz. des U6p., mars 15, 1908, p. 315.

BILLIKIN. Les applications de l’eiectricit6 dans les crises laryngdes et vdsicales
des tabetiques. Bull, de la Soc. Fmngaise d' Blcctrothir., jan. 1908, p. 12.
CASILLO. 11 metodo Flechsig nella cura di epilettico con intoseicazione malarica.
Nota clinico-terapeutica. Manicomio, No. 3, 1908, p. 315.

F. R. COOK. The X-ray and High-frequency Treatment of Exophthalmic
Goitre. Joum. Amer. Med. Assoc., No. 10, 1908, p. 758.

DELHERM. Apropos de la radioth6rapie sur les centres nerveux. Bull . de la
Soc. Franfaise KlectrothL'., fir. 1908, p. 39.

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

40*

BIBLIOGRAPHY

A. J. M'CALLUM. The Colony and Bromide Treatment of Epilepsy. Brit . Med.
Joum., March 14, 1908, p. 616.*

J. J. NUTT. Orthopoedic Therapy during the Early Stages of Acute Anterior
Poliomyelitis. iV. Y. Med . Joum Feb. 29, 1908, p. 402.

OSTERLOH. Die Behandlung der Eklampeie. Munch, tned. Wchnschr ., No. 11,
1908, S. 553.

FREDERICK PETERSON. The After-Cure of the Insane. N Y. Med Jour*,,
Feb. 29, 1908, p. 883.

QUINBY. The Treatment of Trophic Nerve Lesions ; a Study Based on a Case
of Mai Perforans, of Ischemic Paralysis and of Erythromelagia. Boston Med. and
Sur . Journ.f Feb. 27, 1908, p. 281.

RUHRAH. The Rest Treatment in Chorea. Arch of Pediat No. 2, 1908,

p. 101.

THOMAS CLAY SHAW. The Radical Cure: Certification of Inebriates.
Lancet , Feb. 29, 1908, p. 623.

SO UTTER Pendulum Apparatus and an Apparatus for Rotary Correction in
Curvature of the Spine. Boston Med. and Sur. Joum., Feb. 20, 1908, p. 243.
DEL VALLE y ALDABALDE. Tabes dorsal mejorada con el suero antidiftSrico.
Rev. dt Med. y drug. Prac ., Feb. 1908, p. 213.

WORRALL. The Treatment of Sciatica by High-frequency Currents. Arch, of
the Roentgen- Ray , March 1908, p. 272.

ZWEIG. Versuche Tiodin und Atoxyl bei metasyphilitischen Erkraukungen des
Zentralnervensystems. D. med . Wchnschr. 9 No. 11, 1908, S. 457.

Sargleal*—DONALD J. ARMOUR. Hunterian Lectures on the Surgery of the
Spinal Cord and its Membranes. Lancet , March 14 and 21, 1908, pp. 765, 838.
ELSWORTH. Tumour of the Cauda Equina removed by Operation ; Recovery.
Bdin. Med. Joum., March 1908, p. 236.

HAYES. Enqudte sur le traitement actuel de la gibbosity du mal de Pott
(TkUe.) Jacques, Paris, 1908.

W. S. SYME. Operative Procedures in Relation to Disease of the Frontal and
Sphenoidal Sinuses. Glasgow Med. Joum., March 1908, p. 188.

M. WOODS. Operative Procedure as a Therapeutic Measure in the Cure of
Epilepsy. Joum. Amer. Med. Assoc ., No. 9, 1908, p. 663.

Bibliography

ANATOMY

DOGIEL. Der Bau der Spinalganglien des Menschen und der Saugetiere
Fisoher, Jena, 1908, M. 24.

SHINKISHI HATA1. 8tudiee on the Variation and Correlation of Skull
Measurements in both Sexes of Mature Albino Rats. Amer. Journ. Anal,
Vol. vii., No. 4, 1908, p. 423.

W. J. LAW. On the Termination of the Nerves in the Teeth of Mamma li a .
Proc. Roy . Soc, of Med. , No. 5, 1908.

ROTHMANN. Ueber Bau und Leistung der Supranuklearen Horleitung. Beit,
zur. Anal., etc., des Okies, Bd. 1, H. 3, 1908, S. 2o2.

SCHULTZE. Zur Histogenesis des Nerve nsystems. Reimer, Berlin, 1908,

M. —60.

ZANCLA. Sulla decussazione di alcune fibre del fascio piramidale nel corpo
•calloso. Riv. Ital. di Neuropat, Psichiat. ed Elettroter. ., Aprue, 1908, p. 167.

PHYSIOLOGY

APELT. Erwiderung auf die Arbeit von Dr K. Pollack, “ Weitere Beitrgge zur
Himfunktion. ” Mittheil. a. d. Orenzyebeit. d. Med . u. Chir ., Bd. 18, H. 4, 1908,
S. 673.

BERNSTEIN. Zur Thermodynamik der Muskelkoutraktion. I. Ueber die
Temperaturkoeffizienten der Muskelenergie. Arch. f. d. ges. Physiol ., Bd. 122,
H. 4-5-6, 1908,8. 129.

BETHE. Ein neuer Beweis fur die leitende Funktion der Neurofibrillen, nebst
Bemerkungen liber die Reflexzeit, Hemmungszeit, und Latenzzeit des Muskels
beim Blutegel Arch. f. d . ges. Physiol., Bd. 122, H. 1-2-3. 1908, S. 1.

GARREY. Some Effects of Cardiac Nerves upon Ventricular Fibrillation. Amer.
Journ. Physiol., April 1, 1908, p. 283.

HERM. MUNK. Uber die Funktionen des Kleinhims. Reimer, Berlin, 1908,
M. 2.

KASSO WITZ und SCHILDER. Einige Versuch fiber die Feinheit der Empfindung
bei bewegter Tastflttche. Arch./, d. ges. Physiol ., Bd. 122, H. 1-2-3, 1908, S. 119.
LEFEVRE. Sur le besom minimum de l’4nergie. Journ. de Physiol, et dt Pathol,
gin., mars 1908, p. 212.

MARGNON. fctude sur la r6partition du glvcogfene musculaire dans Tinanition.
Journ. de Physiol, et de Pathol, gen., mars 1908, p. 203.

F. W. MOTT. Two Lectures on the Physiology of the Emotions. Bril Med.
Journ., April 4 and 11, 1908, pp. 789, 853.

PIKE, GUTHRIE, and STEWART. Studies in Resuscitation. II. The Reflex
Excitability of the Brain and Spinal Cord after Cerebral Ansemia. Amer. Journ.
Physiol., April 1, 1908, p. 359.

TISSUE et BLUMENTHAL. Contribution & l'6tat de la fatigue dans la course en
montagne. Journ. de Physiol, et de Pathol, gin., mars 1908, p. 238.

TSCHERM AK. Ueber Simultankontrast auf venchiedenen Smnesgebieten (Auge,
Bewegungssinn, Geschmacksinn, Tastsinn und Temperatursinn). Arch./, d. ges.
Physwl/Bd. 122, H. 1-2-3, 1908, S. 98.

VILLIGER. Die periphere Innervation. Engelmann, Leipzig, M. 8.

PSYCHOLOGY

BRADLEY. On Memorv and Judgment. Mind, April 1908, p. 153.

GRAZIANI. Sur le mode de se com porter de la sensibility auditive, visuelle et
tactile, 4 la suite du travail mental. Arch. ital. de Biol., Vol. xlviii., p. 261.

€ 41#

42*

BIBLIOGRAPHY

KATZAROFF. Le role de la recitation oomme facteur de la memorisation. Arch*
de Ptifchol ., T. vii., No. 27, 1908, p. 225.

MAZlTRKIEWICZ. tJber den reaktiven Cbarakter dor Denkrorgange. Neurol.
CentralU., Nr. 7, 1908, a 298.

W. H. RIVERS. The Influence of Alcohol and other Drags on Fatigue. Edward
Arnold, London, 1908, 6s.

SAXINGER. Gefiihlssuggestion und PhantasiegefuhL Ztschr.f. Psychol., Abt. 1,
Bd. 46, H. 6,1908, S. 401.

TCHIRIEV. Le sifcge dee prooeasns psychiques conscients chez les animaur.
Nouv. Icon . de la Salpitriire , jan.-fev. 1908, p. 1.

PATHOLOGY

BETHE. Bemerkung xur Arbeit Ton H. Perroncito. Beit, zurpathol. Anal., Bd.
4. H. 8, 1908, a 283.

BUSCHEN. Bericht Uber die anthropologischen Literature in Entartung and
▼erwandte Zust&nde aud den letzten fiinf Janren. Ztschr.f. d. Erforsch. d.jugend.
Schteachsinns , Bd. 2, H. 2, 1908, S. 139.

DAVID FORSYTH. The Parathyroid Glands: Their Pathology in Man.
Quarterly Journ. of Med., No. 8, 1908, p. 287.

RAMON y CAJAL. Studien liber Nervenregeneration. Ubersetit yon Johannes
Bresler. Barth, Leipzig, 1908, M. 7.60.

GIANNELLI. A New Method of Preserving the Central Nerrous System for
Morphologic Study. Jouni. Meat. Pathol ., No. 8, 1908, p. 117.

KILVINGTON. Pathology of Thyroid and Parathyroid Glands. Intercolonial
Med. Joum ., Feb. 20, 1908, p. 70.

CLINICAL NEUROLOGY

GIN SEAL—

KURT MENDEL. Der Unfall in der Aetiologie der Nerrenkrankheiten (Forts.).
Monatsschr. f. Psychial. u. Newol., M&rz 1908, a 272.

■tJ&CTJES—

BALLET et LAIGNEL-LAVASTINE. Myopathie ancienne aveo disparition de
la plupart des cellules radiculaires antdrieures. L'Rndphalt, No. 8, 1908, p. 229.
BONFIGLI. Peripheral Amyotrophy due to Traumatism. Joum. MenL Pathol..
No. 3, 1908, p. 121.

DIGHTON. Progressive Ossifying Myositis in a Boy set Eleven. Edin. Med.
Joum., April 1908, p. 344.

LORENZ. Ueber eine eigenartige Form von Myositis fibrosa progrediens. Wien,
klin. Wchnschr., April 2, 1908, S. 465.

miPiEftu ifum-

DEBOVE. PolynAvrite alooolique ches un tuberculeux. Gas. des mars 26
1908, p. 423.

»PUf AL CORD—

PellsmyellUs.—MEDEA. Beitrag zur Kenntnis der Poliomyelitis anterior sub¬
acute adultorum (Forts.). Monatsschr. f. PsychiaL u. Neurol. Mfirz, 1908, a 255.

Tales.—ERNEST JONES. The Symptoms and Diagnosis of Juvenile Tabes. Brit.
Joum . Children's Die., April 1908, p. 13L

Paraplegia.— BONO. La paraplegic spasmodique familiale. Rev. de Mid. % mar s
10,1908, p. 209.

ROWLANDS. A Clinical Lecture on Two Cases of Traumatic Spastic P&raplegia.
Clin. Joum., April 8, 1908, p. 408.

Syringomyelia.—CLAUDE et ROSE. Synngomytfhe A debut sacro-lombeire.

g oc. de NeuroL) Rev. Neurol., mars 80, 1908, p. 268.

ILCHNER. Zur Kenntnis der Syringomyelia. Berl. klin. Wchnschr.. April 6
1908,8.685. F '

BIBLIOGRAPHY

43*

RHEIN. Syringomyelia and Syringobulbia. Journ. Med. Research, March 1908,
p. 127.

SPILLER. The Association of Syringomyelia and Tabes Dorsalis. Journ. Med.
Research , March 1908, p. 149.

WEISENBURG. The Diagnosis and Treatment of Syringomyelic Lesions of the
Nervous System. Amer. Journ. Med. Sc., April 1908, p. 651.

Disseminated Sclerosis. —NOICA. Troubles de la Sensibility objective dans lea
cas de Sclerose en Plaques. (Soc. de neurol.). Rev. Neurol., mars 80, 1908, p. 279.

Combined Scleroses. —JULIUS GRINKER. Subacute Combined Cord Degenera¬
tion, with Report of Cases. Journ. Amer. Med. Assoc., April 4, 1908, p. 1109.

BHAUV—

Encephalitis. —LAIGNEL-LAVASTINE. Enc^phalomy^lite aigue hymorrhagique
hyperplastique et diapldytique. Arch, de Mid. Experiment., mars 1908, p. 234.

Meningitis. —HEMENWAY. Two Cases of Acute Meningitis of the Convexity.
Arch, of Pediat. , March 1908, p. 207.

PEABODY. Preliminary Report of a Case of Cerebro-spinal Meningitis of
Streptococcus Origin, apparently cured by Subdural Injection of Anti-
Streptococcal Serum. Med. Rec. t March 14, 1908, p. 428.

SCHLESINGER Ueber Meningitis cerebro-spinalis epidemica im hbheren
Lebensalter. Wien, med . Wchnschr. , April 4, 1908, S. 728.

Mssmerrhage.—MUNRO SMITH. A Case of Rupture of Middle Meningeal
Artery ; Operation; Recovery. Bristol Med.-Ckir. Journ., March 1908, p. 68.

Abscess. —COUGHLIN. Report of a Case of Cerebral Abscess with Masked
Symptoms. N.Y. Med. Journ. , April 11, 1908, p. 691.

GRUNBERGER. Bronchiektasie und Himabszess. Prag. med. Wchnschr,, April
2, 1908, S. 171.

Hemiplegia. —NOlCA. Le mycanisme de la contracture chez les spasmodiques
hemigl5giques ou parapiygiques. Nouv. Icon, de la SalpStritre , jan.-f4v. 1908,

Aphasia. — LADAME et VON MONAKOW. Observation d’aphymie pure
(anarthrie corticale). L'Endphale, No. 8, 1908, p. 198.

LIEPMANN. Uber die angebliche Worttaubheit der Motorisch-Aphasischen.
Neurol. CentralU., Nr. 7, 1908, S. 290.

Hydrocephalus. —HUBER. Meningococcus hydrocephalus. Arch, of Pediat.,
March 1908, p. 161.

Cerebral Sclerosis.— ARM AN D-DELILLE et G1RY. Deux cas de Sclerose cere¬
bral© h type pseudo-bulbaire chezj’enfant. Arch, de Mid. des Enfants, f6 v. 1908,

p. 126.

Tumour. —J. R AYER. Cyst of the Dura Mater Occupying the Left Middle
Cranial Foesa Associated with Anomalous Development of the Left Superior
Temporal Gyrus. Amer. Journ. Insan. 4 Jan. 1908, p. 513.

RAYMOND et CLAUDE. Sur quelques symptOmes des tumeurs de la pro-
tubyrance. L'EnctphaU, No. 8, 1908, p. 264.

JOHN WYLLIE. Tumours of the Cerebellum. H. K. Lewis, London,
1908, 4s.

Bulbar Paralysis. —ALFRED GORDON. Acute Bulbar Paralysis, with an
unusual symptom. Med. Rec. t Feb. 29, 1908, p. 349.

Trauma. —DOUGLAS DREW. Injuries to the Head in Young Children. Prac-
titioner, No. 4, 1908, p. 464.

Cerebral Syphilis. —OTTO RANKE Ueber Gehirnveranderungen bei der
an^eborenen Syphilis. Ztschr.f. d. Erforsch. d.jugend. Schwachsinns, Bd. 2, H. 2

4UHER1L AND FUNCTIONAL DISEASES—

Myxsedema. — ALDO MASSAGLIA. Contribute alia patogenesi del mixedema.
Riv. di Patol. nerv. e ment. , F. 2, 1908, p. 77.

Exophthalmic Goitre. —J. M. JACKSON. Some Clinical Observations on the
Diagnosis and Treatment of Exophthalmic Goitre. Boston Med. and Surg. Journ.,
March 12, 1908, p. 846.

44*

BIBLIOGRAPHY

RENNIE. Exophthalmic Goitre combined with Myasthenia Gravis. Ret. Neurol,
sued Prychiat., April 1908, p. 229.

8CHR0TTER. Morbus RaeedowiL Med, KlinUL, April 5, 1908, 8. 477.

Mjnfgrla.—BABIN8KI. Instability HysUrique dee membre e et da tronc. (Soc.
de nenroL) Rec. Neurol., mars 30, 1908, p. 259.

COURTNEY. The Genesis and Nature of Hysteria. Bottom, Med. and Surg.
Joum. March 12, 1908, p. 341.

DEBOVE. Hysteric toxique cbee on satomin aloooBque. Joum. da Prat.,
anil 11, 1908, p. 225.

SCHULZE. Leber hysteriscbe Hemiplegia. Deutsche mod. Wchnsckr., Mfin 26,
1908, S. 544.

R. C. WOODMAN. General Considerations as to the Nature and Relationships
of Hysteria. Joum. Nerr . and Ment. Die., March 1908, p. 153.

Mewrast hernia.—HOCKEN DO RF. Die nerrosen Magenerkrankongen and die

allgemeine Nerrenschwache. Steinits, Berlin, 1908, M. 2.

ORBISON. The Neurasthenia of Autointoxication. Amor. Joum. Med. Sc.,
April 1908, p. 558.

Wear s ets .—DUPRE et CHARPEXTIER. Des psychopolynyvrites chroniques.
L'Rnctpkale , anil 1908, p. 289.

Adiposis Delereea.—FRANKENHE1MER. Adiposis Dolorosa. Joum. Amor.
Med. Aeeoc., March 28, 1908, p. 1012.

TeCaaas.—POCHHAMMER. Der lokale Tetanus und seine Entstehung. Deutsche
med. Wchnsckr., April 16, 1908, & 685.

WAGNER. Neuere Arbeiten liber den Tetanus. Schmidt 1 e Jahrb. , H. 3, 1908,
8.225.

Tetany.—R. ▼. JAKSCH. Tetania sis Initialsymptom akuter Erkrankungen.
Wien. mod. Wchnsckr., April 4, 1908, 8. 715.

MACCALLUM and VOEGTLIN. On the Relation of the Parathyroid to Calcium
Metabolism and the Nature of Tetany. Bull. Johns Hopkins Hosp., March 1908,
p. 91.

Alcehelistn.—M'ADAM ECCLES. The Relation of Alcohol to Physical Deteriora¬
tion and National Efficiency. Brit. Joum. Inebriety, April 1908, p. 197-
GEORGK PETTEY. Chronic Alcoholism. N.Y. Med. Joum., April 4, 1908,
p. 632.

Epilepsy.—CLAUDE, SCHMIERGELD, et BLANCHETlfcRE. La resistance
globul&ire et le pouvoir h&nolytique du s4rum chez les Ipileptiquea. L'Kn*
dphale , No. 3, 1908, p. 252

LORENZO GUALINO. Contribute olinioo alia patogenesi della EpQeesie
Mestruali. Ann. di Freniat., Die. 1907, p. 364.

ROBINOVITCH. General and Cerebrtu Blood Pressure during an Attack of
Electric Epilepsy. Joum. Ment. Pathol., No. 3, 1908, p. 136.

ROSANOFF. Disturbances of Nitrogenous Metabolism in Epilepsy. Joum.
Amer. Med. Assoc., April 11, 1908j p. 1175.

SCHUPFER. Epilessia Jacksonian* da lesione frontale extra rolandica. Riv.
di Patol. nerv. e ment., F. 2, 1908, p. 58.

VOLLAND. Statistiache Untersuchungen liber geheilte Epileptiker. Alla.
Ztschr.f. Psychiat,, Bd. 65, H. 1, 1908, 8. 18.

Chorea.—ARTHUR 8. HAMILTON. A Report of Twenty-seven Cases of Chronic
Progressive Chorea. Amer. Joum. Insan., Jan. 1908, p. 403.

■erpes.—ROSE. N6vrite sensitive et trophique h la suite d*un sons. Naur. Icon,
de la Salpltrib't, jan.-f4v. 1908, p. 64.

Aeremegaly.—J. H. DOUGLAS WEBSTER. A Case of Unilateral Cerebral
Hyperplasia, with Co-existent Acromegaly of the Feet, and a Slight Degree of
Unilateral Gigantism. Joum. Path, and Bacteriol., 1908, p. 306.

SPECIAL SENSES AND CRANIAL NERVES—

A. R. ALLEN. A New Diagnostic Sign in Recurrent Laryngeal Paralysis.
Joum. Nerv. and Ment. Dis., March 1908, p. 141.

AMAR. Actions solaires sur la vision. L'astigmatisme inverse. Joum. de
Physiol, et de Pathol, gin., mars 1908, p. 231.

BERNHARDT. Beitrag sur Lehre von der Fadalislahmung. Monatsschr. f.
PsychiaL u. Neurol., Mfire 1908, S. 191.

BIBLIOGRAPHY 46*

FRANKL-HOCHWART. Die nervfoen Erkr&nkungen des Geschmaoks und

Geruches. (2. Aufl.) Holder, Wien, 1908, M. 2.80.

Ft)HCHT£. Zur Frage der Embolia arteriae oentralis retinae. Klin. Monatibl.
f. Augenheilk., M&rz 1908, S. 245.

GROSSMANN. Beitrag zur Lehre von den reflektorischen vaso-motorischen

Sttirungen nasalen Ursprungea. Wien. med. Wchnschr.., April 18, 1908, S. 848.
ED. JACKSON. The Importance of Ocular Leeiona and Symptoms. Joum.
Amer. Med. Assoc ., March 28. 1908, p. 1003.

ARNOLD KNAPP. Affections of the Optio Nerve during Pregnancy. Arch,
of Ophtkal., March 1908, p. 186.

LOMBARD et HALPHEN. Le nystagmus r4flexe provoqutf comme mtfthode de
diagnostique des Stats functionnela de r&ppareil vestibulaire. Prog. Mid.,
ayril 18, 1908. p. 186.

STOCK. Ueber eine bis jetzt noch nioht beachriebene Form der famili&r auftret*
enden Netzhautdegeneration bei gleichseitiger VerblOdung und liber typiache
Pigmentd ©generation der Netzhaut. Klin. Monatsbl. f. A ugenheilk ., M&rz 1908,
S. 225.

WALES. The Occipital Bone in Otology and Rhinology. Aixh. of Otol ., Feb.
1908, p. 1.

MISCELLANEOUS CASES—

BABONNEIX et VOISIN. Sur un c&s de L&rion Bulbo-protuWr&ntielle. (Soc.
de neurol.) Rev . Neurol., mars 80. 1908, p. 253.

KLIPPEL et MONIER-VINARD. Sur une forme particulifere de Maladie
Nerveuse Familial©. (Soc. de neurol.) Rev. NeuroL, mars 30, 1908, p. 271.
LONG. (1) Monopllgie crurale par lesion du lobule paracentral. (2) L&ion
dtendue de la region rolandique d’ongine intra-utfrine sans h£mipl6gie consecutive.
Nouv.. Icon . de la Salpiti-iirt, jan.-f6v. 1908, p. 37.

J. W. MILLER. Ein Fall von metastasierendem Ganglioneuroma. Virchotdi
Arch., Bd. 191, H. 3, 1908, S. 411.

PARHON et MIHAILESCO. Sur un cas d*infantiliame dysthyroidien et dyso-
rhitique. Joum. de Neui-ol., mars 20. 1908, p. 210.

RAYMOND et GOUGE ROT. Gangrene symltrique des extremities par arterite
chronique oblit£rante, transitoire ou permanent©, d’6tiologie inconnue. Nouv.
Icon • de SaJpiU-iire, jan.-f^v. 1908, p. 5a

3TELZNER. Uebar einen Fall von Kleinhirnatrophie. Monatsschr. f. Ptychiai.
a. Neui-oL, Marz 1908, S. 240.

Special Symptoms.—BRISSAUD et SICARD. L'h6mispasme facial alteme.
Presse Mid., avril 11, 1908, p. 234.

W. IRONSIDE BRUCE. The Relation between Sciatioa and Disease of the
Hip-Joint. Practitioner, No. 4, 1908, p. 475.

CRAWFORD. Headache and Eye-strain. Canad. Pi-act., March 1908, p. 155.
COCKS and MACKANTY. Headache caused by Pathological Conditions of the
Nose and its Accessory Sinuses. Arch, of Otol., Feb. 1908, p. 5.
COURTELLEMONT. Trophoedhme chronique. Variate congenital© unique.
Nouv. Icon, de la Salpilrib-e, jan.-ftv. 1908, p. 87.

MAX. EGGER. Contribution k l’ltude de l’Ataxie. Atari© p£riph6rique et
ataxie central© sans anesth&ie. (Soc. de neuroL) Rev. Neurol., mars 30, 1908,
p. 257.

GRUBE. Ueber intermittierendes Hinken (Dysbaaia angiosclerotica). Munch,
med. Wchnsckr., April 14, 1908, S. 800.

HILBERT, tfber Storungen dee Farbensinnes im Gefolge interner Erkrangungen.
Klin. Monatsbl. f. A ugenheilk ., MUrz 1908, S. 256.

LBVINSOHN. Ueber Miosis bei reflektorischen Pupillenstarre. Berl. klin.
Wchnschr ., April 13, 1908, S. 745.

MARMORSTEIN. Contribution k l'6tude des aortitea grippalea (un cas d'artlrite
grippale avec thrombose de l’arthre b&silaire). Rev. de Mid., mars 10, 1908,

&ORSE. Kernig’s Sign in Infancy. Arch, of PedicU., March 1908, p. 167.
NEUHOFF. Das Stottem und andere Sprachfehler. Marr6, Leipzig, 1903, M. 1.
NOICA. Sur le m£canisme du sign© de Babinski ou 1© phlnomfene des orteila.
Journ. de Neurol., mars 20, 1908, p. 201.

NOICA. Dissociation et antagonisms des reflexes cutan6s et tendineux. Preset
Mid., mars 25, 1908, p. 193.

46*

BIBLIOGRAPHY

ORMEROD. A Clinical Lecture on Acroparesthesia. Clin. Journ., April 15,
1908. p. 1.

RAYMOND et ROSE. Syndrome de la Calotte Protnb6rantielle. (Soc. de
neuroL) Rev. Neurol ., mars 30, 1908, p. 266.

REDLICH und BON VICINI. Cber das Fehlen der Wahraehmung der eigenen
Blindheit bei Hirukrankheiten. Deuticke, Wien, 1908, M. 3.

RENAUD. N^vrite Radiculaire Cervicale k symptftmes tardifs. (Soc. de neuroL)
Rev. Neurol ., mars 30, 1908, p. 263.

G. EL RENNIE. The Significance of the Pathological Variations of Reflex
Actions. Austral. Med. Oaz., Feb. 20,1908, p. 67.

SIC1LIANO. Esiste una reasione pupillare alia convergenza o all* acoomodazione ?
Riv. di Palol. nerv. e rnent ., F. 2, 1908, p. 49.

SIEMERLING. Zur Symptomatology und Therapie der Kleinhirntumoren.
Berl. klin. Wchnschr., Mkrs 30 u. April 6,1908, Sn. 638, 700.

SOUQUES. Dissociation cutan^o-musculaire de la sensibility et astyr6o-agno«e
i propos d’un cas de l&ion bilateral© du bulbe. Rev. NeuroL, mars 30, 1908,
p. 225.

WEISS. Das Tastsymptom. Vogel, Leipzig, 1908, M. 1.60.

SAMUEL WEST,
1908, p. 364.

Nervous Phenomena m Pneumonia. Clin. Journ., March 18,

PSYCHIATRY

GENERAL—

VERNON BRIGGS. Obeervation Hospitals or Wards for Early Cases of Mental
Disturbance. Boston Med. and Surg. Journ .. April 9, 1908, p. 474.

BRISSAUD. L’ltat antyrieur dans les accidents du travail. Prog. Mid., avril
11, 1908, p. 173.

BUMKE. L&ndlaiifige Irrtlimer in der Beurteilung von Geisteskranken.
BergmAnn, Wiesbaden, 1908, M. 2.

PIERCE CLARK. Freud's Method of Psychiatry. Med. Rec., March 21, 1908,
p. 481.

CONKLIN. The Relation of Mental Attitude to Bodily Function. N. Y. Med.
Jonrn. , March 28, 1908, p. 582.

CUTHBERTSON. The Increase of Lunacy. Colt. Med. Journ., April 1908,

p. 222.

CLARENCE B. FARRER. Some Origins in Psychiatry. Amer. Journ. Insan.,
Jau. 1908, p. 523.

KIRCHNER Wirkung in der Feme. Die Lehre von der Telepathic. Jaeger,
Leipzig, 1908, M. 1.

ALPHONSE MAEDER Nouvelles Contributions h la Psychopathologie de la
Vie Quotidienne. Aixh. de Psychol. , T. 7, No. 27, 1908, p. 2c3.

FRED. PETERSON. WhAt we have not done for the Insane. N.Y. Med.
Journ., April 4, 1908, p. 623

SHUTTLE WORTH. Inherited Syphilis as a Factor in the ^Etiology of Mental
Defect in Children. Brit. Journ. Children's Uis., April 1908, p. 111.

MAX 8ICHEL. Cher die Geisteastbrungen bei den Juden. NeuroL Centralbl.,
April 16, 1908, S. 351.

F. L. WELLS. Technical Aspects of Experimental Psychopathology. Amer.
Jowvi. Insan., Jan. 1908, p. 477.

General Paralysis.—COLE and STEPHENS. Juvenile General Paralysis. Inter¬
colonial Med. Joum., Feb. 20, 1908, p. 98.

JOFFRO Y et HSR!. Resume den donnyes ootuelles sur l’histologie de la para-
lysie gynyrale (suite et finj. L'Endphale , avril 1908, u. 315.

MILIAN. Forme bulbaire de la paralysie gynyrale (syndrome du vague et
d’angoisse). Prog. Mid., avril 4, 1908, p. 161.

FRANCIS VALK. Ocular Rotation in Paresis. Journ. Amer. Med. Assoc.,
April 11, 1908, p. 1167.

Manic-depressive Insanity. —DENY. La Cyclothymie. Semaine Mid., avril 8,
1908, p. 169.

ESPOSITO. Di alcune Questioni Nosografiche sulla psioooi maniaco-depressiva.
Ann. di Freniat., Die. 1907, P. 297.

PFERSDORFF. Der Redearang im manisch-depressiven Irresein (opes. die
dialo^isierende Manic). ZentratlL f. Nerrenheilk . u. Psychiat., Nr. 257, 1908,

BIBLIOGRAPHY

47*

ADAM WIZfiL. Einige Worte betreffs der Benennung u maniach-depressives
Irresein.” Neurol. CeiUralbl., April 16, 1908, 8. 368.

Aeiieitia Pneeax.—BLEULER und JUNG. Komplexe und Krankheitsursachen
bei Dementia praecox. Zentmlbl. /. Nervenheilk. u. Psychiat, Nr, 257, 1908,
8 . 220 .

BOSCHI. Sur lea accessoiros de rbabillement dans la ddmence prtfcoce et dAna
la gsychose maniaque depressive. Nouv. Icon, de la Salpltrih'c, jan.-fdv. 1908,

KOLPIN. Ueber Dementia praecox, insbesondere die paranoide Form derselben.
Alla. Ztschr.f. Psychiat., Bd. 65, H. 1, 1908, 8. 1.

WIEG. Zur Klimk der Dementia praecox. Marbold, Halle, 1908, M. 8.

Alcoholic Psychoses. — SOUKHANOFF. Sur la melancholic alcoolique.
LEnciphale, avril 1908, p. 315.

Trauuitlc Psychoses.—DUPOUY et CHARPENTIER. Traumatismes cr&niens
et troubles mentaux. L Enclphale , avril 1908, p. 297.

Coastltutlonal Abnormality#—FRENZEL. Veroffentlichungen Uber Spracbe,
Sprachstorungen und Sprachunterrioht bei geistig scbwacben Kindera. Hilda*
brandt, Berlin, 1907, M. —60.

NACKE. Einleitung der Homosexuellen. Alia . Ztschr. f. PsychiaL , Bd. 65,
H. 1, 1908, 8. 109.

NACKE. Die Diagnose der Homosexualit&t. Neurol. Centralbl., April 16, 1908,
8. 338.

Special Symptoms#—COTTON and AYER. The Cytological Study of the Cerebro*
Spinal Fluid by Alzheimer’s Method, and its Diagnostic Value in Psychiatry.
Rev. Neurol, and Psychiat., April 1908, p. 207.

KAUFFMANN. Ueber Diabetes und Psychoee. Munch, med. Wchnschr.,
M&rz 24, 1908, 8. 621.

KAUFFMANN. BeitrSge zur Pathologic des Stoffwechsels bei Psychosen.
Fischer, Jena, 1908, M. o.

NACKE. Uber Familienmord durch Geisteskranke. Marhold, Halle, 1908,

M. 4.

RIEHM. Zur Frage der Simulation von Geisteskrankheit. Alia. Ztschr. f.
Nervenheilk. , Bd. 65, H. 1, 1908, 8. 28.

R1SCH. Uber die Verwechslung von Denksperrung mit angeborenem Intelli-
genzdefek bei den Haftpsychosen. Zeniralbl. f. Nervenheilk. u. Psychiat., H. 7,
1908, S. 249.

SCRIPTURE. Detection of the Emotions by the Galvanometer. Joum. Amer.
Med. A ssoc. , April 11, 1908, p. 1164.

OTTO VERAGUTH. Das psycho-galvanische reflex Ph&nomen. Monaisschr. f.
Psychiat. u. Neurol., Miirz 1908, S. 204.

MISCELLANEOUS CASES—

ALBERT KNAPP. Jahrelang Simulation eines Verblddungszustandes. Berl.
k ltn. W chnschr., April 6, 1908, 8. 681.

OETTINGER. A Case of Recurrent Autohypnotio Sleep, Hysterical Mutism
and Simulated Deafness; Symptomatic Recovery with Development of Hypo*
mania. Joum. Nerv. and Ment. Die., March 1908, p. 129.

MARIO OSTERERO. Nota clinica di psicopatologia forense sopra un neur*
astenico omicida. Ann di I rental., Die. 1907, p. 342.

RYAN. The Inebriate Population. Canad. Piact., March 1908, p. 141.

ROUMA. Un cas de Mythomanie. Aixh. de Psychol ., T. 7, No. 2/, 1908, p. 259.
SOUKHANOFF. A Case of Korsakows Psychosis, due to an Unusual Cause.
Joum. Ment. Pathol., No. 3, 1908, p. 126.

TRESPE. Ein Fall von Dementia posttraumatica mit ungewohnliche Begleit-
erscheinungen. Milnch. med. Wchnschr., Marz 31, 1908, S. 675.

W. K. WALKER. A Case of Matricide and attempted Suicide, with brief Psy¬
chologic Analysis. Joum. Nerv. and Ment . Dis., March 1908, p. 144.

TREATMENT*—

G. D’ABUNDO. Della scrittura associata come metodo terapico della Mogigrafia.
Riv. Hal. di NeuropaL, Psichiat. ed Elettroter ., Aprile 1908, p. 161.

BABINSKI. Spondyloee et Douleurs Ndvralgiques trfcs att£nu£es h la suite de

* A number of references to papers on Treatment are Included tn the Bibliography under the
Individual Diseases.

48 *

BIBLIOGRAPHY

pratiques Radiothlrapiques. (Soe. de neuroL) Rev. Neurol man 80, 1908,

p. 262.

BARCAT et DELAMARRE Le radium dans le traitement des n^vralgiee et dee
nlvrites. Arch, d,'Elect. Mtd. f avril 10,1908, p. 243.

BITTNER. Die Klappsche Skolioaenbehandlung. Prag. med. Wcknschr Man 26,
1908 S 169

DRENNAN. The Blood Conservation of Neurotio Individuals. AT. F. Med,

Joum., March 28, 1908, p. 598.

C. H. DUNN. The Serum Treatment of Epidemic Cerebro-Spinal Meningitis.
Boston Med. and Surg. Joum., March 19, 1908, p. 870.

HALLANER. Ueber Suggestionnarkose. Bcrl. klin. Wcknschr ., April 20,1908,

a 78i.

HARET. Rapport: La radioth&rapie dans le traitement des nlvralgiea. Arch.
<Ttiled Mid. , avril 10, 1908, p. 256.

HILLER. Medical Treatment of Exophthalmic Goitre. Intercolonial Med.
Joum. t Feb. 20,1908, p. 65.

MACDONALD. The Development of the Modem Care and Treatment of the
Insane. Joum . Merit. Pathol ., No. 8. 1908. p. 97.

PARHON et PANESCO. Contribution h l’etude du traitement du prurit cutant
chronique avec quelques considerations sur la pathoginie du prurit. Joum. de
NeuroL , man 6, 1908, p. 181.

ROBINOVITCH. Electric Anaesthesia. Joum. Mend. Pathol. t No. 8, 1908,
p. 138.

ROBINOVITCH. Methods of Resuscitating Electrocuted Animals. Joum.
Meni. Pathol. , No. 8, 1908, p. 129.

SCRIPTURE The Treatment of Hyperphonia (Stammering and Stuttering) by
the General Practitioner. Med. Rec ., March 21,1908, p. 480.

ALF. S. TAYLOR. Nerve Bridging: Report of one Successful Case. Joum.
Amer. Med. Assoc., March 28, 1908, p. 1029.

T1RELLI. Studi di technics manicomi&le. Effetti del massaggio sulla pelle di
aliensti. Ann. di Freniat., Die. 1907, p. 346.

DAWSON TURNER. Electrolysis in Tic Douloureux and in Spinal Sclerosis.
Brit. Med. Joum ., April 4, 1908, p. 806.

ZIEHEN. Chemiscne Schlafmittel bei Nervenkrankheiten. Deutsche mod

Wcknschr. , April 2, 1908, S. 580.

ZIMMERN et DELHERM. Rapport sur le traitement des n£vralgies et des
n&vrites par Tflectrioitl. Arch, cr Elect. Mid , avril 10,1908, p. 261.

Barglcal.— HALL. Gynaecological Treatment in the Insane. Canad. Prod..
March 1908, p. 147.

KUTTNER. Beitrfige sur Chirurgie des Gehims und RUckenmark. BerL klin.
Wchnschr.f Mkrz 30 u. April 6, 1908, Sn. 654, 706.

WM. TAYLOR. Graves 1 Disease treated by Thyroidectomy. Med. Press. April
15, 1908, p. 428.

BdseaUsi.—HERZE Die Organisation der Hilfsschule. Ztschr. f. <L ErforscK
d. jugend. Schwachsinns , Bd. 2, H. 2, 1908, S. 110.

ffiibUogvapb^

ANATOMY

HENRY H. DONALDSON. The Nervous System of tho American Leopard
Frog, Rana pipiens, compared with that of the European Frogs, liana esculenta
and liana temporia. Jottrn. Comp. Neurol, and Psychol., April 1908, p. 121.
HANS EVENSEN. Beitriige zu der normalon Anat. der Himgefosse. Histol. u.
hislopathol. Arb. u. d. (* nwhirnrinde, Bd. 2, 1908, S. 88.

HERMAN. Gebim und Schadel. Eine topographischon-anatomische Studie in
photograpbischer Darstollung. Fischer, Jona, 1908, M. 60.
r. T. HERRING. The Development of tho Mammalian Pituitary and its Morpho-
logical Significance. Quart. Journ. E.experiment. Physiol., April 1908, p. 161.

P. T. HERRING. The Histological Appearances of the Mammalian Pituitary
Body. Quart. Jouni. Experiment. Physiol., April 1908, p. 121.

JUDSON HERRICK. On the Phylogenetic Differentiation of the Organs of
Smell and Taste. Jouni. Comp. Neurol, and Psychol ., April 1908, p. 167.
WALTER RANSON. The Architectural Relations of the Afferent Elements
entering into the Formation of the Spinal Nerves. Journ. Comp. Neurol, and
Psychol April 1908, p. 101.

PHYSIOLOGY

BASLER. Beitrage zur Kenntnis der willkurliehen Bewegung. I. Die Kon-
traktion des Froschmuskels bei Strychninergiftung. Pjlugei''s Arch. , Bd. 120,
H. 7-8-9, 1908, S. 380.

HALLS DALLY. A Contribution to the Study of tho Mechanism of Respira¬
tion, with Special Reference to the Action of the Vertebral Column and Diaphragm.
Proc Roy. Soc., B. 80, B. 638, 1908, p. 182.

EYSTER and HOOKER. Direct and Reflex Response of the Cardio-inhibitory
Centre to Increased Blood Pressure. Amer. Journ. Physiol ., May 1908, p. 373.
GREENWOOD. Arris and Gale Lectures on tho Physiological and Pathological
Effects which follow Exposure to Compressed Air. Brit. Med. Journ., April 26,
1908, p. 983.

HELLO. Actions musculaires locomotrices. Journ. de l*Anat., mars-avril 1908,
p. 65.

r. T. HERRING. The Physiological Action of Extracts of the Pituitary
Body and Saccus Vasculosus of Certain Fishes. Quart. Journ. Experiment. Physiol.,
April 1908, p. 187.

LEFAS. Intorno ad un nouvo modo di Coloraziono delle sezioni istologiche e dei
preparati di sangue. Sperimentale, Anno 62, F. 1-2, 1908, p. 163.

LHOTA. Untersuchungen ttbor die vaguslahmendo Wirkung der Digitalis-
kttrper. Arch.f. experiment. Pathol., Bd. 68, II. 6-6, 1908, S. 350.

HAFEMANN. Erlischt das Leitungsvermdgcn niotorischor und sensibler
Froschnorvon bei dersolben Temperaturerhuhung ? PAtigers Arch., Bd. 120, II.
10-11,1908,8.484.

LICHTWITZ. Ueber Wanderung des Adrenalins im Nerven. Airh. f. exjteri-
ment. Pathol Bd. 68, H. 3-4, 1908, S. 221.

MANGOLD. Stmlien zur Physiologie der Nervensystems der Ectodermen.
PAuger's Arch., Bd. 120, H. 7-8-9, 1908, S. 316.

NERNST. Zur Theorie des elektrischen Reizes. PAuger's Arch., Bd. 120, H.
7-8-9,1908,8.275.

SHERRINGTON. On Reciprocal Innervation of Antagonistic Muscles. Eleventh
Note. Further Observations on Successive Induction. Proc. Roy. Soc., B. ?
Vol. lxxx.,1908 p. 53.

SHERRINGTON. Some Comparisons between Reflex Inhibition and Reflex
Excitation. Journ . Experiment. Physiol., Vol. i., 1908, p. 67.

f 49 *

50*

BIBLIOGRAPHY

KATASH1 TAKAHASHL Some Conditions which Determine the Length of
the Internodes found on the Nerve Fibres of the Leopard Frog, Rana pipiens.
Journ . Comp. Neurol, and Psychol ., April 1908, p. 167.

GEORGE B. WALLACE. The Physiological Mechanism of Vaso-Constriction
and Vaso-Dilatation. Med. Rec April 25, 1908, p. 673.

PSYCHOLOGY

ALRUTZ. Untersuchungen Uber die Temperatursinne. Ztsckr. f. Psychol .,
Abt. 1, Bd. 47, H. 3, 1908, S. 161.

BtJHLER. Tatsachen und Probleme zur einer Psychologie der Denkvorgange.
II. Ueber Gedankenzusammenhbrige. I IT. Uebor Gedankenerinnerungen.
Arch. f d. yes. Psychol., Bd. 12, H. 1-3, 1908, S. 1.

BUhLER. Nachtrag. Antwort auf die von W. Wundt erhobenen Einwande
gegen die Mcthode der Selbstbcobachtung an experimentell erzeugten Erleb-
nissen. Arch. f. d. yes. Psychol Bd. 12, H. 1-3, 1907, S. 93.

LEGOWSKI. Beitriigo zur experimentellen Asthetik. Arch.f. cL yes. Psychol.,
Bd. 12, II. 1-3,1908, S. 236.

LINKE. Meine Theorie der stroboskopischer Tiiuschungen und Karl Marbe.
Ztsckr. f. Psychol. , Abt. 1, Bd. 47, H. 3, 1908, S. 203.

MORTON PRINCE. Experiment to Determine Co-Conscious (Subconscious)
Ideation. Journ. Abnonn. Psychol ., April-May 1908, p. 33.

RI VERS. The Influence of Alcohol and other Drugs on Fatigue. Edward Arnold,
London, 1908, Gs.

SEGAL. Ueber den Reproduktionstypus und das Reproduzieren von Vorstel-
lungen. Arch.f. d. yes. Psychol., Bd. 12, H. 1-3, 1908, S. 124.

BORIS SIDIS.* An'Experimental Study of Sleep (Part I.). Journ. Abnoi-m.
Psychol., April-May 1907, p. 1.

PATHOLOGY

BARB&. Etude des Degenerations Secondaires du Faisceau Pyramidal. Octave
Doin, Paris, 1908, 4 fr.

BIKELES. Riickenmarksbefunde (a) nach Nervenkreuzung und (6) nach Nerven
propfling. Neurol. Centralbl Mai 16. 1908, 8. 450.

C. MACFIE CAMPBELL. Ueber die Umwandlung des Nervengewebes in eine
eigonartige homogene Substanz. J/istof. n. histopathol. Arb. u. d. Grosshirnrinde,
Bd. 2, 1908, S : 71.

DEVAUX. Etude histologique des foyers de necrose de l’6corce c£r£bra!e.
Ilistol. u. histopathol. Arb. a. d. Grosshirnrinde, Bd. 2, 1908, S. 115.

FARRAR. On the Phenomena of Repair in the Cerebral Cortex. A Study of
Mesodermal and Ectodermal Activities following the Introduction of a Foreign
Body. Ilistol. a. histopathol. Arb. u. d. Grosshirnrinde , Bd. 2, 1908, S. 1.
FORSTER. Expcrimentelle Beitrago zur Lehre der Phagozytose der Himrinden-
elemente. Ilistol. v. histopathol. Arb. v. d. Grosshirnrinde , Bd. 2, 1908, S. 173.
SUINKISHI I1ATAI. Preliminary Note on the Size and Condition of the Central
Nervous System in Albino Rats Experimentally Stunted. Journ. Comp. Neurol,
and Psychol., April 1908, p. 151.

HOCHHAUS. Beitriige zur Pathologic des Gehirns. D. Ztsckr. f. Nercenheilk .,
Bd. 34, II. 3-4, 1908, S. 185.

ROM BURGER. Zur Lehre von den Strukturformen der pathologischen faserigen
Neuiwlia. Frankfurt. Ztschr. f. Pathol , Bd. 2, H. 1, 1908, S. 100.

ROPPE. Zur pathologischen Anatomie der periodischen Psychose. Arch. f
Psych iat. u. Nercenb'ankh 1908, S. 341.

KNOBLAUCH. Das Wesen der Myasthenie und die Bedeutung der “ hellen ”
Musculofasern fur die menschlichen Pathologie. Frankfurt. Ztschr . f. Pathol.,
Bd. 2, H. 1, 1908, S. 57.

MANDELBAUM and CELLER. A Contribution to the Pathology of Myasthenia
Gravis. Report of a Case with Unusual Form of Thymic Tumour. Journ.
Experiment. Med., Vol. x., No. 3, 1908, p. 308.

MORI Y ASU. Ueber Fibrillenbefunde bei Epilepsia. Arch. f. Psyckiat. u. Nci'ccn -
krankh., 1908, S. 84.

NAMBU. Ueber die Genese der Corpora amylacea des Centralnervensystems.
Arch.f Psych iat. u. Nercen krankh., 1908, S. 391.

OSBORNE and KILVINGTON. Axon Bifurcation in Regenerated Nerves.
Journ. Physiol, May 6, 1908, p. 1.

BIBLIOGRAPHY

51*

RODEN WALDT. Eine Vereinfachung der Nisslschen Farbung und ihre An-
wendung bei Beriberi. Monatsschr. f. Psychiat. u. Neurol ., April 1908, 8. 287.
VERDERAME. Anatornischer Beitriige zur Solitartuberkulose dor Papilla norvi
optici. Klin. Monatsbl. f. Augenheilk ., April 1908, S. 401.

WEBER und SCHULTZ. Zwei Fallo von “Pseudotumor cerebri*’ mit ana-
tomischer Untersuchung. MonatsscJtr. f. Psychiat, u, Neurol Bd. 22, Ergiinz-
ungsheft, 1908, S. 212.

OLINIOAL NEUROLOGY

GENERAL—

BORN8TEIN. Neurologische Beitriige. Ztsehr. f. klin. Med ., Bd. 65, H. 3-4,
1908 S. 193

KURT MENDEL. Dor Unfall in der Actiologio der Nervenkrankheiten (Forts.).
Monatsschr. f. Psychiat . m. Neurol ., April 1908, S. 364.

SCHONBORN. Klinischor Atlas der Nervenkrankheiten. Winter, Heidelberg,
1908, M. 28.

H. CAMPBELL THOMSON. Diseases of the Nervous System. Cassel & Co.,
Ltd., London, 1908.

VILLIGER. Die periphere Innervation. Engelmann, Leipzig, 1908, M. 3.60.

PKK1PHE1AI NERVES—

BARSHINGER. Sciatica. Med. Rec., April 25, 1908, p. 683.

SPINAL CORD—

R. T. WILLIAMSON. Diseases of the Spinal Cord. Oxfod Medical Publication ,
1908, 15s.

Poliomyelitis.—JEFFERIS TURNER. Infantile Paralysis simulating Meningitis ;
Tendon Transplantation. Austral. Med. Ga;., March 20, 1908, p. 120.

Tabes.—GU ILL AIN et LAROCHE. Sur une forme Apntfiquo do la Crise Bulbaire
dea Tabdtiques. (Soc. de neurol.) Rev . Neurol ., avril 15, 1908, p. 343.
HAENEL. Eine typische Form der tabischon Gehstdrung. D. Ztsehr. f. Nerven¬
heilk., Bd. 34, H. 3-4, 1908, S. 279.

PAN EG ROSS I. Beitrag zum Studium der von chronischer spinaler Meningitis
begleiteten Tabes. Monatsschr. f. Psychiat. u. Neurol April 1908, S. 290.
SYDNEY STEPHENSON. Juvenile Tabes Dorsalis: Notes of Five Cases. Lancet ,
May 16, 1908, p. 1401.

TROMNER und PREISER. Friihfrakturon des Fusses bei Tabes als Initial-
symptom. Mitt. a. d. Grenzgcbiet d. Med. u. Chir. t Bd. 18, H. 5, 1908, S. 745.

Paraplegia.—EDUARD MULLER. Uber akuto Paraplegien nach Wutschutzimp-
fungon. D. Ztsehr. f. Nervenheilk ., Bd. 34, H. 3-4, 1908, S. 252.

Syringomyelia.—GRUND. Zur Kenntnis der Syringomyolie. D . Zschr. f.

Nervenheilk., Bd. 34, H. 3-4, 1908, S. 304.

Compression. -RENNER. Uber falscho Lokalisation der Schraerzempfindung bei
Ruckenmarkskompression. D. Ztsehr. f. Nervenheilk., Bd. 34, H. 3-4,1908, S. 210.

Spinal Syphilis.—O. CROUZON and GEORGES VILLARET. A Case of Acute
Paralysis of Syphilitic Origin. Rev. Neurol, and Psychiat May 1908, p. 275.

Tnmonr.—HEILBRONNER. Zur Diagnostik der Ruckenmarkstumors. D. Ztsehr.
f. Nervenheilk ., Bd. 34, H. 3-4, 1908, S. 289.

ZUNIUS. Ein Beitrag zur Kasuistik und Differential diagnose dor Wirboltumoren.
D. Ztsehr. /. Nervenheilk. , Bd. 34, H. 3-4,1908, S. 338.

DRAIN—

Encephalitis.—SCHRODER. Zur Lehro von der akuten hitmorrhagischen Polion-
cephalitis superior (Wernicke). Ilistol. u. histo/xilhol. Arb. u. d. Grosshirnrinde,
Bd. 2,1808, S. 145.

Meningitis.— BALLET et BARBti. Un cas do Mtfningito Syphilitiquo avec
autopsie. (Soc. de neurol.) Rev. Neurol ., avril 15, 1908, p. 337.

OTTO RANKE. Beitrag zur Lehre von der Meningitis tuborculose. Ilistol. n.
histopathol. Arb. u . d. Grosshirnnnde, Bd. 2, 1908, S. 252.

ZAlvD. Klinische Untersuchungen Uber das Verhalten des Blutes bei Meningitis
Cerebrospinalis epidemica, etc. Virchows Arch., H. 1, 1908, S. 1.

52*

BIBLIOGRAPHY

Abscess.— F. L. TAYLOR. A Case of Absoess of the Frontal Lobe of Traumatic
Origin. N. Y. Med. Joum May 9, 1908, p. 891.

Hemiplegia. — NOICA. La perte des Mouvements isotes des Doigts et dee
Mouvements d'opposition du pouce, avec conservation des Mouvements d’ensemble
dee doigts, chez les malades atteints d‘H£mipl6gie c£r£brale tegere. (Soc. de
neurol.) Rev. Neurol., avril 15, 1908, p. 326.

P^JOHIN et DESCOMPS. Traumatisme orbitaire et hemipldgie alterne consecu¬
tive. Rev. Neurol. , avril 15, 1908, p. 286.

Tumour. —BIRO. Uber Hirngeschwulste. D. Ztschr. f. Nervcnheilk., Bd. 34,
H. 3-4, 1908, S. 213.

CANTONNET et COUTELA. Sarcome kystique du cervelet. (Soc. de neurol.)
Rev. Neurol ., avril 15, 1908, p. 336.

FORSTER. Schwerigkeiten in der Diagnostik der Hirntumoren. Bert, klin .
Wchnschr., Mai 11, 1908, S. 927.

ALBERT KNAPP. Fortschritte in der Diagnostik der Gehirntumoren. Munch,
med. Wchnschr ., Mai 12, 1908, S. 1003.

PORTER PARKINSON and STROUD HOSFORD. Cerebellar Tumour with
Proptosis. Ophthal. Rev., May 1908, p. 133.

STERN. Uber Tumoren des vierten Ventrikels. D. Ztschr. f. Nerrtnhcilk ., Bd.
34, H. 3-4, 1908, S. 195.

WEISENBURG. Diagnosis of Tumours and other Lesions in the Cerebro-pontine
Angle. Journ. Amer. Med. Assoc., April 18, 1908, p. 1251.

Pseudo-Bulbar Paralysis. —PERITZ. Dio Pseudobulb&r Paralyse. Ergeb . d.
inner. Med. u. Kinderheilk., Bd. 1, 1908, S. 575.

Trauma. —PEYSER. Zum Nachweis der Basisfraktur. Deutsche med. Wchnschr .,
April 30, 1908, S. 785.

Amaurotic Family Idiocy. —SPIELMEYER. Klinische und anatomische Unter-
suchungen uber eine bosondero Form von familiarer amaurotischcr Idiotie.
llistol. n. hulopathol. Arb. u. d. Orosshirnrinde , Bd. 2, 1908, S. 193.

<>erebro-»p!nal Syphilis. —BARBE et LliVY-VALENSI. Lacunas de Disinte¬
gration Cellulairo dans un system© nerveux d’Herido-syphilitique. (Soc. de
neurol.) Rev. Neurol., avril 15, 1908, p. 339.

HARRY CAMPBELL. A Clinical Lecture on Syphilitic Diseases of the Nervous
System. Clin. Journ., May 13, 1908, p. 69.

GENERAL AND FUNCTIONAL DISEASES—

Arterlo-Sclcrosls.— CIMBAL. Die Arterioscleroso des Zentralnervensystems.
Ergeb. d. inner. Med. u. Kinderheilk., Bd. 1, 1908, S. 298.

Exophthalmic Goitre. —LANDSTROM. Uber Morbus Basedowii. Nord. Med.
Arkiv., Afd. 1, H. 3-4, 1908.

Hysteria. —JUNG. Die Freudsche Hysterietheorie. Monalsschr. f. Pxychiat it.
Neurol ., April 1908, S. 310.

JOHN JENKS THOMAS. Hysteria in Children. Joiirn. Nerv. and Meat. Dis.,
April 1908, p. 209.

THOMSEN. Zur Klinik und Aetiologie der Zwangserscheinungen und Zwangs-
hallucinationen und Uber die Beziehungen der Zwangsvorstellungen zur Hysteric.
Arch. f. Psychiat. u. Nervenkrankh., 1908, S. 1.

Neurasthenia.— BERNHEIM. Neurasthenics et Psychon^vroses. Octave Doin,
Paris, 1908, 2 fr.

RICHE, L’etat mental des neurasthiniques. Prog. Mid., mai 16, 1908, p. 239.

Neuroses.— SCHMIERGELD et PROVOTELLE. La method© psycho-analytique
et les “ Abwehr-Neuropsychosen ” de Freud. Journ. de Neurol., avril 5, 20, 1908,
pp. 221, 241.

Syphilis. — FORNET und SCHERESCHEWSKY. Ueber die Spezifitat der
Pracipitatreaktion bei Lues und Paralysie. Berl. Klin. Wchnschr., Mai 4, 1908,
S. 874.

PLAUT. Sorodiagnostik der Syphilis. Ztntralbl. f. Nervcnheilk. u. Psychic*.,
H. 8, 1908, S. 289.

Alcoholism. — REISS. Klinisch-psychologische Untcrsuchungen an Alkohol-
berauschten. Psychol. Aib., Bd. 5, H. 3, 1908, S. 371.

BIBLIOGRAPHY

53*

Epilepsy. —SMITH ELY JELLIFFE. A Contribution to the Pathogenesis of
Some Epilepsies. Joum. Nerv. and Afent. Dis., April 1908, p. 243.

REDL1CH. Epilepeie und Linkshiindigkeit. Arch. f. Psychiat. u . Ner ten frank h.,
1908, S. f>9.

SALARIS. Su di un caso di epilessia jacksoniana, con autopsia. Riv. Hal. di
Neuropat., Psichiat. ed Elettroter., Maggio 1908, p. 219.

TISSOT. Epilepeie et ponction lombaire. Piag. Mid., mai 9, 1908, p. 226.

Chorea.— FRANK FRY. Some of the Motor Phenomena of Chorea Clinically
Considered. Joum. Amer. Med . Assoc., May 2, 1908, p. 1414.

Cerebro-Splnal Fluid.— CHOTZEN. Beitrag zur Beurtoilung der differential-
diagnostischen Verwertbarkeit der Lumbalpunktion. Zentralbl. f. Neivenheilk. u.
Psychiat., H. 8 u. 9, 1908, Sn. 295, 329.

NIETER Tiber den Nachweis von Typhusbazillen in der Zerebrospinalfllissigkoit
bei Typhus abdominalis. Milnch. med. Wchnschr Mai 12, 1908, S. 1009.

SPECIAL SENSES AND CRANIAL NERVES—

S. H. BROWN. The Fifth Nerve in Relation to Ophthalmic Conditions. Med.
Rec., May 2, 1908, p. 732.

EHRMANN. Beitrage zur Physiologic der Nebennieren und iiber im Blut vor-
handene und andere pupillenerweiternde Substanzen. Deutsche med. Wchnschr.,
April 30, 1908, S. 783.

FRANKL-HOCHWART. Die nervd3en Erkrankungen des Geschmackes und
Geruches. 2. Aufl. Holder, Wien, 1908, M. 2.80.

LENZ. Ueber neuere Untersuchungsergebniase bei der sympathischon Ophthalmie.
Berl. klin. Wchnschr ., April 27, 1908, S. 822.

PINELES. Ueber parathyreogenen Laryngospasmus. Wien. klin. Wchnschr.,
April 30, 1908, S. 643.

RtfTHJ. Amblyopie infolge von Nebenhtthleneiterungon der Nase. Wien. med.
Wchnschr., Mai 9, 1908, S. 1066.

STOCK. Ueber kaverndae Sehnervenatrophio bei Myopie. Klin. Monatsbl. /.
Augenheilk., April 1908, S. 342.

TRAUTMANN. Akuto Koilbeinhohleneiterung mit intrakranieller und orbitaler
Komplikation. Arch.f. LaryngoL tu Rhinal., Bd. 20, H. 3, 1908, S. 381.

MISCELLANEOUS CASES—-

DEJERINE et LANDRY. Un cas de Spasme Glottique, avec rMe tracheal,
datant de 14 ans, chez une Hyat6riquo. (Soc. de neurol.) Rev. Neurol ., avril 15,
1908, p. 328.

ALFRED GORDON. Integrity of Stereognostic Function and of all Forms of
Sensation in a Case with a Lesion of the Left Parietal Lobe. Med. Rec., April 18,
1908, p. 648.

JOACHIM. Ein atypischer Fall von Storung der Reizleitung im Herzmuskel.
Berl. klin. Wchnschr., Mai 11, 1908, S. 911.

KLIPPEL et MONIER-VINARD. Maladie nerveuse Familialo. (Soc. de neurol.)
Rev. Neurol ., avril 15, 1908, p. 334.

MEISSNER. Ein Fall von intermittierendom Exophthalmus. Med. Blatter ,
April 25, 1908, S. 193.

iENEAS ROSE. Note on a Caso of Functional Paraplegia with Associated
Paralysis of the Bladder. Lancet , May 16, 1908, p. 1411.

SCHRODER. Ueber eino Hinterstrang- und Sennervenerkrankungen bei Affen.
Arch. f. Psychiat. u. Nervenkrankh., 1908, S. 193.

SICARD et DESCOMPS. Troubles consdcutifs & la Section de la branche externe
du Spinal. (Soc. de neurol.) Rev. Neurol., avril 15, 1908, p. 324.

STELZNER. Ueber einen Fall von Kleinhirnatrophie (Schluss). Monatsschr. f.
Psychiat. v . Neurol., April 1908, S. 323.

VIGOUROUX. Eeoulement de liquide c£phalorachidien. Hydrocephalic.
Pupillome des plexus choroides du Iv # ventricule. Rev. Neurol ., avril 15, 1908,

p. 281.

Special Symptoms. —BOURDIER. Ataxie oculaire: un trouble de la fonction
synerjrique entre les Muscles moteurs des Paupiferes et des Globes Oculaires.

g \oc. de neurol.) Rec. Neurol., avril 15, 1908, p. 332.

UCHANAN. Sudden Blindness and its Various Causes. N. Y. Med. Joum.,
April 25, 1908, p. 771.

CHASTANG Les Manifestations oculaires au cours du Paludisme. A rch. de Mid.
Navale , avril 1908, p. 241.

54*

BIBLIOGRAPHY

CONZEN. Uber die Bedeutung des Achillessehnenreflexes. Munch . med.

Wchnschr Mai 12, 1908, 8. 1014.

MAX EGGER La sensibility osseuse. Rev. Neurol. , avril 30, 1908, p. 345.

VAN FALKENBUUG. Zur Kenntnis der gestdrten Tiefenwahmehmung. D.
Ztschr.f. Nervenheilk ., Bd. 34, H.;3-4, 1908, S. 322.

FLAT A U. Uobor horeditaren essentiellen Tremor. Arch. f PsychiaL u. Ncrvcn-
brankh. , 1908, 8 . 306.

GRAMEGNA. Sopra il segno di Grasset e Gaussel nolle lesioni di motility degli
arti inferiori. Riv. di Patol. nerv. e meat., Marzo 1908, p. 116.

ALBERT KNAPP. Die Hypotonie. Monatsschr. f. PsychiaL u. Neurol., Bd. IS,
Erganzungsheft, 1908, S. 16.

LE1SCHNER. Die Bedeutung der partiellen Bauchmuskellahmungen fur die
Chirurgie. Mitt. a. d. Grenzgebiet. d. Med. «. CAir., Bd. 18, H. 5, 1908, 8. 891.
CARLO LURASCHI. Dans quelles conditions est possible la radiographic de la
moelle ypinikre ? Arch, d'Elect. Mid., tnai 10, 1908, p. 346.

MARBE. La sensibility styryognostique et la symbolie aux membres infyrieurs.
Rev. Neurol ., avril 30, 1908, p. 351.

MOULMIER. Un cas do reaction paradoxale de la pupille k la lumikre chez un
suiet atteint d’abcks du cervelet Arch, de Mid. Navale, avril 1908, p. 289.
NKUSSELL. Das Verhalten der Pupillen bei Alkoholismus. Psychol. Arb .,
Bd. 5, H. S, 1908, S. 408.

ROSENBACH. Beitrag zur Conjunctivalreaktion. Rerl. klin. Wchnschr., Mai 4,
1908, S. 885.

ROSSOLIMO. Der Zehnenreflex (ein speziell pathologischer Sehnenreiiex).
Neurol. Centmlbl ., Mai 16, 1908, 8. 452.

RICHET. Do 1’anaphylaxie dans I'intoxication par la cocaine. Arch. Internal,
de Pharmacodyn ., Vol. xviil, Nos. 1-2, 1908, p. 5.

SAENGER. iJebor Herdsj rmptome bei diffusen Hirnerkr&nkungen. Munch, med.
Wchnschr ., Mai 12, 1908, 8 . 1001.

SCHAFFER. Beitrag zur Lehre der cerebralen Schmerzen. Arch^f. Psychiai.
u. Nervenb'ankh ., 1908, S. 228.

SOUQUES. Palilalio. (Soc. de neurol.) Rev. Neurol ., avril 15, 1908, p. 340.
WEISS. Das Tastsymptom. Vogel, Leipzig, 1908, M. 1.50.

PSYCHIATRY

JOSEPH SHAW BOLTON. Amentia and Dementia. Part III. Journ. Mem.
Scj. April 1908, p. 264.

THOMAS DRAPES. The Unity of Insanity and its Bearing on Classification.
Joum. Ment. Sc., April 1908, p. 328.

KRONTHAL. Psychiatric und Nervenkrankheiten. Arch./. Psychiat. u. Ner¬
venb'ankh., 1908, S. 167.

ALFRED PI&TREN. Uher Sp&theilung von Psychosen. (Forts.) Nord. Med.
Arbv ., Afd. ii, H. 4, 1907.

PETR6. Sullo guarigioni incomplete della follia. Riv. Ital. di Neuropatol.
Psichial. ed Elettroter ., Maggio 1908, p. 209.

REDEPENNING. Der goistige Besitzstand von sogenannten Dementcn. Mon-
atsschr.f. Psychiat. u. Neurol., Bd. 23, Erganzungsheft, 1908, S. 139.

C. J. ROBERTSON-MILNE. Statistical Notes on Criminal Lunacy in the
Punjab Asylum. Joum. Merit. Sc., April 1908, p. 362.

J. F. SUTHERLAND. Recidivism regarded from the Environmental and Psycho-
Pathological Standpoints. Journ. Ment . Sc. , April 1908, p. 289.

General Paralysis. —DAVIDS. Augenbofunde bei Paralytikern. MoncUsschr.
f. Psychiat. u. Neurol., Bd. 23, Erganzungsheft, 1908, S. 1.

HERR1NGHAM. A Clinical Lecture on General Paralysis of the Insane. Clin.
Journ., May 13, 1908, p, 65.

JUNIUS und ARNDT. Beitrag zur Statistik, Aetiologie, Symptomatology und
pathologischen Anatomie der progressiven Paralyse. Arch./. Psychiat. u. Ncr-
venkrankh ., 1908, S. 249.

O. ROSSI. Lo stato presente della sierodiagnosi nella tabe e nella paralisi pro¬
gressiva. Riv. di Patol. nerv. e ment., Marzo 1908, p. 120.

Mania.— ANDREWS. Two Cases of Acute Mania. Austral. Med. Gaz., March 20,
1908, p. 124.

LEWIS C. BRUCE. The Symptoms and Etiology of Mania: The Morrison
Lectures, 1908. Joum. Ment. Sc., April 1908, p. 207.

BIBLIOGRAPHY

55*

Manfte-deprcflilTe Iuianlty*—HUTT. Rechnenverzuche bei Manisch-Depreesiven.
Psychol. Arb., TkL 5, H. 3, 1908, S. 338.

Dementia Precox. —BUSCH. Aoffaasungs- und Merkf&higkeit bei Dementia
procox. Psychol. Arb., Bd. 5, H. 3, 1908, S. 293.

COSTANTINI. Due casi di “ dementia prococisgima." Riv. di Paid. nerv. e
ment ., Marzo 1908, p. 107.

J. G. FITZGERALD. A Case of Dementia Procox with Certain Unusual
Features. Canad. Pract ., April 1908, p. 229.

TYSON and PIERCE CLARK. Eye Syndrome of Dementia Procox. Journ.
Amer. Med. Assoc., May 2, 1908, p. 1415.

Arterlo-Bclerotlc Dementia* —WEBER. Zur Klinik der arterio-sklerotischen
Seelenstdrungen. Monatsschr. /. Psychiat. u. Neurol Bd. 23, Erg&nzungsheft,
1908, S. 175.

Tranmatlc Psychoses*— WENDENBURG. Posttraumatische transi to ruche Be-
wusstseinstorungen. Monatsschr. f. Psychiai. u. Neurol. , Bd. 23, ErgSnz-
ungsheft, 1908, §. 223.

Constitutional Abnormality* —ALBRAND. Oculistische BeitrSge zur Werthung

der Dogenerationszeichen. Arch. f. Psychiat. u. Ncrvenkrankh ., 1908, S. 121.
HANS GUDDEN. Das Wesen des moralischen Schwachsinns. Arch. f. Psychiat.
n. Nercenhrankh., 1908, S. 376.

NEWMEYER. Defective Vision and the Mentally Subnormal Child. N. Y. Med.
Journ., May 9, 1908, p. 880.

W. A. POTTS. The Recognition and Training of Congenital Mental Defectives.
Brit. Med. Journ ., May 9, 1908, p. 1097.

VIX. Beitrag zur Lehre uber den jugendlichon Schwachsinn an der Hand von
Untersuchungen an Kindem der Gdttigen Hulfsschule. Monatsschr. f. Psychiat.
u. Neurol. , Bd. 23, Erganzungsheft, 1908, S. 158.

Special Symptoms. —BECKER. Krankheitasimulation und ihre Beurteilung.
Thieme, Leipzig, 1908, M. 8.

COURJON et MIGNARD. De l'6tat normal au d6lire. Rev. de Psychiat , avril
1908, p. 152.

KAUFFMANN. Boitrage zur Pathologic des Stoffwechsels bei Psychosen. 1 TI.
Die progressive Paralyse. Fischer, Jena, 1908, M. 6.

K LEIST. Untcrsuchungen zur Kenntnis der psychomotorischen Bewegungs-

storungen bei Geisteskranken. Klinkhardt, Leipzig, 1908, M. 4.50.

ALBERT KNAPP. Sprachstdrungen bei funktionellen Psychosen. Monatsschr.
f. Psychiat. u. Neurol., Bd. 23, Erganzungsheft, 1908, S. 97.

R. R. LEEPER. Of the Onset of Melancholia. Journ. Ment. Sc., April 1908,
p. 357.

PFORRINGER. Verhalten der KOrpergewichts bei zirkul&ren und anderen
Psychosen. Monatsschr. f. Psychiat. u. Neurol., Bd. 23, Erg&nzungsheft, 1908,

S. 124.

FREDERICK PETERSON. The Galvanometer in Psychology. Journ . Abnorm.
Psychol ., April-May 1908, p. 43.

SALARIS. Ricerche urologiche et ematologiche nei psicopatici. Riv. di Patol.
neve, e ment., Marzo 1908, p. 97.

SCHUYTEN. Mosure do la fatigue intellectuelle choz les enfants des deux sexes
avec l’esthesioratitre. Rev. de Psychiat., avril 1908, p. 133.

C. DE VRIES. Psychic Phenomena of Intestinal Toxwmias and their Treatment.
N.Y. Med. Journ., May 2, 1908, p. 826.

TREATMENT*—

BLUMENTHAL. Serum Treatment of Exophthalmic Goitre. Folia Therapeut .,
April 1908, p. 62.

COIIN. The Systematic Occupation and Entertainment of the Insane in Public
Institutions. Journ. Amer. Med. Assoc., April 18, 1908, p. 1249.

ERHARDT. Uebcr dio Verwendung von Gummi als Zusatz zum Anasthetikum
bei Lurabalanasthosie. Munch, med. Wchnschr., Mai 12, 1908, S. 1005.
FOUCAUD. Quatre Cas do Meningite Cerebrospinal© trails |>ar les abc£s
artificials. Airh. de Med. Nacafe , avril 1908, p. 267.

FRENKEL-HEIDEN. Dio Therapie der Tabes dorsalis rait besonderer Bertick-
sichtigung dor Ubungstherapie. Krgeb. d. inner. Med. u. Kinderheilk., Bd. 1,
1908, S. 518.

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

56*

BIBLIOGRAPHY

FRIEDMANN. Zur Jndikataonsstellung fur den klinischen Abort wegen
psychischen Erankheit. Deutsche mtd. Wchnschr ., Mai 7 u. 14, Sn. 821, $73.
FLETCHER INGALS. Intranasal Drainage of the Frontal Sinus. Joum.
Amtr. Med. Assoc., May 9, 1908, p. 1502.

JACOBY. The Colony Settlement for the Nervous and Neurasthenic, a much-
needod Work of Philanthropy. N. Y. Med. Joum ., April 18, 1908, p. 719.
EGBERT LE FEVRE. Therapeutics of Vaao-Constriction and Yaso-Dilatation.
Med. Her., April 25, 1908, p. 676.

LUDLAM. Relationship between the Spinal Cord, Sympathetic System, and
Therapeutic Measures. Joum. Amtr. Med. Assoc., May 2, 1908, p. 1401.
MORAN. Treatment of Eclampsia. Joum . Amtr. Med. Assoc., May 2, 1908,
p. 1411.

REGINALD MORTON. The Electrical Treatment of Atonic Conditions of the
Digestive System. Ijaneti, May 16, 1908, p. 1409.

C. J. SHAW. Clinical Results following the Injection of Tuberculin. Joum.
Ment. Sc., April 1908, p. 344.

RODIET. Les “colonies familiales'* d’alien€s inoffensifs. Joum. de Mid.,
mai 9, 1908, p. 183.

VOELCKER. The Treatment of Chorea. Folia Tkerapeut., April 190S, p. 59.

Psychotherapy.— ARTHUR P. HERRING. Psychotherapy in the Treatment of
the Functional Neuroses. N.Y. Med. Joum., May 9, 1908, p. 885.

B. M. HINKLE. Psychotherapy; with some of its Results. Joum. Amtr. Med.
Assoc., May 9, 1908, p. 1495.

Surgical.—BIRO. Chirurgische Bohandlung der Hirngeschwiilste. D. Ztschr. f.
yervtnhtifk., Bd. 34, II. 3-4, 1908, S. 232.

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ANATOMY

HOFFMANN. Die obere Olive der S&ugetiere nebst Bemerkungen Uber die
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O * 57 *

58*

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PHYSIOLOGY

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FRIEDREICH MILLER. Beziehungen dee Oehirne sum Windungirelief an der
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TRENDELENBURG und KtJHN. Vergleichende Untersuchungen sur Physi-
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POLIMANT1. Neue physiologische Beitr&ge liber die Beoehungen swieohen den
8timlappen und dem Kleinhirn. Aixh. f. Anat. u. Physiol ., Physiol. AbL, H.
3-4, 1908, 8. 81.

AUERBACH. Zur Lokalisation dee musikalischen Talentea im Gehirn und am
Schadel. Arch.f. Anat . u. Physiol ., Anat. AbL t H. 1-2, 1908, 8. 3L
STUCKER. Ueber die Unterechiedsempfindlichkeit fur Tonhdhen in Terechie-
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TIGERSTEDT. Zur Kenntnie des Kreislaufes bei Reizung des Nerrusdepreseor.
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LESBIE et MAIGNON. Contribution k la Physiologic du pneumo-gaetrique et
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CLUZET. Sur 1'excitation des nerfs au moyen d’ondee de longue dur£e. Jonm.
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KOPCZYNSKI. Recherches exp&imentellee physiologiques et anatomiques sur
les racines post£rieurs des nerfs spinaux. Polon. Arch. f. biol. u. mod. Witten-
scha/t , Bd. 3, H. 1-3, 1908, 8. 99.

EPPINGER, FALTA, und RUDINGER. Ueber den Antagonismus symna-
thischer und autonomer Nerven in der inneren Sekretion. Wien. JUin. Wcknschr.,
Mai 21, 1908, 8. 752.

FRANCK et HALLION. Rechorches sur l’innervation vaso-motrioe du corps
thyroide. Jo urn. de Physiol ., No. 3, 1908, p. 442.

KNAUER. Einfluss yon Ausdrucksbewegungen auf das elektrolytisohe Potential
und die Leitfiihigkeit der menechlichen Haut. Klinik f. psych, u. ntrv. Krankhdt.,
Bd.3, H. 1,1908, S. 1.

KOICHI. Zur Froge der Regeneration der Nervenfasern im zentralen Nerven-
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Nervensystem bei Nereis diversicolor. A rch. f KntioicklungsmtcAanik, Bd. 25,
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RUPPERT. Ein Vergleich zwischen dem Distinktionevermdgen und der Be-
wegungseinpftndlichkeit des Netzhautperiphene. Ztschr.f. Sinnesphysiol. , Abt. 2,
Bd. 42, II. 6, 1908, 8. 409.

STCHERBAK. Les mouvements pendulaires bi et monoculaires aooompegnant
la fermeturo volontaire des yeux. Contribution k l’6tude des centres oortioaux
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KONIG. Die Funktion der Netzhaut beim Sehakte. Ztschr.f. Sinnesphysiol
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R. H. CLARKE. The Effect of Structural Changes connected with the Develop¬
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LEWANDOWSK Y. Ueber Abspaltung des Farbensinnes. Monutsschr. f. PtychxaJL
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CORDE1RO. Ueber Farbenempffndung. Ztschr.f. Sinnesphysiol., Abt. 2, Bd. 42.
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SILF V AST. Ueber die Sehscharfe fiir verschiedene Farben im Zentrum der Retina.
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GREGOR. Ein einfacher Apparat zur Exposition optischer Reize. Klinik f.
psych . n. nere. Krank)*eit. , Bd. 3, H. 1, 1908, 8. 20.

ALRUTZ. Untersuchungen liber die Temperatursmne (8chluss). Ztsckr. f.
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BREUKR. Ueber Ewalds Versuch mit d#*m 1 'pneumatischer Hammer" (Bogen-
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59*

HENDERSON, LELAND, and MEANS. The Behaviour of Muscle after Com*
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LILLIE, The Relation of Ions to Contractile Processes. The General Conditions
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ALRUTZ. Die Kitzel- und Juckempfindungen. Skand . Arch. f. Physiol ., Bd. 20,
H. 5-6, 1908, S. 871.

PSYCHOLOGY

MEDEIROS. A queetao dos methodoe em peychologia. Arch. Binsil. de PsychicU.
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MORENO. Los Tipos Endofasicoe. Arch, de Psiquiat. y Criminol ., Marzo-Abril
1908, p. 192.

FRANCES. Funktionelle Selbstgestaltung und Psychomorphologie. Arch. f.
Entwicklungsmechanik, Bd. 25, H. 4, 1908, S. 715.

MULLER. Zur Frage der Referenzflachen. Ztschr. f. Psychol Abt. 1, Bd. 47,
H. 4, 1908, S. 287.

WUNDT. Kritische Nachlese but Ausfragemethode, Arch. /. d. get. Psychol,>
Bd. 11, H. 3-4, 1908, S. 445.

LUCKA. Das Problem einer Charakterologie. Arch. f. d. gesam. Psychol , Bd. 11.
H. 3-4, 1908, S. 211.

VIEREGGE. Priifung der Merkfahigkeit Gesunder und Geisteskranker mit
einfacher Zahlen. Allg. Ztschr. f. Psychiat., Bd. 65, H. 2, 1908, S. 207.
EBERSCHWEILER. Untersuchungen liber die sprachliche Komponente der
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GHEORGOV. Ein Beitrag cur grammatischen Entwicklung der Kindersprache.
Arch. / d. ges. Psychol ., Bd. 11, H. 3-4, 1908, S. 242.

LINDSAY. The Child Brain and Education. Joum. Roy , Inst. Public Health ,
June 1908, p. 321.

ERNST. Hielt Descartes die Tiere fdr bewusstlosf Arch /. d. ges, Psychol.,
Bd. Jl, H. 3-4,1908, S. 433.

PATHOLOGY

SHIMA. Experimentelle Untersuchungen liber die Wirkung des Adrenalin liber
das Zentralnervensystems des Kaninchens. Art. a. d. Neurol Institute a. d. Wien.
Univ., Bd. 14,1908, S. 492.

HULTKRANTZ. Les alterations du cr&ne dans la dysostose cieido-cr&nienne.
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MURATOW. Beitrag zur Pathologic des Zwangsbewegungen bei zentralen
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Onkologie des Kleinhirnbrlickenwinkels. Arb. a. d. Neurol. Institut. a. d. Wien.
Univ., Bd. 14, 1908, S. 406.

SCHEVEIGER. Ueber die tabiformen Veranderungen der Hinterstrttnge beim
Diabetes. Arb. a. d. Neurol. Institut a. d. Wien. Univ., Bd. 14, 1908, S. 391.
BARBE. 6tude des Degenerations secondaires du Faisoeau pyramidal. Doin,
Paris, 1908, 3s. 6d.

GUILLAIN. La degeneration des cordons posterieurs de la moelle associee k la
degeneration descendants du faisceau pyramidal chec les hemipiegiques. Rev.
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MARINESCO. Lesions produites sur la cellule nerveuse par Paction directs des
agents traumatiques. Rev. de Psychiat ., mai 1908, p. 177.
feTIENNE et CHAMPY. Les lesions cellulaires des cornea anterieures de la
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HOMBURGER. Zur Lehre von den Strukturformen derpathologischen faserigen
Neuroglia. Frankfort. Ztschr. f. Pathol, Bd. 11, H. 1, 1908, 8. 100.

MARQUES. Desenvolvimento das neurofibrillas, Arch . Brasil, de Psychiat $

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60*

BIBLIOGRAPHY

OUNIOAL NEUROLOGY

CSBJfULAX—

MENDEL. Dor Unfall in dor Aetiologie der Nervenkrankhei ten (Schhis*).
Monatsechr .. /. Ptychiat. u. Neurol., Juni 1908, S. 528.

BREGMAN. Uber Tot&l&nastliesie. Neurol. Centralbl. , Joni 1, 1906, B. 498.
8ILVIO RICCA. Esperienze e oonsiderauoni gull’ ergografia uaata a aoopo eKnfan
nei pazzi. Riv. di Patol. nerv. t menl April© 1908, p. 150.

T. J. HARRIS. The Diagnostic Value of Symptoms of th© Larynx, Pharynx and
Nos© in Nervous Diseases. N. Y. Med. Joum ., May 16,1908, p. 928.
KOLLARITS. Wei ter© Beitrfcge zur Kenntnis der Heredodegeneration. 2>.
Ztechr.f. Nervenheilk. , Bd. 34, H. 5-6, 1908, S. 410.

ACUNA. Polioencephalomy61ite aigue. Arch, de Mid. dee Enfant*, join 1908,
p. 405.

KUSTNER. Ein Fall yon chronischer Mittelohreiterung kompliaert mit Pons-
tumor. Arch./. Ohrenheilk Bd. 75, H. 8-4, 1908, 8. 181.

SHIMA. Ein Teratom im Kaninchenhira. Arb. a. d. Neurol . Institute a. d.
Wien. Univ ., Bd. 14, 1908, S. 373.

ANTON. Ueber Storungen der psychischen Funktionen bei einseitiger Behinder-
ung der Nasenatmung. Prog. mea. Wchnechr., Juni 4, 1908, 8. 801.

NOICA. Le m6caniame de la contracture. Noun. loon, de la Salptriire, man-
* ayril 1908, p. 152.

Myotenfta. —VOSS. Zur Frage der erworbenen Myotonien und ihrer Kombmation
mit der progressiyen Muskelatrophie. D. ZUchr. /. Nervenheilk ., Bd. 84, EL 5-6,
1908, S. 465.

J. COLLIER and S. A. K. WILSON. Amyotonia Congenita. Brain, Part 121,
Vol. xxxi., 1908, p. 1.

THEODORE THOMPSON. A Case of Amyotonia Congenita. Brain , Part 121,
Vol. xxxi., 1908, p. 160.

Myasthcula.—KNOBLAUCH. Das Weses der Myasthenia und die Bedeutnng
der “ hellen ” Muskelfasern fUr die menschliohen Pathologie. FrankflM. Ztschr.
f. Pathol ., Bd. 11, H. 1, 1908, a 57.

Progressive Muscular Atrophy.—GUTHRIE RANKIN. Progressive Muscular

Atrophy. Practitionei *, Juno 1908, p. 757.

Muscular Dystrophy.— MARINA. Gibt m Formes frustes oder rudimentSr*
Formen der muskularen Dystrophie (Erb) und ist deren Heilung mftglich f D.
med. Wchneck*'., Juni 18, 1908, 8. 1087.

PEUP1E1U MBDYES—

CATOLA. Polyn6vrite amyotrophique tuberoulouse aigue k type descendant.
Nouv. Icon, de la SalpitrUre, mars-avril 1908, p. 129.

triNAt CUDD¬
LE BRETON. Spinal Sprain: its Complications and Consequences, with Report
of Cases. Journ. Amer. Med. As*oc., May 23, 1908, p. 1678.

RENNER. Uber einen Fall von syphilitischer Spinal paralyse. D . ZUchr. f.
NwvenheilL, Bd. 31, H. 5-6, 1908, S. 451.

Tabes.—MI LI AN. Le traitement 6tio1ogique du tab&s. Prog. Mid., juin 20,1908,
p. 301.

ACHARD. Tabes avec intdgrit6 de* Reflexes Pupillaires. (Soc. de neurol.)
Rev. NturoL, mai 15, 1908, p. 447.

J. BENTLEY S^UIER. The Bladder in Tabes. N.Y. Med. Joum ., May 80,
1908, p. 1038.

Poliomyelitis* —RISIEN RUSSELL. The Diagnosis and Treatment of Acute
Anterior Poliomyelitis. Clin. Journ., June 3, 1908, p. 119.

BYROM BRAM WELL. Analysis of Seventy-six Cases of Poliomyelitis Anterior
Acuta. Scot. Med. and Snrg. Journ., June 1908, p. 501.

RAMSAY HUNT. Ein Fall von Poliomyelitis posterior des Ganglion geniculi;

. anschliessend Betrachtungen Uber den dabei festgestellten Symptomenkomplex.
Nenrol. Cenh'atbl., Juni 1, 1908, S. 514.

BIBLIOGRAPHY

61*

Tumit, —RAYMOND at ALQUIER. Mai de Pott saroomateux. Nouv . Icon, de
la SalpHriirt, mars-avril 1908, p. 118.

PEARCE BAILEY. Spinal Cord Tumour and Trauma. A Report of Two
Cases. Joum. Nerv. and MenL Dis., May 1908, p. 815.

CalseoM Disease.—- BOYCOTT and DAMANT. Some Lesions of the Spinal Cord
produoed by Experimental Caisson Disease. Joum. Pathol, and BaeterioL, April
1908, p. 507.

Cerebral Imflaeasa.—ROBERT SAUNDBY. An Address on Cerebral Influenza,
Brit. Med. Joum, June 6,1908, p. 1841.

R. DODS BROWN. The Psyohosee of Influenza. Scot. Med. and Surg. Joum,,
June 1908, p. 509.

MealacftUs. — IVY M'KENZIE and W. B. M. MARTIN. Serum-Therapy in
Cerebro-Spinal Fever. Joum. Pathol, and Bacterid., April 1908, p 589.
THEODORE SHENNAN and W. T. RITCHIE A Bacteriological Investiga¬
tion of Epidemio Cerebro-Spinal Meningitis. Joum. Pathol, and BaeterioL,
April 1908, p. 456.

STUART M 4 DONALD. Observations on Cerebro-Spinal Meningitis. Joum.
Pathol, and Bacteriol., April 1908, p. 442.

HUBER. Genickstarreepidemie in der Pfalz. Milnch. mod. Wchnschr., Juni 9.
1908 S 1 999-

W. JAMES WILSON. A Contribution to the Bacteriology of Cerebro-Spinal
Meningitis. Lancet, June 13, 1908, p. 1686.

H. W. BERG. The Differential Diagnosis of Meningocoocus Cerebro-Spinal
Meningitis from other Types of Cerebro-Spinal Meningitis. Med. Rec .. May 80,
1908 p. 887.

RIBIERRE et PARTURIER. Sur un oas de granulie m4ning4e aveo poly-
nucllose et badllose abondantes du liquids o^phaloraohidien. Prog. MkL, mid 90,
1808, j>. 248.

MATTHIES. Ueber epid.mische Meningitis Med. Klinii, Mai 17, 1908,
8. 733.

HOCHHAUS. Ueber epidemische Meningitis. Med. Klinik, Mai 17, 1908,
3. 737.

KERRISON. Report of a Case of Meningitis of Otitic Origin. Arch, of Otd.,
Vol. xxxvii., No. 2, 1908, p. 122.

ALEXANDER. Klinische Studien zur Chirurgie der otogenen Meningitis. AreA
/. Ohrenheilk ., Bd. 75, H. 8-4, 1908, S. 222.

LAIGNEL-LAVAST1NE. Syndrome d’htfmi-queue de cheval par mlningo-radi-
culite syphilitique. Nouv. Icon, de la SalpStriire, mars-avril 1908, p. 117.

Heredo*€erebellar Ataxia.—NEWMAN MORRIS. Heredo-Cerebellar Ataxia.

Intercol. Med. Joum., Vol. xiii.. No. 4, 1908, p. 185.

Abscess.—ALBERT GRAY. Report of a Case of Cerebral Abecees; Rupture into
tho Lateral Ventricle. Glasgow Med. Joum., June 1908, p. 414.

DONALIES. Ein rhinogener Himabszess. Arch. f. Ohrenheilk., Bd. 75, H. 8-4,
1908, Sv 199.

■emiplegla.—VINCENT. De la valour de quelques signes peu usitds dans le
diagnostic des H&nipldgies Organiques et des Turnouts CArfbrales. (Soo. de
neurol.) Rev. Neurol mai 15, 1908, p. 449.

Apbasfta.—KLIPPEL et WEIL. Aphasie ou Ddmenoe. (Soo. de neurol) Rev.
Neurol., mai 15, 1908, p. 442.

PETERS. Ueber kongenitale Wortblindheit. Munch, med. Wchnschr., Mai 26,
Juni 9, 1908, Sn. 1116,1239.

G. D’ABUNDO. Su d’un caso di cecitk verbals con agrafia in una mancina emi-
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S. A. K. WILSON. A Study of Apraxia, etc. Brain, Pkrt 121, Vol. xxxi, 1908,
p. 164.

BENON. Les amnfeies (6tude dinique). Gaz. des H6p., juin 18, 1908, p. 796*

62*

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Tiaitir.—ZIM MERMAN N. A Case of Lam Cholesteatoma of the Middle Ear
and Posterior Cranial Fossa cured by Radical Operation. Arch. of (Mol. , Vol.
rxxvii., No. 2, 1908, p. 187.

GRAVES. A Clinical Study of a Case of Brain Tumour; Operation; Complete
Recovery. Med. Rec., May 28, 1908, p. 841.

KLOSE. Die radiologische Topik intrakranieller Tumoren im Kindesalter. Arch,
f. KinderheUk. , Bd. 48, H. 1-2, 1908, 8. 19.

RICKSHER and SOUTHARD. A Complicated Case of Brain Tumour. Amer .
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CHABROL. Leg tumours du bulbe. L'Endphale , mai 1908, p. 403.

HELEN BALDWIN. A Case of Meningeal Tumour Compressing the Cerebellum.
Journ. Nerv. and Ment . Dis., May 1908, p. 289.

KNAPP. Fortschritte in der Diagnostik der Gehirntumoren. Munch, mod.
Wchnschr. , Mai 19, 1908, S. 1081.

PFEIFER. Cysticercus cerebri unter dem klinischen Bild einee Himtumon mit
sensorisch-aphasischen und apraktiachen Symptomen durch Himpunktion diag*
nostiziert und operiert. D. ZUchr.f Ncrvcnhcilk. , Bd. 34, H. 5-6, 1908, S. 859.
SOUQUES. Antfvrysme volumineux d'une branche de l’art^re c6r£brale moyenne
ou sylvienne; signes de tumeur c£r£brale ; dur£e de 55 ana ; terminaison par
suicide. Nouv. Icon . de la Salpitriire, mars-avril 1908, p. 108.

glass Thrombosis. —DABNEY. Report of Two Cases of Sinus Thrombosis com*
plicated by Cerebral Abscess in the Temporo-sphenoidal Lobes. Arch, of (Hoi. ,
Vol. xxxvii., No. 2, 1908, p. 97.

Balbar Paralysis.— RIEDEL. Umcasode
de Psychiat. e NeuroL, Nos. 1 e 2, 1908, p.

jMeudo-paralysia bulbar.

ArcA BradL

Syphilis. —DEBOVE. Paralyses et nlvralgies syphilitiques precooes. Presto Mid .,
mai 30, 1908, p. 845.

GENERAL AND FUNCTIONAL DISKAiES-

gpondyilUs Defermams. — DILLER and WRIGHT. Spondylitis Deformans.
Joum. Amer. Med. Assoc., May 80, 1908, p. 1768.

Myxttdema.—ELLIOTT. Inoomplete Myxosdema. Joum. Amer. Med. Assoc .,
May 30, 1908, p. 1763.

■ysterla.—LAURENT. Contusion du cr&ne; confusion mentale, hyst&o-neuras*
thdnie. Joum. de Mid., mai 80, 1908, p. 213.

MATTHIES. Ueber einen Fall von hysterischem D&nmenustand mit retrograder
Amnesie. Ally. Ztschr.f. Psychiat ., Bd. 65, H. 2, 1908, S. 188.

RISCH. Die forensische Bedeutung der psychogenen Zust&nde und ihre Abgren*
zung von der Hysterie. Zenlralbl. f. NervenhtUk. u. Psychiat , Nr. 261, 1908,
S. 369.

CRUCHET. Consid6rations cliniques sur quelques Accidents Hyst6riques; H6mi«
anesth&ie, Amblyopic, R4tr6oissement du Champ Visuel. (Soc. de neuroL) Res.
Neurol., mai. 15, 1908, p. 458.

MAX EGGER. De rH€mianeeth6sie Hyaterique. (Soc. de neuroL) Rev. NeuroL,
mai 15, 1908, p. 458.

JAHNEL. Ein Beitrag sur Geschichte des hysterischen Mutismus. NeuroL
Centralbl., Juni 1, 1908, §. 512.

AUSTREGESILO. Novas concepcoes sobre a hysteria. Arch. Brasil, de Psychiat
e Neurol., Nos. 1 e 2, 1908, p. 52.

S. E. JELLIFFE. Hysteria and the Re-education Method of Dubois. N.F. Med .
Journ., May 16, 1908, p. 926.

Epilepsy.—BEVERLEY TUCKER. Epilepsy. N.Y. Med. Joum., June 6,1908,

p. 1086.

E. E. SOUTHARD. On the Mechanism of Gliosis in Aoquired Epilepsy. Amer*
Joum . Insan., No. 4, 1908, p. 607.

MEEUS. Epilepsie et d&ire chronique. Contribution i l*6tude des psyohosea
combines. Ann. Mid.’Psychol., m&i-juin 1908, p. 853.

TREPSAT. Epilepsie et menstruation, recherohes cliniques. L’ Endphalc, join
1908, p. 486.

BIBLIOGRAPHY

63*

Chorea*—TILNEY. A Family in which the Choreic Strain may be Traced back to
Colonial Connecticut. Neurograph*, VoL L, No. 2, 1908, p. 124.

SMITH ELY JELLIFFE. A Contribution to the History of Huntington’s Chorea.
A Preliminary Report. Neurographs, Vol. L, No. 2,1908, p. 110.

STROM PELL. Zur Casuistik der chronischen Huntington’sohen Chorea.

Neurogmphs , Vol. i., No. 2, 1908, p. 98.

C. W. BURR. The Mental State in Chorea and Choreiform Affections. Joui'n.
Nerv. a fid Ment. Dis., June 1908, p. 853.

DIEFENDORF. Mental Symptoms of Huntington’s Chorea. Neurographs, Vol.
i., No. 2, 1908, p. 128.

WILLIAM OSLER. Historical Note on Hereditary Chorea. Neui'ogmphs , VoL
i., No. 2, 1908, p. 113.

LANNOI8 et PAVIOT. La Nature de la Lesion Histologique de la Chor6e de
Huntington. Neurographs , Vol. i., No. 2, 1908, p. 105.

Headache.— A. E. RUSSELL. The Pathology and Treatment of Headache. Clin.
Joum., June 10, 1908, p. 136.

Migraine.—ALGER. To what Extent is Migraine amenable to Treatment of the
Eyes ? N. Y. Med. Jovrn ., June 0, 1908, p. 1082.

Nemroses.—HOMER SMITH. The Co-relation of Eye-Strain and the Functional
Neuroses. Med. Nee., May 30, 1908, p. 894.

SOUQUES et HARVIER. N6vrose S4cr4toire. Rev. Neurol., mai 30, 1908,
p. 465.

SCHWARZ. Die “ traumatitche Neurose,” eine epidemische Volkserkrankung.
St Peters, med . Wchnschr., No. 18, 1908, S. 183.

Neuralgia.— WALLISCH. Trigeminus-neuralgien, hervoigerufen duroh Verknder
ungen an den Zfchnen. Wien. klin. Wchnschr., Juni 11, 1908, S. 874.

Henri Us.—SHERRAN. Chronic Neuritis of the Ulnar Nerve due to Deformity in
the Region of the Elbow Joint. Edin. Med. Joum., June 1908, p. 500.

Neurasthenia.— ORMOND GOLD AN. Neurasthenia. N.Y. Med. Joum., June
13, 1908, p. 1141.

Alcohol Inn.— SOUTZO Fils et DIM1TRESCO. D’une olasse d’alcooliques
chroniques amoraux. Ann. Mti.-PsychoL , mai-juin 1908, p. 883.

Hyperldrosls nnilateralls.— FRIEDLANDER. Zur Kenntnis der Hyperhidroeis
unilateralis. D. med. Wchnschr., Juni 4, 1908, S. 1010.

Herpes.—DEBOVE. Le zona ophthalmique. Joum. des Prat., juin 6, 1908,
p. 352.

Cerebrospinal Syphilis.— MA RB& Le Sdro-diagnostic Syphilitique dans les
Maladies Nerveuses. (Soc. de neurol.) Rev. Neurol ., mai 15, 1908, p. 450.

SPECIAL SENSES AND CRANIAL NERVES—

CHARD INAL et GUIMARAES. Contribution h l’6tude de la pupille des
aliln£s. Arch. Brasil, de Psychial. e Neurol., Nos. 1 e 2, 1908, p. 3.

S. A. R. WILSON. A Note on an Associated Movement of the Eyes and Ears in
Man. Rev. Neurol, and Psychiat., June 1908, p. 331.

W. G. SYM. A Case of Partial Ptosis with Exaggerated Involuntary Movement
of the Affected Eyelid: the “Jaw-winking Phenomenon.” Rev. Neurol, and
Psychiat., June 1908, p. 337.

HUDOVERNIG. Die Unterschiede centraler und peripherer Facialisl&hmungen
und die anatomische Grundlage dereelben. Neurol. Centralhl., Juni 16, 1908,
S. 577.

MELTZER. Zur Pathogenese der Opticusatrophie und des sogenannten Turin*
schadels. Neurol. Centralbl., Juni 16,1908, S. o62.

R. T. WILLIAMSON. A Clinical Lecture on Hemiplegia with Unilateral Optio
Atrophy. Brit. Med. Joui'n. t June 6, 1908, p. 1345.

J. RUTTER WILLIAMSON. Herniatrophia Facialis Progressiva, or Facial
Hemiatrophy. Lancet, May 30, 1908, p. 1545.

64 *

BIBLIOGRAPHY

WEBER. Ueber subkutane total® Zerreissung dee Plexus braohtalis ohne Verleta-
ung der Knochen. M%nch. mat Wchnsckr ., Mai 26,1208, S. 1188.

CA WADI AS et VINCENT. Tic des Paupifcres et fanase contraction p&radoxale.
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UCHERMANN. Otitische Gehirnleiden. Arch. f. OhrenheilL , Bd. 75, H. 8-4,
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KNAUSE. A Case of Mastoiditis with Brain Complications. Arch, of OtoL,
Vol. xxxvii., No. 2, 1908, p. 116.

SCOTT. A Casa of Acute Internal Hydrooephalus secondary to Streptoooooal
Infection of the Labyrinth. Arch, of OtoL , Vol. xxxrii., No. 2, 1907, p. 108.

MIMEIXAIVMVS SYMPTOMS—

STURSBERG. Beitrag zur Kenntnis der Nachkrankheiten nach Kohlenoxydver-
giftung. D. Ztschr.f. Nervenheilk ., Bd. 84, H. 5-6,1908, S. 480.

PLONIES. Ueber die Beziehungen der wichtigeren Schlafstdrungen and der
toxiscben Schlafloaigkeit su den gutartigen Magenlanonen. Klinik. /. psych. %u
nerv. Kranhheil Bd. 8, H. 1,1908, S. 33.

W. G. SPILLER. The Symptom-Complex of Occlusion of the Posterior Inferior
Cerebellar Artery : Two Cases with Necropsy. Joum. Nerv. and Ment. Die.,
June 1908, p. 865.

SCHWARZ, ftber akute Ataxie. D . Ztschr.f Nervenheilk ., Bd. 84, H. 5-6,1908,
& 456.

MAUSS. Klinische Beitrfige sur Diagnostik bulbttrer Herderkrankungen. D.
Ztschr. f Nerrenheilk ., Bd. 34, H. 5-6,1908, S. 398.

STCHERBACK. Signe de Babinski et dissociation des rdflexes profonda et
qutan£s. provoqu^s exp€rimentalement ches l’homme. Valour s6m6iologique du
rlflexe dorsal du pied. Rev . Neurol ., mai 15,1908, p. 408.

KOBLAUCK. Ueber nasale Reflexe. D. rued. Wchnsckr ., Juni 11, 1908, S.
1046.

LEOPOLD UfcVL Troubles Vaao-moteun, Psychothlrapie Hypnotique. Pithi-
atisme. (Soc. de neurol.) Rev. Neurol ., mai 15,1908, p. 468.

CROZER GRIFFITH. A Case of Anorexia Nervosa in an Infant. Arch . of Pedial
May 1908, p. 821.

PSYCHIATRY

BECKER Die Simulation von Krankheiten und ihre Beurteilung. Thieme,
Leipzig, 1908, p. 8.

HENRY A. COTTON. Alcohol as an Etiological Factor in Mental Disease. Amer.
Joum. Insan. 9 No. 4,1908, p. 685.

DAWSON. Alcohol and Mental Diseases. Dublin Joum. Med. Sc. t June 1908.
p. 412.

SOMMER. Depressionzust&nde und ihre Behandlung. D.med. Wchnschr ., Juni
18,1908, S. 108L

WILHELM STEKEL. Nervtfse Angstzust&nde und ihre Behandlung. Urban and
Schwarzenberg, Berlin, 1908, M. 8.

TOULOUSE. Rapport sur le maintien dans un asale privd d’une femme atteinte
de d$lire de persecution avec interpretations multiples. Rev. de PsychiaL, mat
1908, p. 196.

SOMMER. Ein Schema zur Unter&uchung von Idioten und Imbezillen. Klinik.
f psych, u. nerv. Krankheii Bd. 8, H. 1, 1908, S. 68.

GREGOR. Diagnose psychischer Prozesse im Stupor. Klinik. f. psych, h. nerv.
KrankheiL , Bd. 3, H. 1, 1908, S. 22.

PAILHAS. Dessins et manifestations d’art ches deux alidnds. Nouv. Icon, de la
Salpitrikre , mars-avril 1908, p. 162.

RIUS y MATAS. Consideraciones Acerca de la “Obsesidn dela Mirada.’* Arch,
de Psychial. y Criminol. 9 Marzo-Abril 1908, p. 188.

RISCH. Beitrag eum VerstSndnis der psychogenen Zustande. Ally. Ztschr. /.
Psychiat ., Bd. 65, H. 2, 1908, S. 171.

BIBLIOGRAPHY

65*

Alcth#Ue Psychoses. —VILLALTA 7 CISNEROS. Delirio Sistatisado Alooholioo
oon Ideas Delirantes de Deaconfiansa, Peraeeucion 7 Celos. Arch. de PsiquiaL y
Criminol., Marao-Abril 1908, p. 204.

SOUKHANOFF. Note sur l’amn&ie dans la pi 7 ohose Korsakorienne. Rev. de
Psychiat ., mai 1908, p. 194.

GREGOR. Zur Kenntnis des Zeitsinnes bei der Korsakoffschen Geistesstdrung.
Monatsschr. f. Psychiat. u. Neurol ., Juni 1908, 8 . 477.

Dellrlam.—DEL VALLE. Los Sentimientos 7 el Genesis del Delirio de Perseou-
ciones. Arch, de Psiquiat. y Criminal ., Mario-Abril 1908, p. 129.

Senile Dementia. — PACHANTONI. Dissolution de la vie affective dans la
vieillesse. L Rnciphale, juin 1908, p. 463.

Arterflo-gclerotle Dementia. — BENON et VLADOFF. Evolution des Itats
d&nentiels (artlrio-scllrose). Considerations cUniques et m6dico-16galeii. L'En-
ciphalt, juin 1908, p. 602.

Dementia Procox.— MINGAZZINI. Sulla morte improwisa nella demenza
precoce. Riv. di Patol. nerv. e m*nt, y Aprils 1908, p. 145.

ANGLADE et JACQUIN. Un oas de dlmence prScooe k forme paranoids aveo
autopsie et examen histologique. L’Enciphale , juin 1908, p. 453.

Paranela.—GREGORY. The Present Da 7 Limitation of our Conception of
Paranoia. N, Y. Med, Joum. , June 13, 1908, p. 1136.

Amaarotlc Idiocy.— BABONNEIX et BRELET. L'idiotie amaurotique familiale.
Qaz. des H6p ., mai 16, 1908, p. 675.

XsBgsllun.—VOISIN et GIRY. Un cas d’idiotie mongolienne. Prog, Mid,,
juin 13, 1908, p. 291.

General Paral 7 sis.—MORA VESIK. Rascher Wee heel expansiver und depreesiver
Zustandsbilder in einem Falle progresssiver Paralyse. Zentralbl. f. Nervenheilk.
a. Psychiat., Nr. 262, 1908, S. 409.

JOFFROY. La paralysis g 6 n 6 rale juvenile. Joum. des Prat. , juin 6 , 1908,
p. 356.

ANTHEAUME et MIGNOT. Insolation et paralysis g£n£rale (quelques par¬
ticularity cliniques). LEnctphule, juin 1908, p. 493.

Pellagra.—What are Pellagra and Pellagrous Insanity ? Does such a Disease Exist
in South Carolina, and what are its Causes? Amer. Joum. Insan ., No. 4, 1908,
p. 703.

Maeeilaneons Cases.—Zur Pathologic der GrOssenideen. Alin. Ztschr. f. Psychiat ..
Bd. 65, H. 2,1908, S. 272.

SPECHT. tJber die Struktur und klinisohe Stellung der Melancholia agitata.
Zentralbl.f. AcrvenheUk. u. Psychiat., Nr. 263, 1908, S 449.

H. W. MITCHELL and E. E. SOUTHARD. Melancholia with Delusions of
Negation : Three Cases with Autopsy. Joum. Nerv. and Merit. I)is., May 1908,

DEXTER. Ueber das Vorkommen yon Psychoeen bei den S&ugetieren. Prog,
med. Wchnschr., Mai 21, 1908, S. 273.

MJfcZIE. Confusion d&irante hallucinatoire aigue. L' Bnclphale, juin 1908,

p. 508.

Medico-legal.—C. A. DREW. An Insane (?) Malingerer. Amer. Joum. Insan..
No. 4, 1908, p. 669.

BALL 1 VE. El Patronato de Exc&rcelados en la RepubUca Aigentina. Arch, de
Psiquiat. y Criminal. , Marso-Abril 1908, p. 180.

FRANCOTTE. Des ciroonstances qui justifient ou ndeeasitent l’examen mental
de 1'inculpA Joum. de Neurol ., mai 20, 1908, p. 282.

Treatment.— CLERAMBAULT. Notes sur le regime des ali 6 n& en Angleterre.
Ann. Med.-Psychol., mai-juin 1908, p. 413.

ROXO. Attencao nos alienados. Atrh. Brasil, de Psychiat. e Neurol., Nos. 1 e 2,
1908, p. 67.

MORE 1 RA. Assistencia a alienados na Allemanha, Clinica de Munich. Arch.
Brasil, de Psychiat. e Neural., Noe. 1 e 2, 1908, p. 172.

CARLOS MACDONALD. The Development of the Modern Care and Treatment
of the Insane, as illustrated by the State Hospital System of New York. Amer.
Joum Insan., Na 4, 1908, p. 645.

BIBLIOGRAPHY

66*

TBKATnOT*—

HJLRLK Amylenhydrat bei Ekl&mpsie. Munch, med. Wchnsckr., Mai 26,1908,
8. 1134.

LIBOTTE. Th^rapeutiqae hydrothlrapique dam let n£vrites et let nSvralgies.
Joum . de NcuroL, mai 5, 1908, p. 261.

FUCHS. Elektrodiagnostik und Elektrotherapie des Pratikers. Wien, klin.
Wcknschr ., Mai 16, 1908, S. 1122.

CHRISTIN. Weak nervous Children and Arsenic. Brit. Joum. Child. Die.,
May 1908, p. 201.

Psychotherapy.—ONUF. Psychotherapy. Joum. Amer. Med. Assoc. , June 6»
1908jp. 1892.

CROTHERS. The Psychic Treatment of Spirit and Drug Neuroses. Joum.
Amer. Med. Assoc., May 23, 1908, p. 1684.

ftarglcal.—HENRY CURTIS. Some Interesting Cases of Cranial Surgery. Clin .
Joum. , May 20 and 27, 1908, pp. 81, 103.

HENRY CURTIS. Brief Notes of Interesting Cases of Cranial Surgery. Lancet,
May 23, 1908, p. 1480.

CUSHING. Subtemporal Decompressive Operations for Intracranial Complica¬
tions associated with Bursting Fractures of the SkulL Ann. of Surg., Part. 185,
1908, p. 641.

ROBERT SOUTTER. The Use of Silk Ligaments in addition to Muscle and
Tendon Transference in Infantile Paralysis. Boston Med. and Surg. Joum.,
June 4, 1908, p. 865.

PUECH. Therapeutics cirurgica na alienaeao mental Arch. Brasil, de Psyckiat.
e Neurol ., Nos. 1 e 2, 1908, p. 102.

STIMMEL. Biersche Stauung bei Otitis media. Munch, med. Wchnsckr ., Mai 26,
1908, S. 1128.

STURSBERG. Kritische und ezperimentelle Beitr&ge sur Frage der Verwend*
barkeit der Bierschen Stauung bei HirnhautenMndungen. MUneh. med.
Wcknschr ., Mai 19, 1908, S. 1060.

EUGENE S. YONGE. The Treatment of Intractable Hay Fever and Paroxysmal
Coryza by Resection of the Nasal Nerve. Lancet, June 13, 1908, p. 1688.

* ▲ number of references to papers on Treatment are Included In the Bibliography under the
Individual Diseases.

Bibliography

ANATOMY

FRORIEP. Ueber Entwioklung und Bau des autonomen Nervensystema. Mtd.~
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KAPPERS. The Structure of the Autonomic Nervous System compared with its
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JACOBSOHN. tjber die Kerne dea Rlickenmarkes. Neurol, Cenlralbl ., Juli 1,
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BLUMENAU. Zur Frage liber die Vaguskerne dea Menschen. Neurol, Centralbl.,
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BRODMANN. Beit rage zur hiatologisohen Lokaliaation der Qroashimrinde.
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A. VAN GEHUCHTEN et L. BOl/LE. Lea Noyaux Extra- et P6rim6dullaires
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T. K. MONRO and LEONARD FINDLAY. Notes on the Course of the Cerebello-
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A. VAN GEHUCHTEN. Les Cellules du Ganglion de Scarpa chez l’homme
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MOLLARD. Lea Nerfs du Cceur. Masson et Cie, Paris, 1908, 16 fr.
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L. BOULE. L’Impregnation dea Elements Nerveux du Lombrio par le Nitrate
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PHYSIOLOGY

FROLICH und DOEW1. Untersuchungen zur Physiologie und Pharmakologie
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AMELIN E. Mecanique cerebrale. Bussiere, Saint-Amand, 1908.

FROHLICH. Der Mechanismus der nervfeen Hemmungsvorgknge. Med.-
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BECK. Uber die Ermiidb&rkeit des Nerven. Hager, Bonn, 1908, M. —60.
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67*

68*

BIBLIOGRAPHY

LEO HEINE. Ufeber die Verh&ltnisse der Refraktdon Akkommod&tioii mid dee
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S. §23.

BALDENWECK. Etude an&tomique et cliniqu de l’oreille moyenne, avec la.
points du rocher, le ganglion de Gasser, et la Vie paire cranienne. Steinheil,
Paris, 1908.

LUGARO. Bur lea fonctions de la n£vroglie. Aixh. itaL de Biol,, VoL xlviii.,
p. 357.

CARLO CENI. Sugli intimi rapporti funrion&li tra oerrello e testicolo. Riv,
Speriment. di Freniatria , VoL xxxiv., f. 1-2, 1908, p. 57.

CERLETTI. Sopra speciali cor pi a forma navicolare nella corteocia oerebrale
normale e patologica e spora alcuni rapporti fra il tessuto oerebrale e la pia madre.
Riv. Stvrimcnt di Freniatria, Vol. xxxiy., f. 1-2, 1908, p. 224.

PIG HI NI. Sopra una special© forma reticolare di precipitarione della costansa e
aulle strutture di precipitazione di vari tessuti organici. Riv. j SpcrimtnL di
Freniatria , Voi. xxxiv., f 1-2, 1908, p. 247.

PIGH1NI. Sul potere che hanno la colesterina e la sostanza nervosa di neutral-
izz&re la emolisi da lecitioa e da sieri specific! Riv. SperimenL di Freniatria ,
Vol. xxxiv., f. 1-2, 1908, p. 188.

KEITH LUCAS. The Temperature-Coefficient of the Rate of Conduction in
Nerve. Journ. Physiol ., June 30, 1908, p. 112.

WOOLLEY. The Temperature Coefficient of the Rate of Conduction and of the
Latent Period in Muscle. Journ. Physiol ., June 30, 1908, p. 122.

PSYCHOLOGY

BOIGEY. itude psychologique sur lTslam. Ann. mSd.-psychol., juillet-aofit
1908, p. 5.

HOULLEVIGNE. Les Idees des Physicians sur la Mati&re. L f Annie Psychol.,
Vol. xiv., 1908, p. 95.

ZIEHEN. Die Prinzipien und Methoden der IntelligenzprUfung. Karger,
Berlin, 1908, M. 1.50.

BINET et SIMON. Le developpement de l’lntelligence chex les enfant*.
LAnnie Psychol., Vol. xiv., 1908.

MAROTTA. La Teoria di Darwin e la Pedagogia. Ann, di Freniatria, Vol.
xviii., f. 1, 1907, p. 76.

FRODERSTROM. Ueber die Irisbewegungen als Aeqnivalente der psychiechen
Vorgiinge. Monatsschr. /. Psychiat. u. Neurol ., H. 5, 1908, S. 405.

CLOUSTON. Blood and Mind. Ed in. Med. Journ., July 1908, p. 9.

STERN ECK. Das psycho-physische Gesetz und der Minimal-Sehraom. Ztsckr.
f. Psychol. , 1 Abt., Bd. 48, H. 1-2, 1908, S. 96.

MENZERATH. Die Bedeutung der sprachliche Gelaufigkeit oder der formalen
sprachlichen Beziehung fur die Reproduktion. Ztsckr. f. Psychol ., 1 Abt.,
Bd. 48, H. 1-2, 1908, Si 1.

BOHN. Introduction h la psychologic des animaux k sym6trie rayonnde* Colin,
Paris, 1908.

CANLECOR. Le pragmatism©. L'Annie Psychol Vol. xiv., 1908, p. 355.
MAIGRE. fctude sur la Reflexion. L'Annie Psychol., Vol. xiv., 1908, p. 380.
BINET et SIMON. Langage et Pens6e. VAnnie Psychol ., VoL xiv., 1908,
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RAUH. Morale et Biologie. VAnnie Psychol ., VoL xiv., 1908, p. 249.

BINET. L’^volution de I’enseiguement Philosophique. VAnnie Psychol., VoL
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SOURIAN. L’enseignement de TesthStique. VAnnie Psychol., VoL xiv., 1903,

p. 110.

BOREL. Le calcul des probability. LAnnie Psychol., Vol. xiv., 1908, p. 125.
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D. FRASER HARRIS. Coloured Thinking. Journ. Abnom. Psychol., June-
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BORIS SIDIS. An Experimental Study of Sleep. (Part II.) Journ. Abnorm,
Psychol., June-July 1908, p. 63.

MORTON PRINCE and FRED. PETERSON. Experiments in Psycho-Galvanic
Reactions from Co-Conscious (Subconscious) Ideas in a Case of Multiple Person¬
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BIBLIOGRAPHY

69 *

PATHOLOGY

BYROM BRAM WELL. Lesions of the Anterior Horn of Grey Matter of the

Spinal Cord. Clin. Studies , Vol. vi., Part 4, 1908, p. 346.

NAGEOTTE. Greffe de ganglions rachidiens, survie des 616ments nobles et
transformation des cellules unipolaires en cellules multipolaires, etc. Lab.
dCHistol. du Coll. de France, Trav. de VAnnie , 1907, p. 1.

BERTINI. Presenza di due ossa sopranumerie nella norma lateralis sinistra da
divisions del nasale e del mascellare superiors. Ann* di Freniatona, Vol. xviii.
f. 1, 1908, p. 20.

PETRAZZANI. Di un singolare atteggiamento del collo che si osserva in qualche
malato di mente. Riv. Speriment. di Freniatria , VoL xxxiv., f. 1-2, 1908, p. 159.
MERLE. 6tat varioliforme de I’lilpendyme des Ventricules lat6raux. Trois cm
pr&entant quelques caractferes particulars. (Soc. de neurol.) Rev. Neurol.,
juin 15,1908, p. 574.

FRANCA IS et JACQUES. Etude Anatomo-clinique d'un cas de Ramolissement
Bulbo-protub6rantiel. Rev. Neurol., juin 15, 1908, p. 521.

DENKER. Weitere Beitrage zur Anatomic der Taubstummheit. Bergmann,
Wiesbaden, 1908, M. 14.60.

CIMORONI. Sur Thypertrophie de l’hypophyse c6r6brale chez les animaux thy-
rSoidectomises. Arch, ital . de Biol., Vol. xlviii, p. 387.

PRATI. Sulla resistenza del reticolo intemo delle cellule nervose alia putre-
faziono. Ann. di Freniatria , Vol. xviii., f. 1, 1908, p. 33.

LASAGNA. Degli effetti della ipertermia e ipotermia sul reticolo neurofibrillar*
della cellula nervosa di animali adulti (metoao Ramon y Cajal). Riv. di Patol.
nerv. e ment., Vol. xiii., f. 5, 1908, p. 211.

DE PAOLI. L’azione del freddo e dell’ elettricita sul reticolo neurofibrillare.
Riv . Speriment. di Freniatria , Vol. xxxiv., f. 1-2, 1908, p. 217.

CARLO CENI. I veleni delle muffe pellagrogene e le stagioni dell' anno. Riv,
Speriment. di Freniatria , Vol. xxxiv., f. 1-2, 1908, p. 84.

PALAD1NO-BLANDINI. Le stagioni dell' anno e i veleni delle muffe. Riv,
Speriment. di Freniatria, Vol. xxxiv., f. 1-2, 1908, p. 69.

CARLO CENI. Sulla pellagra sperimentale nei polli Riv. Speriment, di Freni-
(Uina, Vol. xxxiv., f. 1-2, 1908, p. 16.

MONTESANO. Sul reperto dei Plasmatociti nei centri nervosi di conigli intoa-
ricati con 1’alcooL Riv. Speriment. di Freniatria , Vol. xxxiv.. f. 1-2, 1908,
n. 104.

REICH LIN. Di un reperto negativo d’infiltrazione perivascolare nei sistema
nervoso centrale di conigli alcoolirzati. Riv. Speriment. di Freniatria, Vol. xxxiv.,
f. 1-2. 1908, p. 63.

SCIUTI. Le fine alterazioni degli elementi nervosi nella paralisi progressiva.
Ann. di Nevrol., f. vi, 1908, p. 393.

CLINICAL NEUROLOGY

42BNKRAL—

SCHOENBORN und K RIEGER. Klinischer Atlas der Nervenkrankheiten.
Winter, Heidelberg, 1908, M. 28.

EDINGER. Die nolle des Aufbrauches bei den Nervenkrankheiten. Med.
Klinik, Juli 12, 1908, S. 1053.

WEISENBURG. Neurological Teaching in America. Joum. Amer. Med. Assoc.,
July 4, 1908, p. 1.

F. RAYMOND. The Relationship of the so-called Family Diseases to a Premature
Physiological Senescence Localised to Certain Organic Systems, and considered
with Special Reference to the Nervous System. Lancet, June 27, 1908, p. 1859.
GUTTMANN. Untersuchungen liber die Unterschiedsempfindlichkeit auf dem
Gebiet der Schallempfindungen bei Nerven- und Geisteskrankheiten. Monatsschr.
f. Psychiat. u. Neurol., H. 5, 1908, S. 423.

GRASSET. Diagnostic des maladies de l'enc^phale, sifege des lesions. 2e 6d.
Baillifcre et fils, Paris, 1908, 1 fr. 50.

STENE RT. Die Bedeutung von Bewegungssttirungen der Susseren Augenmuskeln
flir die Lokalisation zerebraler Herderkrankungen. Med. Klinik, Juni 21, 1908,
S. 938.

BEHR. Beitrage zur gerichts&rztlichen Diagnostik an Kopf, Sch&del und Gehirn.
Fischer, Jena, 1908, M. 2.50.

70*

BIBLIOGRAPHY

■min-

PANELUL Action du prindpe actif surrdnal sur la fatigue musculaire. Arch*
Hal. de Biol VoL xlriii., p. 480.

PAVIOT et NOVA-JOSSER AND. Myoclonie chez un viellard arec antopeie.
Rev. de Mid. t juin 10, 1908, p. 505.

■uciltr Atrophy*—PERRERO. Contributo alio studio delle atrofie muaoolare
congenita e parti oolarmente della atrofia numerica di KlippeL Riv. di Paid,
nerv. e menu, VoL xiii, f. 5, 1908, p. 193.

PKK1PHEKAI NESTED

ZENNER. Casas of Very Generalised Polyneuritis. Joum. Amer. Med. Assoc.,.
July 4, 1908, p. 28.

HUET. Paralysis et atrophie reflexes des extenseurs propres du pouce. (Soc,
de neurol.) Rev. Neurol., juin 15, 1908, p. 561. #

RAYMOND. Les paralysies radiculairee du plexus brachial. Journ. des Prat.,
juin 27, 1908, p. 434.

REAU. N^vrites et n^vromes du nerf cubital k longue 6cheance apres resection
du coude. Delaroche et Schneider, Lyon, 1908.

RAYMOND et ALQUIER. La maladie de Recklinghausen, ses TandtSs noeo-
logiques. L*Enc&phale, juillet 1908, p. 0.

RAYMOND et CLAUDE. Un cas de Neuro-fibrosarcomatose avec accidents
endph&liques. (Soc. de neurol.) Rev. Neuivl., juin 16, 1908, p. 671.

SPINAL 10*1)-

Tabes.— FREUDENTHAL, Laryngeal Manifestations in Locomotor Ataxia and
Multiple Sclerosis. Joum. Amer. Med. Assoc ., June 13, 1908, p. I960.

FAGE. Les Symptftmes oculaires du tabes. Germain et Graasm, Angers, 191^.
BONELLI. Tabe dorsale giovanile. Ann. di Freniairia, Vol. xviiL, f. 1, 1908,.

fuCHS. Symp
Med. Klinik, H.

tomatische Therapie und Pflege
5, 1908, S. 117.

bei Tabes dorsalis.

BeihcfU u

Pellemy el ltl«. —BYROM BRAMWELL. Analysis of Seventy-six Cases of Polio
myelitis Anterior Acuta. Clin. Studies, Vol. vi., Part 4, 1908, p. 371.
WICKMAN. Ueber die akute Poliomyelitis und verwandte Erkrankungen
(Heine-Medinsche Kraukheit). Jahrb. f. Einderheilk., Bd. 67, Erganxnngsheft,
l908 S 182

A. VAN GEHUCHTEN. Cas de Poliomyflite AntArieure d’origine sp&dfique.
Nivraxe , juin 10, 1908, p. 331.

Spastic Spinal Paralysis.—UGOLOTTI. Sulla paralisi spinale spastica. Riv.
Speriment. di Freniairia, VoL xxxiv., f. 1-2, 1908, p. 91.

Landry's Paralysis.—MtjNZER. Zur Histologie und Klassifikation dor Landry-
schen Paralyse. Berl. Li in. I Vchnschr., Juni 29, 1908, S. 1223.

Infhntlle Paralysis. —KEPPLER. The Treatment of Infantile Paralysis. F. Y.
Med. Joum. } June 20, 1908, p. 1180.

Myelitis—TSUNODA. Beitrag zur Kenntnis der Myelitis ox Nountide, Wien,
med. Wchnschr.y Juni 20, 1908, S. 1410. . T .

FREUND. Ein Fall ron Schwangerschaftsmyelitis. Prog. med. Wcknschr., Juni
18, 1908, S. 327. . , . .

Syringomyelia.—ALEXANDER BRUCE. A Case of Spasmodic Syringomyelia(f).
Rev. de F envoi. and Prychiat., July 1908, p. 390. ... , ,

BIENFAIT. Le traitement de la syringomySlie par la radiothfirapie. de

Feurol., juin 20, 1908, p. 321. . _. . .

ROGER LABEAU. Contribution h la radiotMrapie de la syringomyelia. Arch,
d'Elect. Med., juin 29,1908, p. 473.

Spinal Syphilis.—GILBERT et LION. Syphilis de la Moelle. Bailliere et fils
Paris 1908, 1 fr. 60.

Caisson Disease.—HOWARD MUMMERY. Diving and Caisson Disease. Brit.
Med. Joum., June 27, 1908, p. 1565.

BIBLIOGRAPHY

71 *

rett's Disease.—CABOT. Le mal de Pott. Joum. da Prat., juin 20 et 27,1908,
pp. 885, 409.

Trauma. —SOLIERI. Transversaler Schnitt des RUckenm&rks bedingt durch eine
Schuttwaffe in der Hohe des 3. Ruckenwirbels. Mitt. a. d. Orenzgebiet. d. Med.
Chir., Bd. 19, H. 1, 1908, S. 85.

gpaudylltls Deformans. —PREISER. Zur Frage der Aetiologie der Spondylitis
cervic&lis deformans. Munch, mcd. Wchnschr ., Juli 7, 1908, S. 1433.

DRAIN—

Meningitis.—ALT. Die Taubheit infolge von Meningitis oerebroepinalis epidemioa.
Deuticke, Wien, 1908, M. 4.

DUNN. The Serum Treatment of Epidemic Cerebro-Spinal Meningitis. Joum .
Amer. Med. Assoc., July 4, 1908, p. Id.

MILLER and BARNER. The Epidemic of Cerebro-Spinal Meningitis; Successful
Use of Flexner’s Antiserum. Joum. Amer. Med. Assoc., June 13, 1908, p. 1975.

F. S. CHURCHILL. The Treatment of Meningococcic Meningitis with
Flexner’s Serum. Joum. Amer. Med. Assoc., July 4, 1908, p. 21.

Hemorrhage. —ISRAELOWITZ. Un cas d’H6morragie lin^aire dans la Capsule
Interne. (Soc. de neurol.) Rev. A 'enrol., juin 15, 1908, p. 573.

Syphilis.— BONFIGLIO. Di speciali reperti in un caso di probabilo sifilide
cerebrale. Riv. Speriment. di Freniatria, Vol. xxxiv., f. 1-2, 1908, p. 196.
LEWINSKI. Ungewdhnlich ausgedehnte Sympathicus-Beteiligung bei Klump-
kescher Lahmung infolgo von Lues cerebroepinalis. D. med. Wchnschr., Juli 9,
1908, S. 1222.

RANKE. Ueber Gehimverletzungen bei der angeboren Syphilitis (Schluss).
Ztschr.f. d. Erforsch. d. jugend. Schwachsinns, Bd. 2, H. 3, 1908, S. 211.
Abscess.— LEW ANDO WSKY. Die Diagnostike des Hirnabezesses. Med. Klinik ,
July 5, 1908, S. 1011.

D. R. PATERSON. The Treatment of Otitic Cerebellar Abscess, with Remarks
upon Three Successful Cases. Brit. Med. Joum., July 18, 1908, p. 132.
Hemiplegia.— SAMUEL WEST. The Respiratory Movements in Hemiplegia.
Quart. Joum. of Med., July 1908, p. 448.

KLIPPEL et FRAN£01S-DAINVILLE. H6mipl6gie droite avec aphasie
motrice, d’origine typhique, datant de 30 ans, accompagnfc d’alexie et de dissocia¬
tion syringomyClique de la sensibility. Rev. Aeurol., juin 30, 1908, p. 581.
Aphasia.— DEVAUX et LOGRE. Considerations sur l’aphasie d’aprfcs V. Monakow.
VEncephale, juillet 1908, p. 75.

FROM ENT. Aphasie avec Dysarthrie. Rev. de Mid., juin 10, 1908, p. 531.
GRASSET et RIMBAUD. Un cas de paraphasie, ramollissement de la premiere
circonvolution temporale gauche. Rev. Fenrol. , juin 30, 1908, p. 677.

Tumeur. —ACCORNERO. Sopra la sindrome oscura di tumore oerebrale. Riv.
Speriment. di Freniatria, Vol. xxxiv., f. 1-2, 1908, p. 264.

F. X. DERCUM. Tumour of the Frontal Lobes with Symptoms Simulating
Paresis. Joum. Serv. and Ment. Die., July 1908, p. 438.

SLATO W. Gliom der Medulla oblongata im Kindesalter. Monatsschr. f. Psychiat.
u. Fenrol., H. 5, 1908, S. 445.

Thrombosis of Sinuses. —EDWARD HARRISON. Two Cases of Lateral Sinus
Thrombosis. Brit. Med. Joum., June 27, 1908, p. 1563.

Hydrocephalus. —RIVA. Idrocefalo intemo ed eatemo. Riv. Speriment. di
Freniatria , Vol. xxxiv., f. 1-2, 1908, p. 207.

Trauma.— CLAIRMONT. Zur Kenntnis der hyperalgetischen Zone nach SchSdel-
verletzungen. Mitt. a. d. Qrenzgebiet. d. Med. u. Chir., Bd. 19, H. 1, 1908,
S. 59.

Cerebellum.— ANGLADE et JACQUIN. Syndrome cyr6belleux chez une femme
de 51 ans. Atrophie cyr6belleuse. Rev. de Mid., juin 10, 1908, p. 524.

GENERAL AND FUNCTIONAL DISEASES—

Hysteria.—MEIGE. La revision de Thyst^rie h la Society de Neurologic de Paris.
Les prytendus stigmates hystyriques, etc. Preset Mid., juillet 4, 1908, p. 426.
ERNEST JONES. The Significance of Phrictopathic Sensation. Joum. Nerv.
and Ment. Dis., July 1908, p. 427.

Epilepsy.—LE ROY. Is Idiopathic Epilepsy with Associated Paralysis due to the
Action of a Germ ? F. Y. Med. Joum., June 20, 1908, p. 1200.

72 *

BIBLIOGRAPHY

VOLLAND. Zur Kasuistik der krampfhaften Respirationsstbrungen auf epi-
leptischer Basis. Neurol. Centralbl ., Juli 16, 1908, S. 661.

ENRICO ROSSI. Epilessia da PellagTa. Nlvraxt, juin 10, 1908, p. 261.
MARGARIA. Le resistenze dei globuli rossi all© soluzioni di cJoniro di sodio
negli Epilettici. Ann. di Freniatria , VoL xviii., f. 1, 1908, p. 25.

GUIDO GUIDI. Sulla patogenesi della epileasU. Riv. SperimsnL di Freniatria ,
VoL xxxiv., f. 1-2, 1908, p. 110.

Telany.—J. A. GIBB. Tetany in the Adult. BriJU Med. Joum ., July 11, 1908,
p. 77.

Headache.—VECKENSTEDT. Der Kopftchmere als h&ufige Folge yon Nasen-
leiden und seine Diagnose. Kabitseh, Wiirzburg, 1908, M. —85.

Neureses.—SCHWERDTNER. Zur Atiologie der Psychoneurosen. Wien. mad.
Wchnschr Juni 20 u. 27, 1908, Sn. 1406, 1478.

I8SERLIN. Die Erwartungsneurose. AfUnch. wed. Wchnschr., Juli 7, 1908, S.
1427.

Trasmatlc Neuroses.—VERST RAETE. G6n6ralit6s sur lee simulations dans les
accidents du travail; observations peraonnelles. Gout, Orleans, 1908.

Neuritis.— RAMOND et COTTBNTOT. N^vrite chloroform ique. Prog. Mid.,
juillet 11, 1908, p. 841.

Chorea.—RUDINGER. Chorea und Tetanie. Wien. klin. Wchnschr ., Juli 4,1908,
S. 1527.

Paralysis A glia as.—KLIPPEL et WEIL. Maladie de Parkinson. Tremblement
des ^aupihres. Atrophie optique. (Soc. de neurol.) Roe. Neurol ., juin 15, 1908,

Exophthalmic Goitre.—CRILE. Psychical Aspects of Graves' Disease. Ann. of

Sura Part 186, 1908, p. 864.

MOURIQUAND et BOUCHAUD. L’asystolie mortelle dans la maladie de
Basedow. Simaine mid., juillet 8, 1908, p. 325.

SAINTON et RATHER Y. Troubles pupillaires et inlg&litl pupillaire h bascule
dans le syndrome de Basedow. UEnciphale, juillet 190§, p. 36.

KAPLE. A Case of Exophthalmic Goitre, and its Treatment. Tier. Oaz .,
May 15, 1908, p. 325.

BERNHARDT. Die Behandlung der Basedowschen Krankheit. D. med.
Wchnschr. , Juli 2, 1908, 8. 1169.

THURSTAN HOLLAND. X-ray Treatment of Exophthalmic Goitre. Arch, of
the Rontgen Raps, July 1908, p. 89.

BABINSKI. Le salicylate de soude dans la maladie de Basedow. Joum. da
Prat. , juin 27, 1903, p. 424.

Neurasthenia.—HARTENBERG. L’autoeuggestion chez les Neurasth&iiquea.
Rev. de Mid., Juin 10, 1908, p. 561.

MILLIAN. The Diagnosis and Treatment of Syphilitic Neurasthenia. Med.
Press , June 24, 1908, p. 686.

ERIC MACNAMARA. Blood Pressure in Neurasthenic States and the Effects
of Certain Forms of Treatment thereon. Lancet, July 18, 1908, p. 151.

Tetanus.—BOCKENHEIMER. Ueber die Behandlung des Tetanus auf Grand
experimenteller und klinischer Studien. Arch. f. klin. Chir., Bd. 86, H. 2, 1908,
S. 277.

Aleehollsui.—FRANCIS HARE. The Sanatorium Treatment of Inebriety.
Brit. Joum. Inebriety, July 1908, p. 29.

Rabies.—A. VAN GEHUCHTEN. Un cas de Rage Humaine ^voluant clinique-
ment comme une Poliomy6lite Antlrieure Aigue Ascendants ou oomme une
Paralysie Ascendants de Landry. Ntrraxe, juin 10, 1908, p. 235.

SPECIAL SENSES AND CRANIAL NERVES—

LACHMUND. Untersuchungen Uber die Convergenzreaktion bei reflektorisoher
Pupillenstarre. Berl. klin. Wchnschr., Juli 6, 1908, S. 1268.

PEYSER. Ueber isolierte Lahmung des Musculus rectus externus bei gleich-
witiger eiteriger Mittelohrentzundung. Berl. klin. Wchnsehr., Juni 29, 1908,

FROMAGET. Paralysie r^cidivante de l'accommodation Chet une hyperm&roep
k la suite de la diphterie. Germain et Grassin, Angers, 1908.

BIBLIOGRAPHY

73 *

MISCELLANEOUS CASES—

DESPLATS. Hypertrophie Segmentaire considerable du Bras et de l’Avant-bra*
avec dissociation syringomy&ique des Sensibility. (Soc. de neurol.) Rev .
Neurol juin 15, 1908, p. 575.

STRAUSSLER. Zur Frage der zerebralen Sensibilitatsstdrungen von spinalem
Typus. Monatsschr. f. Psychiat. u. Nettl'd., H. 5, 1908, S. 381.

LIEPMANN. t)ber die agnostischen Storungen. Neurol. Centralbl ., Juli 1 und
16, 1908, Sn. 609 and 664.

PIERRE BONNIER. La Baresth6sie. Rev . Neurol ., juin 15, 1908, p. 526.

CHAVIGNY. Lea Analg6sies-Ane8th6sies; leur Diagnostique m£dioo-16gal.

Ann. d'Hygiine Publique, juin 1908, p. 498.

DROMARD. Tremblement h£r£ditaire rappelant celui de la scl6rose en plaques.
LEnciphale, juillet 1908, p. 45.

BYROM BRAMWELL. A Case of Intermittent Claudication (Angina Cruris),
etc. Clin. Studies, Vol. vi., Part 4, 1908, p. 317.

BYROM BRAMWELL. Intermittent Claudication. Med. Press , July 8, 1908,
p. 42.

VINCENT. Syndrome Thalamique avec troubles CSrdbelleux et Vaso-asymdtrie.

S Soc. de neurol.) Ree. Neurol ., juin 15, 1908, p. 553.

FOSEPH COLLINS and H. S. MAITLAND. Disease of the Primary Motor
Neurones causing the Clinical Picture of Acute Anterior Poliomyelitis: the
Result of Poisoning by Cyanide of Potassium. Joum. Nerv. and Ment. Dis..
July 1908, p. 417.

PURVES STEWART. A Case of Disease of the Post-Central Gyrus associated
with Astereognosis. Rev. Neurol, and Psychiat., July 1908, p. 379.
SCHWKNKENBECHER. Ueber Mentholvergiftung des Menschens. MUnch.
med. Wchnsekr., Juli 14, 1908, S. 1495.

ESPOSITO. SulF isolamento. Riv. Speriment. di Freniatria, Vol. xxxiv., f. 1-2,
1908, p. 1.

C. HART. Die Meso-Periarteriitis (Periarteriitis nodosa). Berl. Hin. Wchnsekr .,
Juli 13, 1908, S. 1305.

SEMI MEYER. Relative Eupraxie bei Rechtsgelahmten. D. med. Wchnsekr .,
Juni 25, 1908, S. 1143.

STEKEL. Nervose Angstzust&nde und ihre Be hand lung. Urban A Schwarzen-
berg, Wien, 1908, M. 8.

CODET-BOISSE. Pied-bot paralytique, transplantations tendineuses. Gou-
nouilhou, Bordeaux, 1908.

LEG RANGE. La scoliose des Ecoliers. Arch, de Mid. des Enfants , juillet 1908,
p. 449.

PSYCHIATRY

MILSON RHODES. The Mentally Defective in Prison. Brit. Med. Joum.,
June 27,1908, p. 1568.

FUCHS. Fruhsymptome bei Geisteskrankheiten, Vererbung, etc. Gelsdorf,
Eberswalde, 1908, M. 1.50.

R^V^CZ. Die Rechenfahigkeit der Schwachbefkhigten und deren genauere
Wertung. Ztschr. f. d. Erforsch. d. jugend. Schwachsinns, BcL 2, H. 3, 1908,
S. 189.

SCHtJLLER. Ueber psychische Storungen im Kindesalter. Ztschr. /. d.
Erforsch. d. jugend. Schtcachsinns, Bd. 2, H. 3, 1908, S. 206.

CRISTIANI. L’abolizione dell’ uso del tabacco per gli alienati nel Manicomio di
Lucca. Riv. Speriment. di Freniatria, Vol. xxxiv., f. 1-2, 1908, p. 286.
TAMBURINI. La difesa sociale dagli alienati criminali, Riv. Speriment. di
Freniatria , Vol. xxxiv., f. 1-2, 1908, p. 274.

Alcoholic Delirium. —MARGARIA. La Frenosi Alcoolica nel Manicomio di
Torino, nel triennio 1903 1905. Ann. di Freniatria , Vol. xviii., f. 1, 1908, p. 40.

Dementia Priecox.— PURDUN and WELLS. Dementia Pruecox; a Composite
History of 200 Cases, with Blood Findings in 50 Cases. Joum. Amer. Med.
Assoc., July 4, 1908, p. 34.

EWENS... Dementia Prsecox in India. Indian Med. Oaz., June 1908, p. 206.
JAHRMARKER. Endzustande der Dementia Prtecox. Zentralbl.f. Nervenheilk.
u. Psychiat., Nr. 264, 1908, S. 489.

BEN1GNI e ZILOCCHI. Due casi olassificabili fra le demenze precoci. Riv .
Speriment. di Freniatria , VoL xxxiv., f. 1-2, 1908, p. 23.

74*

BIBLIOGRAPHY

fieiertl PartljiU. —JOFFROY. Paralysie g6n6rale juvenile chez un sujet de
vingt-trois ana. L'BndpkaU, juillet 1908, p. 1.

MAUMY. Lee Troubles trophiques dans la paralysie gdndrale. Dirion, Toulouse,
1908, 2 fr.

SOUTZO bis. Lea nouvelles donates relatives k la sdro-rdaction de la syphilis
dans la paralysie gdndrale par la mdthode de Wassermann. Ann. mid.-Psychol
juillet-aoOt 1908, p. 52.

M lace 1 Ian eons 4*ases.— GAVER. A Case of Alternating Personality. Jour a.

Amer. Med. Assoc., July 4, 1908, p. 9.

AMELINE. Considerations sur la psycho-physiologie des obsessions et impulsions
morbides. Busstere, Saint-Amand, 1908.

DE CLfeRAMBAULT. Passion drotique dee etofifes cbez la femme. Arch.
cT Antkrop. Crim., join 15, 1908, p. 439.

TREATMENT*

PORTER. Alphamonobrom Isovaleryturia ; A New Nerve Sedative and Somni¬
facient. Boston Med. and Snrg. Joum., June 25, 1908, p. 971.

CRON. Innervationsstorungen in heilpadagogischer Behandlung. Ztsehr.f. <L
Brforsch. d. jugend. Schwachsinns, Bd. 2, H. 3, 1908, S. 101.

Fsyehothtrapy.— BLISS. Psychotherapy. Joum. Amer . Med. Assoc., July 4,
1908, p. 37.

RIGGS. Adverse Suggestion. Med. Rec., June 27, 1908, p. 1071.

DERCUM. An Analysis of the Psychotherapeutic Methods. Ther. Gas., May
15, 1908, p. 305.

WEIR MITCHELL. The Treatment by Rest, etc., in relation to Psychotherapy.
Joum. Amer. Med. Assoc., June 20, 1908, p. 2033.

Electrotherapy. —FRY. The Attitude of Neurologists towards Electrotherapy.
Joum. Amer. Med. Assoc., July 4, 1908, p. 13.

DAWSON TURNER. L’dleqtrolyse dans le traitement du tic douloureux et de
la sclerose spinale. Arch. <T Elect. Mid., juillet 10, 1908, p^ 506.

ZIMMERN. Ndoessitd de l’dlectrisation prdcoce dans le traitement dee atrophies
reflexes (dtude pathogdnique). Presse Med., juillet 1, 1908, p. 417.

Surgical.— ALBERT J. WALTON. A Consideration of the State of the Auto¬
nomic Nervous System in Acute Surgical Conditions. Lancet , July 11, 1908,
p. 85.

MUMFORD. Psychical End-results following Major-Cerebral Operations. Aim.
of Sura., Part 180, 1908, p. 853.

ALFRED GORDON. Bier’s Method in the Treatment of Some Neuroses. Ther.
Gas., May 15, 1908, p. 322.

MARTEN. The Treatment of Increased Intracranial Tension. Austral. Med.
Gaz., May 1908, p. 227.

HAJEK. Ueber Indikationen sur operativen Behandlung bei der chronischen
Stimhbhlenentzundung. Wien. med. Wchnschr ., Juni 27, 1908, S. I486.
HERMANN OPPENHEIM. Zur Gehimchiruigie. BerL tUn. Wchnschr Juli
13, 1908, S. 1301.

KRAUSE. Subcutane Dauerdrainage der Himventrikel beim Hydrocephalus.
Berl. klin. Wchnschr., Juni 22, 1908, S. 1165.

F. VAN FLEET. Intradural Tumour of the Optic Nerve removed by the Kron-
lein Method. Med. Ree June 27, 1908, p. 1063.

SPITZ Y. Zur Frage der Behandlung von L&hmungen mittels Nervenplastik.
Milnch. med. Wchnschr., Juli 7, 1908, S. 1423.

WAHL. Was diirfen wir von der heutigen Skoliosenbehandlung erwarten?
Milnch. med. Wchnschr Juli 14, 1908, 8.1493.

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

Bibliography

ANATOMY

ZANCLA. Rioerche anatomo-patologiche in un caso di sordomutismo e con*
tributo sperimentale alio studio del deoorso della branca oooleare del* VIII. paio.
Riv. Ital. de Neurovaiol. , Prick, ed Elettroter ., Luglio, 1908, p. 805.

SCHWALBE. CJeDer das Windungsrelief des Gehirns. Anat. Am,, Aug. 7,
1908, S. 83.

HOLL. tJber Furchen und Windungen der Scheitel-Hinterhauptgegend an den
Gehirnen der Affen der neuen Welt Htilder, Wien, 1908, M. 8.15.
LANGELAAN. Development of the Large Commissures in the Human Brain.
Brain, Vol. xxxi., Part 122, 1908, p. 221.

SCHRODER. Einfiihrung in die Histologie und Histopathologie dee Nerven*
svstems. Fischer, Jena, 1908, M. 2.80.

BOAS and PAULLI. The Elephant’s Head. Studies in the Comparative
Anatomy of the Organs of the Head of the Indian Elephant and other Mammals.
Part 1, The Facial Muscles. Fischer, Jena, 1908, M. 100.

BOTEZET. Die Nerven der Epidermis. Anat. Am., Aug. 7, 1907, S. 45.
WALTER. Zur Kenntnis der peripheren markhaltigen Nervenfasern. D. Zttchr .
/. Nervenheilk., Bd. 35, H. 1-2, 1908, S. 152.

PHYSIOLOGY

POLIMANTI. Beitrag zur Physiologic der Varolsbriicke und der Vierhiigel.
Arch.f. Anat . u. Physiol ., H. 8-4, 1908, 8. 271.

TOMLINSON. Cerebral Inhibition with Relation to Motor Function. Joum.
Amer. Med . Assoc., July 18, 1908, p. 183,

BLASSBERG. Neuere Anschauungen iiber die Sprachzentren. Wien. klin.
Wchnschr., Aug. 13, 1908, S. 1175.

NIESSL VON MAYENDORFF. Ueber die Lokalisation der motorisohen Aphasie.
Berl . klin. Wchmchr.^ Aug. 10, 1908, S. 1481.

FROHUCH. Zur Thermodynamik der Muskelkontraktion. PJlUger's Arch.,
Bd. 123, H. 11-12, 1908, S. 596.

SOLOMOWICZ. Vom Centrum der Submaxillardriise. Neurol. Centralbl.,
Aug. 1, 1908, S. 724.

EYCLESHYMER. The Reactions to Light of the Decapitated Young Necturus.
Joum. Como. Neurol, and Psychol., June 1908, p. 303.

CONGDON. Recent Studies upon the Locomotor Responses of Animals to White
Light. Joum . Comp . Neurol, and Psychol., June 1908, p. 309.

LANGLEY. On the Contraction of Muscle, chiefly in Relation to the Presenoe
of u Receptive’ 1 Substances. Part II. Joum. Physiol ., Aug. 12, 1908, p. 165.
BAYLISS. The Excitation of Vaao-dilator Nerve-fibres in Depressor Reflexes.
Joum . PhvsioL, Aug. 12, 1908, p. 264.

RISCH. Die Gehirnsperrung eine Schutzmassregel des Zentralnervensystems.
ZentralbLf. Nervenheilk. u. Psychiat., Nr. 266, 1908, S. 561.

WEBER. Ueber Beeinflussung der Herztatigkeit vom N. splanchnicus aus durch
den Grenzstrang. Arch.f. Anat. u. Physiol ., H. 3-4, 1908, S. 259.
LEHNDORFF. Ueber die Ursachen der typischen Schwankungen des allge-
meinen Blutdruckes bei Reizung der Vasomotoren. ^4rcA. /. Anat. u. Physiol..
H. 3-4, 1908, S. 362.

FROHUCH. Zur Frage der hemmenden Fasem in der Muskelnerven. Arch. f.
Anat. u. Physiol., H. 8-4, 1908, 8. 892.

k 7b*

BIBLIOGRAPHY

LAPICQUE. Exp 6 riaooe montrant quU 0*7 a pas une dur€e limit© pour
l’excit&tion. Joum. de Physiol., Nr. 4, 1908, p. 024. * • » J

LAPICQUE. Sur la throne de l'exdtatioii Hectrique. Joum. de PhysioL f
Nr. 4, 1908, p. 661.

KRAMER. Elektriache Seoabtfitatsunternichungen mittels Kondcnsatorentla-
dungen. Barth, Leipzig, 1908, M. 1.

GORDON J. LANE. Dissociation Changes in Saline Solutions produced by
Electricity. Him’*, VoL zzxL, Part 122, 1906, p. 269.

PSYCHOLOGY

BURNHAM. The Problem of Fatigue. Amur. Jour a. Psychol., July 1908,

p. 385.

WELLS. A Neglected Measure of Fatigue. Amur. Joum. PsyckoL, July 1908,
p. 345.

THORNDIKE. The Effect of Practice in the Case of Purely Intellectual Function.
Amer. Johitl. Psychol., July 1908, p. 374.

MURRAY. A Qualitative Analysis of Tickling; its Relation to Cutaneous and
Organic Sensation. Amer. Jour, a. PsyckoL , July 1908, p. 269.

LOWY. Die Aktionsgefuhle. Ein Depersonalisationsfall als B et trag sur Puy*
chologie des Aktivit&tsgefuhles und dee PersSnlichkeitsbewu as teeina. Pray. mod.
Wchnschr .. Aug. 6 , 1908, S. 443.

REIN HARD. Der Ausdruck von Lust und Unlust in dsr Lyrik. Arck /. d. qcu

PsyckoL, Bd. 12, H. 4. 1908, S. 481.

NAGEL Emfuhrung in die Kenntais dor Farbensinnstdrungen und flue Dh^
noee. Bergman n, Wiesbaden, 1908, M. L

MANGOLD. Unsere Sinneeoigane und flue Funktionen. Quelle 4 Meyer,
Leipzig. 1908, M. L

T. H. KELLOGG. Sane Prototypes of Ixuane Mental Proceeds. Jour a. Abnorm.
Psychol., Aug.-Sept. 1908, p. 141.

PHILIP B. HADLEY. The Behaviour of the Larval and Adotoaoent Stages of
the American Lobster (Homarus Americanus). Joum. Comp, NcuroL mmd Psychol.,
June 1908, p. 199. r~j|

T. CLAYE SHAW. A Lecture on the Psychology of Suooess. Lancet, July 25,

1908, p. 211.

ZIEHEN. Zur Lehre von dor Aufxnerbnmkeit. Monatsschr. f. PsychiaL u.
NeuroL . Aug. 1908, S. 173.

B01RAC. La Psychologic inoonnue, introduction et contribution k l'ltude ex-
p 6 rimentale des sciences psychiques. Alcan, Paris, 1906, 5 fr.

BORIS SIDIS. An Experimental Study of Sleep (Part ILL). Joum. Abmom.
Psychol., Aug.-Sept 1908, p. 170.

YARENDONCK. Les iddals d’Enfant*. Arch, de PsyckoL, juillet 1906, p. 865.
CLAPARfeDE. Classification et plan des Mlthodes Psychologiquee. Arch, de

PsuchoL, juillet 1908, p. 321.

ERNEST JONES. Rationalisation in Every-Day life. Joum. Abnorm. Psychol
Aug.-Sept. 1908, p. 161.

KLEMM. Bericht liber den dritten Kongreas der Gesellschaft fiir expertmentelle
Psychologic in Frankfurt a. M. vom 22 bis 25 April 1908. Arckf. d. yes. Psychol
Bd. 12, H. 4, 1908, S. 546.

PATHOLOGY

VOGT. Zur Pathologic und pathoiogischen Anatomic der versohiedenen Idiotie-
form en. Monalsschr. f. Psychiat. u. Neurol ., Aug. 1908, 3. 106.

WILLIAM M‘DOUG ALL State of the Brain during Hypnosis. Brain, VoL
xxxi., Part 122, 1908, p. 242.

ERB. Riickblick und Ausblick auf die Entwicklung und die Zukunft der
deutschen Nervenpathologie. D. Ztscknf. Nervenheilk., Bd. 35, H. 1-2,1908, S. 1.
ORR and ROWS. Some Points in the Histology of Lymphogenous and Hasmato-

§ enous Toxic Lesions of the Spinal Cord. Joum. MenL Sc., July 1908, p. 560.

ANNA SALAR1S. Sul comportamento dalle Neuro-fibrille del mauteUo ©are-
brale d’un epilettico morto in stato di male. Riv. Iial. di NcuropoL, Pskk. ed
Blettroter. , Luglio, 1908,p. 328.

MARCH AND. Ueber F ormverknderung des Schkdels und des Qehirn* infolge
friihieiti^er Nahtverknhcherung. Arck /. Bntwidtlwngwmockanik. , Bd. 26, H.\

BIBLIOGRAPHY

77*

VOLLAND. Cosuistischer Beitrag zu den traumatischen Rindendefecten der
Stira- and Centralwindungen. Arch./, Psychiat. u. N ervenkrankh., Bd. 44. H. 2,
1908,8,835.

BARBE. Etude des d4g£nOrations secondaires fbulbo-protuMrantiellea et
mldullaires) du faisceau pyramidal. Doin, Paris, 1908.

ALESSI. Lesioni traumatiche sperimeutali del cenrelletto in animali neonati.
Riv. Ital, di Neuropat., Psick. td Elettroter., Luglio, 1908, p. 324.

SPIELMEYER. Veranderungen des Nervensystems nach Stovainanksthesie.
MUnch. med. Wchnschr., Aug. 4, 1908, S. 1829.

CLINICAL NEUROLOGY

GENERAL—

LOTS. Nervoee Zustknde. Salle, Berlin, 1908, M. 1.50.

FUCHS. Neurologiaehe Kasuistik. Wien, klin . Wchnschr Aug, 13, 1908, S»
1180.

■UftCLES—

CLAUDE et VINCENT. Un cas de Myasth6nie Bulbo-spinale avec Atrophie
Musculaire localise, etc. (Soc. de neurol.) Rev. Neurol ., juillet 15, 1908, p. 697.
THEODORE THOMPSON. Familial Atrophy of the Hand Muscles. Brain, Vol.
xxxi., Part 122, 1908, p. 286.

Hkiprekal nerveb—

BABINSKI et TOURNAY. Section du Cubital et du Median, k la partie
inferieure de PAvant-bras. (Soc. de neurol.) Rev. Neui-ol ., juillet 15,1908, p. 688.
SICARD et GY. Le Oreux Sus-claviculaire dans la Paralysie de la Branchs
Exteme du Spinal. (Soc. de neurol.) Rev. Neurol ., juillet 15, 1908, p. 679.
BR1SSAUD et GOUGEROT. N4vrite localise avec troubles trophiquea a la suite
de coupure du pouce; n^vralgie ascend ante. Rev. Neurol ., juillet 15, 1908, p. 645.

•PINAL CORD—

Tabes.—DEBOVE. Tabes et chirurgie. Preset mAf., juillet 22, 1908, p. 465.
ERBEN. Ueber den Romberg’schen Versuch bei Tabes und bei traumatischer
Neurose. Wien. med. Wchnschr ., Juli 18, 1908, S. 1626.

RAMSAY HUNT. The Relation of Locomotor Ataxia and Paresis. N. Y. Med.
Joum., July 4, 1908, p. 3.

VANDERLOET. De l’importance des troubles de la sensibility dans le diagnostic

S r&ocedu tabes. Joum. de Neurol. , juillet 5, 1908, p. 341.

[ATT1ROLO. Contribution k l’£tude du tabes rudimentaire associl aux affections
de l'aorte. Rev. Neurol., juillet 15, 1908, p. 648.

DERCUM. Tabes Associated with Trophic Changes Suggesting Acromegaly.
Joum. Nerv. and Ment. Die., Aug. 1908, p. 507.

SCHMIERGELD. De l’emploi de la Tiodine dans le traitement du Tabes. (Soc.
de neurol.) Rev. Neui'ol., juillet 15, 1908, p. 711.

Poliomyelitis.—ARCHAMBAULT. Acute Anterior Poliomyelitis in the Adult,
with Exposition of a Case. N. Y. Med. Journ., Aug. 8, 1908, p. 255.
STE1NHARDT. Anterior Poliomyelitis. N. Y. Med. Joum. , Aug. 8,1908, p. 251.
BABINSKI. Poliomyelitis att4nu6e. Journ. des Prat., aoftt 1, 1908, p. 488.
ALLAN STARR. Epidemic Infantile Paralysis. Joum. Amer. Med. Assoc.,
July 11, 1908, p. 112.

OSTERHANS. Nerve Anastomosis in Infantile Paralysis. Med. Rec., July ll y
1908, p. 54.

LOVELL. The Occurrence of Infantile Paralysis in Massachusetts in 1907.
Boston Med. and Surg. Joum., July 30, 1908, p. 131.

IKyelftlfts—CAT6LA. A proposito di alcune mieliti infettiva s penmen tali. Riv. di
Patol. no v. e ment., guigno 1908, p. 241.

Disseminated Sclerosis.—BAUER. Beitrag sur Frage der Prognose und Therapie
der multiplen Sklerose. Voss, Hamburg, 1908, M. —60.

Pott’s Disease.—T1SSOT. Mort subite dans un cas de mal de Pott silenoieux.
Prog. mSd., aodt 15, 1908, p. 399.

SERVICE Le Pseudo-Mal de Pott syphilitique chez 1’adulte. Firmin, Mon-
' tane et Sicardi, Montpellier, 1908.

78*

BIBLIOGRAPHY

Thumi—ALESSANDRI und MINGAZZINI. Beitrag sum Studium der durch
Geschosseeneugten Ruckenm&rksverletsungen. Monatsechr. f. PsyckiaL «•
Neurol., Aug. 1908, 8. 112.

—MOELLER. An Unusual Case of Cerebro-Spinal Meningitis treated
with Antimeningitis Serum. Med. Rec., July 18, 1908, p. 19.

FLEXNER and JOBLING. Analysis of 400 Cases of Epidemic Meningitis
treated with the Antimeningitis Serum. Joum. Amer. Med. Assoc ., July 25,
1908, p. 269.

LEO COHN. Ueber Zerebrospinalmeningitis. Med. Klinik , Aug. 16, 1906,
S. 1260.

ERNEST WATT. A Digest of Eighty-Six Cases of Epidemic Cerebro-Spinal
Meningitis admitted to the Middle Ward Hospital, Motherwell, in 1907. Lancet,
Aug. 22, 1908, d. 624.

COMMANDEUR. Des m&iingites c^rebrales et c€r 6 brospinales suppur 6 es au
oours de la puerp^ralitA UObsUtrique, juin 1908, p. 289.

■MBorvhage.—M. et Mme. DEJERINE. Presentation d’une Photographic en
oouleur d'une H^morragie M 6 ning 6 e en nappe occupant l’Espace Sous-Arach*
noidien. (Soc. de neurol.) Rev. Neurol., juillet 15, 1908, p. 70a
A. R. ALLEN. Haemorrhage into the Ventricles. Joum. Amer. Med . Assoc., July
18, 1908, p. 216.

Byphllis*—BIRNBAUM. Ueber Geisteestdrungen bei Gehirnsyphilis. AUg.
Ztschr. f. Psychiat. , Bd. 66 , H. 3, 1908, S. 340.

■emlplegfcu—KLIPPEL, SERGUEFF et WEIL. Hemiplegia C 6 r 6 brale aveo
Troubles marquees de la Sensibility. (Soc. de neuroL) Rev. Nenvoi., juillet 15,
1908, p. 694.

Aphasia.—QUENSEL. tjber Erscheinungen und Grundlagen der Worttaubheit»
D. Ztschr./. NervtHheUk., Bd. 35, H. 1-2, 1908, S. 25.

RAYMOND et SEZARY. Aphasie Hystyrique. (Soc. de neurol.) Rev. NewroL ,
juillet 15, 1908, p. 683.

DEJERINE et TINEL. Un oas d'Aphasie de Broca. (Soc. de neurol.) Rev .
Neurol. , juillet 16, 1908, p. 691.

Tamoar* — ZOLLNER. Ein Fall Ton Tumor der Sch&delbasis ausgehend von der
Hypophyse. Arch. /. Psychiat. u. Nervenkrankh ., Bd. 44, H. 2, 1§08, S. 815.
SEIFFER. Zur Pathologie der Kleinhirngeschwiilste. Berl. Min. Wchnschr.,
Aug. 10, 1908, S. 1477.

MEYER. Glioma of the Brain. N. Y. Med. Joum., July 4. 1908, p. 4.

M'KENN AN. A Case of Neuroglioma Gangliocellulare of the Brain; Operation ;
Recovery. N.Y. Med. Joum., July 18, 1908, p. 115.

BAB1NSKI et CLCNET. Tumours Myningyes unilat4ralea. Hymiptegie
siygeant du m&me cOty que lea Tumeure. (Soc. de neurol.) Rev. Neurol.,
juillet 15, 1908, p. 707.

RAIMIST. Zur Kasuistik der Kleinhimtumoren. Neurol. Cerdralbl., Aug. 16,
1908, S. 762.

MILLS and FRAZIER. A Brain Tumour Localised and Completely Removed,
with Some Discussion of the Symptomatology of Lesions Variously Distributed in
the Parietal Lobe. Joum. Nerv. and Ment. Die., Aug. 1908, p. 481.

AaearlHm.—ALEXANDER BRUCE. A Case of Arterio-Venous Aneurism of the
Internal Carotid Artery and Cavernous Sinus. Rev. Neuiol. and Psychiat., Aug.
1908, p. 462,

BRUCE, PIRIE and MACDONALD. Aneurism of the Anterior Cerebral
Artery, with Unusual Prolongation of Life after Rupture ; Autopsy. Rev. NeuroL
and Psychiat., Aug. 1908, p. 449.

Acromegaly.—ROUBTNOVITCH. Sur un cas d’ocromygalie avec epilepsie et
psychose maniaque dypressive. Qaz. dee Hdp., aoOt 6 , 1908, p. 1059.

Arteriosclerosis.—GALLl. Kiinstliche Hyperttmie des Gehirns bei initialer
Gehirnarteriosklerose. Munch, med. Wchnschr., Aug. 4, 1908, S. 1634.

Encephalo-Myelltis. —BRISSAUD et GY. Un oas de Poliencyphalomyyiite aigue.
(Soc. de neurol.) Rev. Neurol., juillet 15, 1908, p. 705.

Traama.—BOWLBY. Two Clinical Lectures on Injuries of the Head. Clin. Joum.,
July 22 and Aug. 5, 1908, pp. 241, 257.

REYHER. Ein Fall von Trauma des Hinterkopfes. St Peters, med. Wchnschr . t
Nr. 29, 1908, S. 313.

BIBLIOGRAPHY 79*

JOHN JENKS THOMAS. Injuries of Cranial Nerves from Fractures of the
Skull Journ. Amer. Med. Assoc., July 25,1908, p. 271.

BABINSKI. Les Measures par armes k feu dans la region temporals. Journ.
du Prat ., iuillet 18, 1908, p. 456.

CUSTODIS. Die Verletzung der Arteria meningea media. Hireohwald, Berlin,
1908. M. 3.

Cerebellum — ALFRED GORDON. A Special Diagnostic Phenomenon in Cere¬
bellar Disease. Report of Six Cases. Journ. Amer. Med. Assoc., Aug. 8 , 1908.
p. 461.

6IMUUL AND FUNCTIONAL DISEASES—

Hysteria. —ALQUIER. Le problems de lliysttfrie. Oat. dee H6p., aoflt 8 , 1908,
p. 1071.

MEIGE. La revision de rhyst 6 rie k la Soci 6 t 4 de Neurologie de Paris : Sur la
suggestion. Preeee mid., juillet 25, 1908, p. 474.

KAFKA. Zur Kenntnis der Gerichtafelasinschr&nkungen von hemianopischen
Typus auf hysteriacher Grundlage. Pray. med. Wchnschr, ., Aug. 18, 1908, S. 488.
DONATH. Ueber hysterische Amnesia. Arch. f. Psychiat. a. Nervenheilk.,
Bd. 44, H. 2, 1908, S. 559.

PALLMANN. Die hysterische Frau als Mtfrderin und Verbreoherin. Marrtf,
Leipzig, 1908, M. —50.

Epilepsy, —C. G. POLK. Epilepsy in Private Practice, especially that from Reflex
Causes. Med. Rec., Aug. 1, 1908, p. 186.

EULENBERG. Zur di&tetischen und pharmazeutischen Epilepsiebehandlung in
der arztlichen Privatpraxis. Med. Klinik, Aug. 9, 1908, S. 1229.

LUNDBORG. Ueber die sogenannte metatropische Behandlungsmethode nach
Toulouse-Richet gegen Epilepsia. Arch. f. Psychiat. u. Nervenkrankh.. Bd. 44,
H. 2, 1908, S. 452.

Headache,— WILFRED HARRIS. An Address on the Troatment of some of the
Severer Forms of Headache. Brit. Med. Journ. , Aug. 8 , 1908, p. 297.

BALLET et BOUDON. C4phal4e intense, avec Lymphocytose r^comment oon-
stat€e datant de 10 ans, sans symptdmes nets de lteion organique. (Soo. de
neurol.) Rev. Neurol., juillet 15, 1908, p. 701.

Migraine.—G. L. WALTON. Migraine an Occupation Neurosis. Journ. Amer
Med. Assoc. , July 18, 1908, p. 200.

HUBBELL. The Relation of So-called Ophthalmic Migraine to Epilepsy. Journ.
Amer. Med. Assoc., Aug. 8, 1908, p. 480.

Neuralgia,—Formes cliniques et diagnostiques des nlvralgies. (Rapport au Con*
grfes Fran 9 ais.) Semaine mid., aofct 5, 1908, p. 376.

JL^VY et BAUDOUIN. A propos du Traitement des Nlvralgies Faciales par lea
injectionsd’Alcool. (Soc. de neurol.) Rev. Neurol., juillet 15, 1908, p. 685.

Tranmatle Neuroses. — REBIZZI. Contributo alia Conoscenza della Nevrosi
Traumatica. Nota Clinical. Tipografia Perugina, Perugia, 1908.

Chorea.—FERRARIS-WYSS. Der Rheumatismus als Nachkrankheit der Chorea
minor. Jahrb. f. Kinderheilk ., Juli 4, 1908, 8 . 60.

FRIEDENTHAL. Ein Fall von Huntingtonischer Chorea. St Peters, med.
Wchnschr., Nr. 29, 1908, S. 312.

STEYERTHAL. Ueber Huntington’sche Chorea. Anh.f. Psychiat. u. Nerven •
krankh., Bd. 44, H. 2, 1908, S. 656.

Paralysis Agitans. —PELZ. Ein Beitrag zur Symptomatologie der Paralysis
agitans. Neurol. Centralbl., Aug. 1, 1908, S. 720.

MUR1YASU. Zur pathologiscnen Anatomie der Paralysis agitans. Arch. /.
Psychiat. u. Nervenkmnkh. , Bd. 44, H. 2, 1908, S. 787.

DYLEFF. Sur la Force Musculaire dans la Maiadie de Parkinson. (Soo. de
neurol) Rev. Neurol ., juillet 15, 1908, p. 680.

Exophthalmic Goitre,— DEBOVE. Le goitre exophthalmique. Journ. des Prat. 9
aoflt 15, 1908, p. 513.

GROBER. Zum erblichen Auftreten der Basedow’schen Krankheit. Med. Klinik,
Aug. 16, 1908, S. 1262.

HILDEBRANDT. Die chirurgische Behandlung des Basedow'schen Krankheit.
Berl. klin. Wchnschr., Juli 20, 1908, S. 1362.

80*

BIBLIOGRAPHY

TftaftM.—VINCENT. Le phlnomfene d’appel dans l^tiologio du tltanos. Joum.
de Physiol ., Nr. 4, 1908, p. 664.

POCHHAMMER. Experimentelle Benchtigungen cor Pathogenese dee lokalen
Tetanus. D. med. Wcknschr. , Aug. 13, 1908, 8. 1425.

Pellagra.—BELLAMY. Pellagra : its Occurrence in this Country. Joum. Amur.
Med . Assoc., Aug. 1, 1908, p. 397.

NICOLAS et JAMBON. Contribution i l'ltude de la pellagra et du syndrome
pellagreux. Ann. de Dermatol., juillet 1908, p. 385.

Aleekellsas.—DANNREUTHER. A Practical Consideration of Delirium Tremens,
with Special Reference to its Treatment. N.Y. Med. Joum., July 11, 1908,
p. 57.

Drag Habit* —SIR DTCE DUCKWORTH. A Clinical Lecture on the Opium
Habit and Morphinism. Lancet, Aug. 15, 1908, p. 439.

HANKELN. fan Fall von Bromismus. Alia. Ztschr. f. PtuchiaL , Bd. 65, H. 3,
1908, S. 366.

Rabies.—RUCKER. The Smear Method as a Means of the Rapid Diagnosis of
Rabies. Joum. Amer. Med. Assoc., July 25, 1908, p. 288.

IPICIAL ftKNBES AND CRANIAL NERVES—

FRI EDEN WALD. Differential Diagnosis of Affections of the Optic Nerve.

Joum. Amer. Med. Assoc., Aug. 8, 1908, p. 483.

BONNE Zur Entstehung der konjugierten Deviation der Augen. D. Ztsckr.f.
Nervenheilk., Bd. 35, H. 1-2, 1908, §. 2.

Mme. DEJERIXE KLUMPKE. Paralysis radiculaire totals du plexus brachial
avec phenomfenes oculo-pupill&ires autopsies trente-six jours aprfes l’accident.
Rev. Neurol., juillet 15, 190o, p. 637.

MISCELLANEOUS CASES—

LEVY et TOURNAY. H6morr&gies cutan6es. Albuminuria, Hypertension
art6rielle, N6vropathie. (Soc. de neuroL) Rev. NturoL , juillet 15, 1908, p. 702.
CHEl NISSE. L'ent6ro-myxorrho£e nerveuse. Semaine mid. , aoOt 12,1908, p. 385.
MATHIEU. Troubles digestifs d’origine psychique. Joum. des Prat. , aoOt 15,
1908, p. 516.

WINCKELMANN. Ueber nevroee Storungen der Herxt&tigkeit. Med. Klinik,
Juli 26, 1908, S. 1139.

BULKELEY and JANEWAY. Nutritive and Neurotic Disturbances of the Hair.
Joum. Amei\ Med. Assoc., July 25, 1908, p. 279.

GOLDSTEIN. Intermittierendes Hinken eines Baines, eines Armes, der Sprach-.
Augen- und Kehlkopfmuskulatur. Intermittierendes Hinken oder Myasthenic F
Neurol . Centralbl., Aug. 16, 1908, S. 754.

BYROM B RAM WELL. Intermittent Claudication, or Intermittent Limping
and Obliterative Arteritis, with Illustrative Cases. Lancet, July 25, 1908, j>. 229.
ORBISON. Herpes of the Membrana Tympani; due to Zosteroid Affection of
the Petrosal Ganglion. Joum. Nerv. and Meni. Dis. , Aug. 1908, p. 500.

NONNE und FROND. Klinische und anatomische Untersuchung von sechs
F&llen von Pseudo-systemerkrankung des RUckenmarks. D. Ztschr. /. NervenheiH
Bd. 35, H. 1-2, 1908, S. 102.

PSYCHIATRY

DERCUM. Elements of Psychiatrical Prognosis. Joum. A mer. Med. Assoc., July
11,1908, p. 108.

WESLEY SMITH. Insanity: its Genesis and Transmissibility. Med. Rsc
July 11,1908, p. 57.

PLONIES. Der Verminderung des GedSchtnisses und der geistigen Leistungen
durch gastrogene Toxine mit besonderer Beriicksichtigung des Einflusses der
An&mie und UnterernShrung. D . Ztschr. f. Nervenheilk ., Bd. 36, H. 1-2, 1908,
S. 75.

CRAMER. Psychiatriscbe Wiinsche zur Strafrechtsreform. Munch, used.

Wchnschr., Juli 21 u. 28, 1908, Sn. 1529, 1593.

ROBERT JONES. How to Secure Mental Health and How to Prevent Mental
Breakdown. Practitioner , Aug. 1908, p. 229.

NACKE. tJber Familienmord durch Geisteskranke. Marhold, Halle, 1906,
M. 4.

BIBLIOGRAPHY

81*

ALEXANDER ROBERTSON. Observations on the Less Severe Forms, Path*
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July 1903, p 500.

ROBERT JONES. The Mental Recreations of the Mental Nurse. Joum. Merit .
Sc., July 1908, p. 490.

BERNARD HART. A Philosophy of Psychiatry. Joum. Ment. Sc. f July 1908,
p. 473.

LEONARD BAUGH. Observations on Insane Epileptics Treated under Hospital
Principles. Joum. Ment Sc., July 1908, p. 518.

HARVEY BAIRD. Some Observations on Insanity in Jews. Joum. Ment. Sc.,
July 1908, p. 528.

R. CUNYNGHAM BROWN. The Boarding-Out of the Insane in Private Dwell¬
ings. Joum. Ment. Sc., July 1908, p. 532.

D. G. THOMSON. The Teaching of Psychiatry. Joum. Ment. Sc., July 1908,
p. 550.

WILLIAM FLETCHER* Latah and Crime. Lancet , July 25, 1908, p. 254.
PAILHAS. De Tart primitif chez I’ali6n6. L*Enciphale, aoOt 1908, p. 196.

ALT. Die Heilsaussichten in der Irrenanstalt Neurol. Centralbl., Aug. 1, 1908,

S. 706.

RAMADIER et MARCH AND. La glande thyroide chez les alilnds. I»En-

ctpkale , aoOt 1908, p. 121.

EDMOND CORNU. Le rein mobile dans ses rapports avec les troubles mentaux.
L'Encivhalc, aoCtt 1908, p. 175.

LADAME. L’association des iddes et son utilisation comme m£thode d’examen
dans les maladies mentales. L'Knciphale, aoilt 1908, p. 180.

PAIN et SCHWARTZ. Hallucinations aveo impulsions sous l’influenoe du tabac.
L'Encipkale, aoClt 1908, p. 199.

J. S. BOLTON. Maniacal-depresdve Insanity. Brain, r Vol. xxxi., Part 122,
1908, p. 301.

DOLLKEN. Ueber Hallucinationen und Gedankenlautwerden. Arch. f. Psychiat.
u. Nei'venkrankh. , Bd. 44, H. 2, 1908, S. 425.

DONLEY. The Clinical Use of Hypnoidiaation in the Treatment of some Func¬
tional Psychoses. Joum. Abnorm. Psychol ., Aug.-Sept 1908, p. 148.
Melancholia.—JOFFROY. Les homicides dans la melancholic. Joum. da Prat.,
juilJet 25, 1908, p. 470.

DOBLLN. Zur pemiziosverlaufenden Melancholic. Alla. Ztschr. f. Psychiat .,
Bd. 65, H. 3, 1908, S. 361.

Dementia Prrecox.—WIEG-WICKENTHAL. Zur Klinik der Dementia praecox.
Mar hold, Halle, 1908, M. 3.

ZABLOCKA. Zur Prognosestellung bei der Dementia praecox. Allg. Ztschr. f.
Psychiat., Bd. 65, H. 3, 1908, S. 318.

ZIM MERMAN N. Kasuistischer Beitrag zur Atiologie undpathologisohen Ana¬
tomic der Dementia praecox. Voss, Hamburg, 1908, M. 1.20.

BRENNECKE. Dementia praecox in der Armee. Grieben, Leipzig, 1908, M. 1.
GABRIEL DROMARD. Apraxie et d£mence pr6coce. L'Enc&phalc, aoClt 1908,

p. 162.

EARL ABRAHAM. Die psychosexuellen Differenzen der Hysterie und der De¬
mentia praecox. Zentralbl.f. Nervenheilk. u. Psychiat ., Nr. 2o5, 1908, S. 521.

THWAITES. Dementia Pracox and Mental Degeneracy in Syria. Joum. Ment.
Sc., July 1908, p. 511.

Ctencral Paralysis.—COLIN M‘DOWELL. General Paralysis in Father, Mother,
and Son. Joum. Ment. Sc., July 1908, p. 562.

PILCZ. Beitrag zur Lehre von der iconjugaleh, hereditaren und famili&ren
Paralyse progressiva. Wien, med . Wchnschr., Aug. 8 u. 15, 1908.

RODIET. L’in6galite pupillaire dans la paralysie g6n£rale. Arch. OSn. de Mid.,
iuillet 1908, p. 423.

JUNG und ARNDT. Zur Statistik, Aetologie, Symptomatologie und patholo-
gischen Anatomie der progressiven Paralyse. Arch, f Psychiat. u. Nervenheilk.,
Bd. 44, H. 2, 1907, S. 493.

Miscellaneous Cases.— HALBERG. Ueber das Symptom des “ Gedanken-

sichtbarwerdens.” Allg. Ztschr. f. Psychiat., Bd. 65, H. 3, 1908, S. 807.

TREATMENT *

AGNIEL. Sur la Phototli6rapie et quelques-unes de ses applications dans les
maladies nerveuses. (Thfcse.) Waltener et Cie, Lyon, 1908.

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

82*

BIBLIOGRAPHY

Psyefcetherapy. —L. F. BARKER. Psychotherapy. Jo ter*. A our. Mod. Assoc.,
Aug. 1, 1908, p. 868.

■toctretfcerapy. —BECK. A New Method of Treatment of Sinuses and Abscess
Cavities. Arch, of the Roentgen Rags , Aug. 1908, p. 04.

LOUIS DKLHERM. La radiothtfrapie dans les affections mddullaires. Arch,
i Sleet MU., juillet 26, 1908, p. 661.

Smrgteal.—A. KNAPP. The Surgical Treatment of Orbital Complications in
Diseases of the Nasal Accessory Sinuses. Joum. Amer. Med. Assoc., July 25,
1908, p. 299.

GORSKY. Contribution au traitement obirurgical de la nlrralgie facials.

S ChfeseJ Waltener, Lyon, 1908.

. F. COTT. Facio-hypoglossal anastomoses. Joum. Amer. Med. Assoc., Aug.
8 . 1908, p. 455.

BECK. A New Method of Frontal Sinus Operation without Deformity. Joum.
Amor . Mod. Assoc» Aug. 8, 1908, p. 451.

KRAUSE Zur Frage der Hirnpunktion. Berl. klin. Wchnschr., Juli 20, 1908,
a 1851

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ANATOMY

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554.

G. BOSCHI. Richerche sui centri nervosi di un embrione umano di duo
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VAN DER STRICHT. L’histog&nese des parties constituantes du neuro-
epithelium acoustique des taches et des crates acoustiques et de l’organe de
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PHYSIOLOGY

SALVJOTI et CARRARO. Sur la physiologie de Thypophyse. Arch. ital. de
Biol., T. 49, f. 1, 1908, p. 1.

POLIMANTI. Contribution a la Physiologic du rhinenclphalie. Jouvn. de
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F. H. SCOTT. On the Relative Parts played by Nervous and Chemical Factors
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SALA. Sur les faits qui se d6veloppent a la suite des Measures aseptiques du
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VAN BEMBEKE. Considerations sur la genese du n6vraxe, specialement sur
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DELAUNEY. L’existence probable du nerfs excitoglandulaires pour la secretion
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MACLEOD and RUH. The Influence of Stimulation of the Great Splanchnic
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PSYCHOLOGY.

RICHARD HENNING. BeitrSge zur Psychologic des Doppel-Ichs. ZeiLf. Psych,
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ANATHON AALL. Uber den Masstab beim Tiefensehen in Doppelbildern.
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E. v. ASTER. Die psyehologische Beobachtung und experimentelle Unter-
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H. 1-2, S. 56.

KOFFKA. Untersuchungen an oinem protanomalen System. Ztschr.f. Sinnes -
physiol ., Abt. ii., Bd. 43, H. 1-2, 1908, S. 123.

hENIUS. Die Abhiingigkeit der Lichtempfindlichkoit von dor Flachengrosse des
Reizobjektes unter den Bedingungen des Tagossohens und des Dammerungs-
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VON MALTZEW. Ueber individuelle Verschiedonhcit dor Helligkeitsvorteilung
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83 *

84*

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VON KRIE3. Ueber ein fiir das phyaiologische Praktikum geeignetes Verfahren
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LEONTOWITSCH. Das Weber-Fechnersche Geeetz bei Reizung der Haut durch
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43, H. 1-2, 1908, S. 17.

FnEUND. Zum Lehre vom binokularen Sehen. Ztschr./. Sinnesphysio!. , Abt. ii.,
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LIEBERMANN und REVESZ. Ueber Orthosymphouie. Ztschr. f. Psycho!.,
1 Abt., Bd. 48, H. 3-4, 1908, S. 259.

HELLPACH. Unbewusstes oder Wechselwirkung. Ztschr.f. Psychol., 1 Abt., Bd.
48, H. 3-4 u. 5-0, 1908, Sn. 238 u. 321.

W1EGAND. Untersuchungen liber die Bedeutung der Gest&ltqualitSt Fur die
Erkennung von Wortem. Ztschr. f. Psychol ., 1 Abt., Bd. 48, H. 3-4, 1908,

S. 161.

WILLI WARSTAT. Das Tragische. Eine psychologisch-kritische Unter-
suchung. Arch. f. d. gesamtc Psycho! Bd. 13, fl. 1 a. 2, 8. 1.

VITTORIO BENUSSI. Zur experimentellen Analyse des Zeitvergleichs. Arch,
f. d . gesamtc Psycho!. , Bd. 13, H. 1 u. 2, S. 71.

SCHULZE. Monochord zur Bestimmung der oberen Horgrenze und der Perzep-
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T. j! DE BOER. Zur gegenseitigen Wortassoziation. Zdt.f. Psych u. Phys i. dc
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ERICH BECHER. Energieerhaltung und psycbologische Wechaelwirkung. Zeit.
f. Psych, u. Phys. der Sinnesorgane , Bd. 48, H. 5 u. 6, S. 406.

OTTO LIPMA&N. Eine Methods zur Vergleichung von zwei Kollektivgegen-
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PATHOLOGY

G. FICHERA. Per lo studio della struttura normale e patologica del sistema
nervoeo. Nuovi metodi di indagine microscopica. Riv. at Pat . ncre. e merit.,
Vol. xiii, Fasc. 7, p. 310.

8 . PRATI. Sulla resistenza del reticolo intemo delle cellule nervose alia putre-
fazione. Ann. di Freniatria, Mar. 1908, p. 33.

LONG et ROUSSY. ifctude des d£g 6 n£rescenoe 8 secondaires descendantes de
la formation r£ticul£e, chez Thom me, cons£cutives aux lesions en foyer de la calotte
p^donculaire. Rev. Neurol., aofit 15, 1908, p. 757.

G. D’ABUNDO. Dottrina metamerica e rigenerazione oonsecutiva alio strappo
contemporaneo del prolungamento midollare di molteplici gangli intervertebrali
nei primi tempi della vita extra-uterina. Riv. Ital. di Neuropat ., PsichiaU e
Elettrotcrap., Vol. i., Fasc. 8 , p. 353.

J. N. LANGLEY. The Reaction of Frog's Muscle to Nicotine after Denervation.
Joum. of Phys., Vol. xxxvii., No. 4, p. 285.

V. SCARPINI. Le leeioni primarie delle fibre nervose nell* urinemia, studiate in
condizioni sperimentali con la colorazione positive di Donaggio per le degenera-
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TORATO SANO. tJber das entgiftende Vermbgen einzelner Gehimabechnitte
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Psychiat .. Bd. 65, H. 4. S. 657.

A. W. ZINGERLE. Ueber einen Fall von Hydrencephalocele frontalis. Beit .
zur Path. Anatom., Bd. 44, H. 1, S. 36.

PIKE, GUTHRIE, and STEWART. Studies in Resuscitation: Return of Function
in the Central Nervous System after Temporary Cerebral Anaemia. Journ.
Experiment. Med., July 8 , 1908, p. 490.

WOSSIDLO. Experimentelle Untersuchungen und Ver&nderung der Nisslschen
Granule bei der Lumbalanasthesie. Arch. f. klin. Chir., Bd. 86 , H. 4, 1908,

S. 1017.

GUERRINI. Sur la fonction des muscles d£g£n 6 res. L&ions morphologiques
et leur rapport aveo les alterations fonetionnelies. Arch. ital. de Bio!., T. 49 . 4
f. 1, 1908, d. 49.

GUERRINI. Sur la fonction des muscles d 6 g£n£res. Courbes de contraction ;
courbe iaotonique, oourbe isom 6 trique, oourbe v4ratrmique. drrA ital. de Biol.,

T. 49, f. 1, 1908, p. 57.

BIBLIOGRAPHY

85*

CLINICAL NEUROLOGY

STERTZ. Die Serodiagnostik in der Psychiatric und Neurologic. Alla, ZeU .
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M. K. KASSABIAN. Roentgenology in Neurology. Joum. Am, Med. Assoc, t
Aug. 29, 1908, p. 723.

W. FEILCHENFELD. Gehaufte Erkrankungen des Nervensystems bei einer
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A. PILCZ. Konjugale, hereditare und familiare Paralysie progressiva. Wien,
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W. A. JONES. Disease of the Cerebral Vessels, with Problems in Diagnosis.
Joum. Amer. Med. Assoc., July 18, 1908, p. 179.

MI&CLE&—

ZIEHEN. Beziehungen zwischen angeborenen Muskeldefekten, infantilem
Kernschwund und Dystrophia muscularis progressiva infantilis. Btrl. klin. Woch.,
Aug. 24, 1908, S. 1557.

MUNTZ Eine eigenartige Form progressiver seitlicher Kieferdeviation myogener
Natur. D. med. Wchnscnr ., Juli 30, 1908, S. 1849.

PERIPHERAL NERVES—

DISEN. Inflammation of the Circumflex Nerve. Med. Rec., July 4, 1908, p. 18.
DORRIEN. Ueber Lahmung des N, supra-scapularis. D. med. Wchnschr., Juli
30, 1908, S. 1345.

J. LEWINSKI. Einseitige Zwerchfallparese bei totaler Plexuslahmung mit
Sympathikusbeteiligung. Med. Khn. % Sept 13, 1908, p. 1413.

SPINAL CORD—

Pachymeningitis. —CHRISTIAN SIEBERT. Ein Fall von Pachymeningitis
cervicalis hypertrophies. St Petersburg med. Wchn. , Aug. 22, 1908.

Serous Meningitis. —KURT MENDEL u. S. ADLER. Zur Kenntnis der Menin¬
gitis Serosa Spinalis. Berl. klin. Woch ., Aug. 31, 1908, S. 1596.

Tabes.— TOM WILLIAMS. Pathogenesis of Tabes Dorsalis. Amer. Joum. Med.
Sc., Aug. 1908, p. 206.

SCHOTZE. Tabes und Lues. Ztechr. f. klin. Med., Bd. 65, H. 5-6, 1908, 8.
397.

S. BONELLI. Tabe doraale giovanile d’origine tubercolare. Ann. d. Freniatria,
Mar. 1908. p. 11.

FRIEDBEKG and FREER. Laryngeal Crises and Paresis of the Abductors of
the Vocal Cords as important early Symptoms of Tabes. Report of a Case. Joum.
Amer. Med. Assoc., Sept. 5, 1908, p. 815.

KNAUER. Ueber Porsche Augenkrisen und einige seltenere Sensibilit&ts-sttir-
ungen bei Tabes Dorsalis. Miinch. med. Woch., Sept 15, 1908, p. 1926.

D. DE VRIES REILINGH. Over den invloed der olfeningstherapie volgens
Frenkel op de geleidingsnelheid in het periphere centripetele neuron bij tabes
dorsalis. Ned. Tijdschr. voor Oeneeskunde, Tweede H., No. 9, p. 719.

Friedreich*! A tax I e.—J. GEERTS. Deux Cas de Maladie di Friedreich. Joum,
de Neurol., Aug. 5, 1908, p. 281.

Poliomyelitis.— WOLLSTEIN. A Biological Study of the Cerebro-spinal Fluid in
Anterior Poliomyelitis. Joum. Experiment. Med., July 8, 1908, p. 476.

Paraplegia.— J. M. CLARKE. A Clinical Lecture on Three Cases of Paraplegia,
etc. Brit. Med. Joum., Sept. 12, 1908, p. 699.

Disseminated Sclerosis.—HOLDEN. The Optic Nerve Changes in Multiple
Sclerosis, with Remarks on the Causation of Non-toxic Retrobulbar Neuritis in
General. Joum. Amer. Med. Assoc., July 11, 1908, p. 120.

BAGH. Ueber Neuritis optica bei multipier Sklerose. Klin. Monatsbl. f. Augen-
UUk., Juli 1908, S. 10.

86 *

BIBLIOGRAPHY

AUGUST KNOBLAUCH. Ein Fall von multipler Sklerose, komplmert durch
eine chronische Geistesstorung. Monatsschr. f. Psychiat. u. Aeurol., Sept. 1903,
8. 238.

SCHLEY. Die Bedeutung der Sehnervenerkrankungen in Fruhstadium der mul-
tiplen Sklerose. Bed. klin. Sept. 21, 1908, S. 1724.

LAMBRIOR. Un cas de sclerose en plaques avec hypotonie. Rev. nenrol.. Sept.
15, 1908, p. 906.

MURRELL. A Case of Acute Disseminated Sclerosis. Med. Press , July 15, 1908,
p. 59.

Syriagemyella*—SOLLIER et CHARTIER. Un cas de Syringomyelia Cervico-
bulbaire. LBnciphale, Sept. 1908, p. 249.

ENDERS. Ein Fall von Syringobulbie mit Sektionsbefund. D. Arch. f. lit a.
Med., Bd. 93, H. 5-6, 1908, S. 608.

Traanuu—C. D. CAMP. Traumatic Cervical Myelomalacia. Journ. Amev. Med .
Assoc., Aug. 22, 1908, p. 684.

Cmmdm Equina.—S. S. RABINOWITSCH. Beitrag zu den Erkrankungen des
Conus medullaris. Btrl. khn. If och., Aug. 31, 1908, S. 1610.

KLINEBERGEU. Klinischer Beitrag zu den Erkrankunger der Cauda equina.
Monatsschr. f. Psychiat. u. Neurol. 9 Aug. 1908, S. 97.

gptaa Bifida. —PETER PATERSON. The Treatment of Spina Bifida by Drainage
of the Cerebral Subdural Space. Lancet, Aug. 15, 1903, p. 456.

Vertebral Column.—A. CITELLI. Contribute alio studio della spondilosi
rizomelica. Riv. crit. di elm. sued., No. 35, 1908.

VAN ASSEN. Eine seltene Verletzung der Wirbelsaule. Ztschr. f. orthopdd.
Chir., Bd. 21, H. 1-3, 1908, S. 117.

Cerebro-3plnal Fluid.—REHM. Ergebnisse der zytologischen Untersuchungen
der Zerebrospinalfliissigkeit un i deren Aussichten. Minch, med. Wchnschr.,
Aug. 4, 1908, S. 1636.

CHOTZEN. Die Lumbalpunktion in der psychiatriscben Diagnostik. Med.
Klinik, Aug. 9 u. 16, Sn. 1226, 1265.

APELT und SCHUMM. Untersuchungen liber den Phosphorsauregehalt der
SpinalflIissigkeit under pathologischen Verhaltnissen. Airh. /. PsycJiiat. u.
Nervenkrankh., Bd. 44, H. 2, 1903, S. 845.

I. BERGAMASCO. Sul liquido cerebro-spinale. Riv. ait. di din. med ., No.
36, 1908.

P. NEU u. 0. HERMANN. Experi men telle Untersuchungen liber Lumbal-
punktionen bei gleichzeitiger Anwendung von passiver Hyperamie des Kopfes.
Monatsschr. f. Psychiat. u. Neurol., Sept. 1908, S. 251.

F. S. ME1JERS. Bigdrage tot de klinische Waarde der Lumbaalpunkte. Ned.
Tijdsch. voor Geneeskunde, Tweede H., No. 10, p 775.

R. D. RUDOLF. The Clinical Estimation of the Pressure of the Cerebro-Spinal
Fluid. Canadian Practitioner, Vol. xxxiiL, No. 9, p. 545.

BBA1N—

JACOBSOHN. Fehldiagnoson in der Lokalisation von KrankheitsprozeflSen der
Groashirnhemispharen bedingt durch die Uberragende funktionelle Stellung der
linken Hemisphiire gegenliber der rechten. Beit. s. Anal., etc., des Okres, Aug.

1908, S. 366.

6NODI. Ueber die rhinogenen Gehirnkomplikationen, Wien. med. Wchnschr .,
Aug. 15, 1908, S. 1826.

Menlnaltls.— LEWIS THOMSON. The Epidemiology and Infectivity of Cerebro-
Spinal Meningitis. Med. Press, Sept. 23, 1908, p. 344.

JOSEPH BEARD. Two Cases of Meningitis admitted to Hospital as Enteric
Fever, with Treatment. Ldin. Med. Jou.rn., Sept. 1908, p. 212.

Li KIRCHHEIM. Meningismus und Meningo-Encephalitis bei krouposer
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BIBLIOGRAPHY 87*

S. WEISS EDER. Ueber komplikationen und Serum-therapie bei Meningitis
cerebrospinalis epidemica. Med. Klinik, Aug. 30, 1908, p. 1337.

BARNES. Serum Treatment of Cerebro-Spinal Meningitis, Canadian Practitioner,
Aug. 1908, p. 489.

Hsemorrhage. — GILBERT. Case of Extra-dural Haemorrhage; Operation;
Recovery. Austral. Med. Gaz., June 20, 1908, p. 292.

Aphasia.—KOBRAK. Allgemeine Pathogenese und Symptomatology der kind-
lichen Sprachstorungen, insbesondere der Stotterns. Med. Klinik , Juli 26, 1908,

S. 1152.

H. GUTZMANN. Sprachstorungen und Sprachhelkunde. St Peters. med.
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T. CORTES I. Un Caso di apasia totale per lesione sottocorticale della zona di
Broca e della zona di Wernicke. Ric. di Pat. nerv. t ment , Aug. 1908, p. 337.
KARL LIEBISCHER. Die transkortikale motorische Aphasie in ihren Bede-
hungen zu den Psychosen. Monatsschr. f. Psychiat. u. Neurol., Bd. 24, H. 3,

H. LIEPMANN. Relative Eupraxie bei Rechtsegelahmten. Deul. med.
Wchnschr ., Aug. 20, 1908, S. 1470.

JOHN HAY. Aphasia; Report of Two Cases. Licerpool Med. and Chir. Journ.,
July 1908, p. 342.

BRtJHL. Ueber Taubblinde. Beit. z. A not., etc., des Ohrts, Aug. 1908, S. 351.

HAMME RSCHLAG. Zur Kenntnis der hereditiirdegenerativen Taubstummheit.
Ztschr f. Ohrtnheilk., Bd. 56, H. 2, 1907, S. 126.

SEMI MEYER. Korticale sensorische Aphasie mit erhaltenem Lesen. Neurol.
Centmlbl ., Sept. 1908, S. 814.

F. H. LEWY. Ein ungewohnlicher Fall von Sprachstorung als Beitrag zu Lehre
von der sogennanten amnestischen und Leitungsaphasie. Neurol. Centralbl.,
Sept. 1 u. 16, 1908, S. 802 u. 850.

E. POGGIO. Die korticale Lokalisation der Asymbolie. Neurol. Centralbl .,
Sept 1, 1908, S. 817.

GEERTS. Un Cas d’aphasie avec apraxie. Journ. de Neurol., July 20, 1908,

p. 261.

VARIOT. La c6cit5 cong£nitale pour les mots imprimis. Journ. des Prat.,
aoftt 1,1908, p. 488.

Tumour. —VERCO and POULTON. Hydatid of Brain. Austral. Med. Gaz.,
June 20, 1903, p. 290.

VERCO and POULTON. Fibro-cartilaginous Tumour of Dura Mater. Austral.
Med. Gaz., June 20, 1908, p. 289.

M. J. KARP AS. Report of a Case of Brain Tumour, with Autopsy. Med. Rec .,
Sept. 5, 1903, p. 397.

P. PEROL. La C6phal6e dans les tumeurs de I’enc^phale. Journ. de Med.,
Aug. 22, 1908, p. 333.

Abscess.—E. AM BERG. Cerebral Abscess. Journ. Amer. Med. Assoc., Aug. 22,
1908, p. 667.

Aneurism. —JOHN ROSE BRADFORD. Certain Aneurysms of Cerebral Vessels.
Lancet, Sept. 5, 1908, p. 703.

Encephalo-Myelitls.—MASCHKE. Ueber zwei Falle von Multipler Encephalitis
bei Meningokokken-Meningitis. Berl. klin. Woch., Aug. 24,1908, S. 1561.

Trauma. —G. H. HUME A Case of Traumatic Subdural Hmmatona Trephined
Three Months after Injury. Lancet , Sept. 19, p. 866.

Cerebellum. — F. LOTMAR. Ein Beitrag zur Pathologic des Kleinhirns.
Monatsschr. f. Psychiat. u. Neurol., Sept. 1908, S. 217.

CENEKAI AND FUNCTIONAL DISEASES—

C. F. HOOVER. A New Sign for the Detection of Malingering and Functional
Paresis of the Lower Extremities. Journ. Am&'. Med , Assoc., Aug. 29, 1908, p.
746.

88 *

BIBLIOGRAPHY

Hysteria*— 6 ERLACH. Em Fall von Fahnenflucht in hysterischen Dammar-
sustande. AUg. Zeit. f. PsychiaJL ., Bd. 66 , H. 4, 8 . 640.

NERI. Sur lea c&r&cteres p&radoxaux do la demarche choi loo hystenques.
Y a-t-il une demarche hyst^rique ? Kouv. Icon* de la SalpSt., Mai-Juin 1908,

&ARL URBAN. Pieudo-appendicitis hjitnid Wien. med. Wchiuchr., Nr. 35,
1908 S. 1918.

B. MEYER. Die Behandlung der Hysteric. D. med. Wchn., Sept. 17, 1908,
8 . 1617.

BpUepey.— 1 TILMANN. Anatomiache Befunde bei Epilepsie nach Trauma. Med.
Klinit, Sept. 20, 1908, S. 1442. .

HEINRICH VOGT. Epilepsie und Schwachsinnswutaude im Kindesalter.
Arch./. KinderheM., Bd. 48, H. 5 u. 6, p. 321. ...

G. MARGARIA. Le reeistenze dei globuli rosei alle soluzioui di cloruro di sodio
negli epilletici. .4»a. di Freniatria, Mar. 1908, p. 25.

RODIET, PANSIER et CANS. L’fetat du fond de l’oeil chez lea tipileptiques.
Ann. Med. Psychol., Sept.-Oct 1908, p. 239.

Cfcerea.—GUTHRIE RANKIN. A Clinical Lecture on Chorea. Bril. Med.
Journ., Sept. 12, 1908, p. 696.

MfiRY et BABONNEIX. Un cas do choree mortollo. Oaz. de* HdpiL , Sept. 15,
1908. p. 1251. , _

E. BEYER-RODERBIRKEN. Invalidity durch Huntingtonache Chorea.
Med. Klin., Sept. 13, 1908, p. 1414.

Meanutkeala.—B. WEINSTEIN. Neurasthenia Ventriculi and Gastroptonw.
N. Y. Med . Journ., Sept 12, 1908, p. 608.

Torticollis.— A. BROCA. Torticolis par retraction infla mm atoire du muscle
Stemo-cleido-mastoidien. La Press Mldicalt, Sept. 12, 1908, p. 685.
KOLLAR1TS. Weitere Beitrage sur Kenntnis des Torticollis mentalis (hystericus)
mit eincm Sektionsbefund. D. Ztschr. f. Ntrvenheilk., Bd. 35, H. 1-2, 1908,
S. 141.

Exopfctfcalmic Gel Ire.—OHLEMANN. Zur Based owschen Krankheit Munch,
med. Woch., Sept. 8 , 1908, S. 1883.

LANDSTROM. Ueber Morbus B&sedowii. Ztschr. f. orthopttrt. Chir., Bd. 21,

H. 1-3, 1908, S. 196.

GORDON GULLAN. A Contribution to the Discussion on Exophthalmic Goitre,
with Special Reference to the Antithyroid Treatment. Liverpool Med. and Chir.
Oaz., July 1908, p. 325.

WARRINGTON. Introduction to Discussion at the Liverpool Medical Institu¬
tion on Exophthalmic Goitre. Liverpool Med. and Chir. Journ ., July 1908,
p. 311.

THEODOR KOCHER. Blutuntersuchungen bei Morbus Basedowii mit Beitragep
zur Friihdiagnose und Theorie der Krankheit. Arch. f. klin. Chirurg ., Bd. 87,
H. 1, S. 131.

A. GORDON GULLAN. Exophthalmic Goitre. A Discussion on its Pathology
and Treatment. Lancet , Sept. 5, 1908, p. 708.

CAPELLE. Ein neuer Beit rag zur Basedowthymus. Munch. med. Woch. , Sept.
L 1908, S. 1826.

W. B. SNOW. Treatment of Exopth&lmic Goitre and Myxoedema. Arch. of the
Roent. /fay, Sept. 1908, p. 103.

DUNHILL. Surgical Treatment of Exophthalmic Goitre. Intend. Med . Oaz. of
Austral ., June 20, 1908, p. 293.

Cretinism. —GUY R. EAST. A Case of Cretinism. Journ. Ment. Sc. t July
1908, p. 570.

Telmans.—M. J. ROSTOWZEW. Das Kemig’sche Symptom bei Tetanus. Bert,
klin. Wchn., Sept. 7 u. 14,1908, Sn. 1649 u. 1686.

POWERS. Tetanus, with a Report of a Case treated by Intraspinal Injections of
Magnesium Sulphate. Med . /fee., July 25, 1908, p. 146.

Tetany. —K. WIRTH. Tetanie bei Phosphorvergiftung. Wien. klin. Wchn .,
Sept 17, 1908, S. 1325.

BIBLIOGRAPHY

89*

ADLER und THALER. Experimentelle und klinisehe Studien Uber die
Gravidit&tstetanie. Ztschr.f. Oeburtsh., Bd. 62, H. 2, 1908, 8. 194.

GIOVANNI SAIZ. Beitrag zum Vorkommen und zur Behandlung der Tetania.
Wien, klin. Wchn., Sept. 17. 1908, S. 1323.

HjtithemlA Gravis. —G. MARINES(X). Contribution h l’6tude de la myas-

th6nie grave pseudo-j>aralytique. La Sem. mid.. Sept. 2, 1908, p. 421.

Delle Myasteme gravia (Riviste). Riv. crit. di clin. med., No, 38, 1908.

Alcohol lam.—G. MARGARIA. La frenosi alooolica nel manicomio di Torino, nel
triennio, 1903-5. Ann. di Freniatria, Mar. 1908, p. 40.

ROBERT. L’Alcoolisme. Arch, de Mid. navale , juillet 1908, p. 50.

FECIAL SENSES AND CRANIAL NERVES—

KORNER. Ein Vergleich der klinischer Erscheinungen bei Kern- und Stamm-
l&hmungen des Vagus-Recurrens und der Oculomotorius ala Beitrag zur Kritik dea
aogenannten Rosenbach-Semonschen Gesetzes. Ztschr. f. OhrenheilJb ., Bd. 56,
H. 2, 1908, S. 153.

C. K. MILLS. The Cerebral Centres for Taste and Smell and the Uncinate
Group of Fits. Joum. Am. Med. Ass., Sept. 12, 1908, p. 880.

BLOCH und HECHINGER. Anosmie bei Schlafenlappenabszess. Arch. f.
Ohrenheilk ., Juli 1908, S. 32.

HANSELL. An Infrequent Type of Optic Nerve Atrophy. Joum. Amer. Med.
Assoc., July 25, 1908, p. 290.

V. HIPPEL. Die Palliativtrepanation bei StauungBpapille. Munch, med.
Woch. , Sept. 15, 1908, S. 1916.

VON REUSS. Sehnervenleiden infolge von Graviditat. Wien. klin. Wchnschr .,
Juli 30, 1908, S. 1116.

TOOTH. A Clinical Lecture on a Case of Homonymous Hemianopia, with
unusual Sensory Symptoms. Clin. Joum., Aug. 12, 1908, p. 273.

CASPAR. Herpes Zoster Ophthalmicus and Paralysis of the Trochlearis. Arch,
f. Ophthalmol ., Vol. xxxvii., No. 5, p. 588.

RAMSAY HUNT. A Further Contribution to the Herpetio Inflammation of the
Geniculate Ganglion : a Syndrome characterised by herpes zoster oticus, facialis,
or occipito-collaris, with Facial Palsy and Auditory Symptoms. Amer. Joum.
Med. Sc., Aug. 1908, p. 226.

ARNOLD KNAPP. Paralysis of the Abducent Nerve associated with Otitis
Media. Arch. f. Ophthalmol., Vol. xxxvii., No. 5, p. 552.

GOULERMANN. Zur Kasuistik der Abducensliihmung nach Lumbalanasthesie
mit Tropococain. Berl. klin. Wchnschr., Aug. 17, 1908, S. 152.

RICE. Symptomatology of Recurrent and Abductor Nerve Paralyses of the
larynx. Med. Rcc., Aug. 8 , 1908, p. 220.

LIEBREICH. Die Asymmetric des Gesichtes und ihre Entstehung. Bergmann,
Wiesbaden, 1908, M. 2.

BOUGHAUD. N€vralgie de la face du c 6 t 6 droit et h&nispasme facial du m£me
c 6 t& Rev. Neurol., Sept. 15, 1908, p. 901.

G. FUMAROLA. Contribute alio studio della cura elletrica e chirurgica delle
paralisi periferische del facciale. Riv. di Pat. nerv. e ment ., Faso. 7, voL xiii.,
p. 289.

MACLEOD YEARSLEY. A Case of Severe Vertigo and Tinnitus ; Destruction
of the Labyrinth ; Cure. Lancet , Sept 19, p. 871.

W. E. CASSELBERRY. Recurrent and Abductor Paralysis of the Larynx. Diag¬
nosis and Treatment. Med. Rec ., Aug. 22, 1908, p. 303.

GLE1TSMANN. Recurrent and Abductor Paralysis of the Larynx. Introductory
Remarks on the Anatomy and Physiology of Paralysis of Central Origin. Med.
Rec., July 18, 1908, p. 12.

DELAVAR. The Etiology of Paralysis of the Recurrent Laryngeal Nerves of
Peripheral Origin. Med. Rec., July 18, 1908, p. 92.

SIEBOLD. Traumatischer L&hmung des Halssympathikus. D. med. Wchnschr..
Aug. 6 , 1908, S. 1387.

90*

BIBLIOGRAPHY

MIftCELLANE+IT* CASE®—

DESPLATS. Hypertrophie segmentaire considerable du bras et de l’avant-hras
avec dissociation sy riagomy eiique des sensibilites. Nouv. Icon, de la SalpiL,
Mai-Juin 1908, p. 200.

HOPE et FRENCH. (Edfeme Persistant h£r£ditaire avec Exacerbations digues.
None. Icon, de la Sal pit., Mai-Juin 1908, p. 177.

P. F. BENIGNI. Claudicazione cerebrate psichica? Riv. di Pal . nerv. emenl.,
Vol. xiii., Fasc. 7, p. 300.

RENAUT. Sur un cas de rhumatisme cerebral au coura d’un erythfeme poly¬
forme. Lyon Mid., aotit 9, 1908, p. 197.

LUIGI PANICHI. Beobachtungen Uber den Tremor. Berl. kit*. Wchn.,
Sept. 21, 1908, S. 1723.

W. PEXA. Ataxie im Kindesalter. Wien* med. I Vchn., Nr. 32 u. 34, 1908.
ANTON und VON BRAMANN. Balkenstich bei Hydrozephalien, Tumoren and
bei Epilepeie. Munch, med. Wchnschr., Aug. 11, 1908, S. 1673.

J. A. DONOVAN. Headache and its Cure. N . Y. Med . Joum., Aug, 15, 1908,
p. 310.

Reflexes.— RISIEN RUSSELL. The Value of the Reflexes in Diagnosis. Mon.
trtal Med. G'az., Aug. 1908, p. 598.

E. LEV I. Nouvelles recherckes graphiques sur le ph6nomfene de la trepidation da
pied. LEncepkale, Sept. 1908, p. 260.

M. P. NIKITIN. Uber den Bechterew'schen, *' Beugereflex der Zehen.” BerL
Min. HVA., Sept. 7, 1908, S. 1643.

KLIPPEL, WEIL, et SERGUEFF. R6flex Contralateral Plantaire Heterogfcne.
(Soc. de neurol.) Rev. Neurol., juillet 15,1908, p. 690.

PSYCHIATRY

DE FURSAC. Rosanoff. Manual of Psychiatry. 2nd Am. Ed. New York, 1908.
A. F. TREDGOLD. Mental Deficiency. London, 1908.

NORMAN MOORE. A Clinical Lecture on Mental Disturbances in Women.
Clin. Joum , Aug. 26,1908, p. 305.

H. WAKEFIELD. The Physiology and Pathology of the Emotions; the Physical
Bases of Mental Etiology. Med. Rec., Aug. 22, 1908, p. 310.

ADOLPH MEYER. The R61o of the Mental Factors in Psychiatry. Am. Joum.
of Inean., July 1908, p. 39.

WESLEY MILLS. Psychology in relation to Physiology, Psychiatry, and General
Medicine. Am. Joum of I man., July 1908, p. 25.

H. M. HURD. Psychiatry as a part of Preventive Medicine. Am. Joum. of
Insan., July 1908, p. 17.

CHARLES P. BANCROFT. Hopeful and Discouraging Aspects of the Psy¬
chiatric Outlook. Amer. Joum. of Insan., July 1908, p. 1.

MAX KAUFFMANN. Beitrage z. Pathologie des Stoffwechsels bei Psychosen.
Zweiter Teil: Die Epilepsie. Jena, 1908.

Lee trouble* psychiques par perturbations des glandes it secretion interne.
(Rapport au Congrfes Fran^ais.) Semaine mid., aodt 5, 1908, p. 373.
LAIGNEL-LAVASTINE. Secretions internes et psychoses. Presse mid., aoflt

I, 1908, p. 491.

H. DEXLER. Die Hauptsymptome der psychotisohen Erkrankungen der Tiere.
Pray. med. Wchn., N. 35, 36, 37, 38, 1908.

C. C. BECKLEY. Some Border-line cases of Mental Deficiency. Boston M. and
S. Joum., Aug 20, 1908, p. 238.

RICHARD SARTORIUS. Die toxensische Bedeutung der dementia praeoox.
Ally. Zeit. f. Psychiat Bd. 65, H. 4, S. 666.

JOSEPH SHAW BOLTON. Amentia and Dementia: a Clinico-Pathological Study.
Joum. Ment. Sc., July 1908, p. 433.

BIBLIOGRAPHY

91*

General Paralysis.— J. G. FITZGERALD and W. T. WILSON. Report of a
Case of Juvenile Paresis. Canadian Practitioner , Vol. xxxiii., No. 9, p. 550.

J. D. O'BRIEN. Experimental Observations into the Etiology and Treatment
of Paresis. Med, Journ. of Insan., July 1908, p. 77.

Hlieellftieoii Cases. — HASCHE-KL&NDER. Ueber atypisch verlaufende
Psychosen nach UnfalL Aixh. f. Psychiat. u. Na-venkrankh. , Bd. 44, H. 2, 1908,
S. 668.

A. KNAPP. Kdrperliche Symptoms bei functionellen Psychosen. Atxh. f.
Psychiat. u. Nervenxrankh. , Bd. 44, H. 2, 1908, S. 707.

GOLDSTEIN. Zur Theorie der Hallucinationen. Arch.f Psychiat, u. Nerven-
krankh., Bd. 44, H. 2, 1908, S. 584.

SCHMIERGELD. Un cas d’agitation motrice fontee chez im deg 6 n 6 r£ psych-
asthdnique. Prog. mid., aoht 15, 1908, p. 897.

CRINON. Observations pour servir k la pathogenic des fctees de negation. Rev.
de Psychiat ., juillet 1908, p. 273.

PAIN. Du rdle de Tintoxication en pathologic mentale, de l’influence du
traumatisme ou de quelques maladies incidentals sur Involution de oertaines
v&anies. Rev, de Psychiat. , juillet 1908, p. 281.

SEIGE. Periodische Indikanurie bei zirkulhrer Psychose. Monatsschr. /.

Psychiat. u. iVeurol., Aug. 1908, S. 178.

ALFRED GORDON. Insanities caused by Acute and Chronic Intoxications with
Opium and Cocain. Journ. Amer. Med. Assoc., July 11, 1908, p. 97.
FITZGERALD. Differential Diagnosis of some Forms of Mental Disturbance,
with a Note as to Treatment. Montreal Med. Gas., Aug. 1908, p. 586.
POULTON. Fracture of Vault; Insanity. Austral. Med. Gas., June 20, 1908,
p. 291.

W. N. BULLARD. The High-Grade Mental Defectives. Boston M. and S. Journ .,
Aug. 20, 1908, p. 240.

G. RAVIART, etc. Alteration mentale et reaction de Wassermann. La Presse
mtdicale , Sept. 2, 1908, p. 564.

RICHARD KELLY. Recent Mania: its Cause and Treatment. Dub. Journ.
of Med. Sci Sept. 1, p. 161.

KARL BIRNBAUM. Ueber voriirbergehende Wahnbildungen auf degenerativer
Basis. Zeit.f. Na'renkcilk. k. Psychiat , Sept. 1908, S. 687.

BERNHARD RISCH. Uber die phantastische Form des degenerativen Irreeeins.
Allg. Zeit. f. Psychiat. , Bd. 65, H. 4, S. 576.

R. THOMSEN-BONN. Wahnbildung und Paranoia. Med. Klinik , Aug. 30,
1908, p. 1329.

A. PETRIiIN. Vber Spfttseilung von Psychosen. Nord. med. Ark., 1908, Bfd.
iL, flft 1, p. 129.

LAIGN EL-LAVASTINE. Les troubles psychiques dans les syndromes thyroidiens.
Rouv. Icon, de la Salpit., Mai-Juin 1908, p. 204.

L. LAGRIFFE. Guy de Maupassant. Etude de psychologic pathologique (I er
Article). Ann. med. Psychol., Sept.-Oct. 1908, p. 203.

W. R. DUNTON, Jr. Mental State of the Blind. Amer. Journ. of Insan., July
1908, p. 103.

P. C. KNAPP. The Psyohopathio Hospital and Psychiatrical and Neurological
Wards. Boston M, and & Journ., Aug. 27,1908, p. 259.

EDM. FORSTER. Ueber die korperlichen Strafen in der Schule. Berl. klin.
Woch., Aug 24, 1908, S. 1568.

ERNST REHM. Dber die kunftige Angestaltung de IrrenfUrsorge in Bayern.
Zentralbl. f. Nerrenhtilk. u. Psychiat., Aug. 1908, 8 . 601.

CLfiRAMBAULT. Notes sur le regime des alten& en Angleterre (suite). Ann.
med. Psychol., Sept.-Oct. 1908, p. 257.

M. S. GREGORY. Reception Hospitals, Psychopathic Wards and Psychopathic
Hospitals. Amer. Joui'n. of Insan., July 1908, p. 63.

C. P. BANCROFT. Reception Hospitals and Psychopathic Wards in State
Hospitals for the Insane. Amer. Journ. of Insan., July 1908, p, 67.

92*

BIBLIOGRAPHY

TREATMENT*

KOHTS. Ueber diphtherische L&hmungen und Dure Bebandlung. Tker.
Monarch., Juli 1908, 8. 829.

SCHNEIDER et VANDEUVRE. Contribution h l’dtude de le s6rumth6rapie
das paralyses post-diphthdriques. Le ProgrU nUdicale , Aug. 20, 1908, p. 421.
MALYNNIZ. tTber die H&tifigkeit der postdiphterischen LKhmungen vor und
naoh der Serumbehandlung. Speidel, Zurich, 1&08, M. 1.20.

T. A. JOHNSTON. A Case of Sleeping Sickness treated with Atoxyl; apparent
recovery. Lancet , Sept. 19, p. 867.

LITTLE and BOKENHAM. On Bulbar Paralysis followed by Progressive
Muscular Atrophy ; treated by a new method of Tonic Medication. BnL Med.
Joum.f Sept. 12,1908, p. 703.

E. W. SCRIPTURE. Treatment of Negligent Speech by the General Practitioner.
Med . Rec ., Aug. 15, 1908, p. 257.

C. J. DOUGLAS. The Narootio Method of treating Morphinism. Med . Rec.,
Sept 5, 1908, p. 404.

ARTHUR GAMGEE. On Chronic Morphinism and its Treatment Lancet,
Sept 12, 1908, p. 794.

Isiflctl.—ALEXANDER. Klinische Studien zur Chirurgie der otogenen Menin¬
gitis. Arch./. OkrenhcUk ., Bd. 76, H. 1-2, 1908, S. 1.

HEILE. Zur Behandlung dee Hydrooephelus. D. med. Wchn ., Aug. 20, 1908,
a 1468.

NAEZELI. Ueber den operativen Ersatz des geiahmten Quadricepsfemoris
insbesondere dutch Ueberpflanzung des Tractus iliotibialis. Ztechr. /. ortkop&d.
Chir., Bd. 21, H. 1-3, 1908, a 1.

PURCHBAUER. Nerven oder Sehnenplastik. Ztdchr. /. mtkopOd. Chir., Bd. 21,
H. 1-3, 1908, S. 170.

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

©(bliogiapb^

ANATOMY

PAUL SCHRODER. Einfuhrung in die Histologie und Histopathologic des
Nervenssystems. Acht Vorlesung. Fischer, Jena, 1908, M. 3.

RETZIUS. Principles of the Minute Structure of the Nervous System as Re¬
vealed by Recent Investigations. Proc. Roy. Soc ., Vol. B lxxx., No. B542, 1908,
p. 414.

OXODI. Das Gehirn und die Nebenhohlen der Nase. Holder, Wien, 1908,
M. 10.

REICHARDT. Ueber die Hirnmaterie. Monatsschr. f. PsychiaL u. Neurol..
Okt. 1908, S. 285.

SCHUSTER. Descriptions of three Chinese Brains presented by Dr F. W. Mott
to the Museum of the Royal College of Surgeons. Joum. Anat. and Physiol.,
Oct., 1908, p. 59.

ARIENS-KAPPERS und H. VOGT. Die Verlagerung der motorischen Ob-
longatakerne in phylogonetischer und teratologischer Beziehung. Neurol.
Centralbl ., Okt. 16, 1&08, S. 958.

AMATO. Contributo alio studio del reticolo neurofibrillare endocellulare in con-
dizioni normali e patologiche. Riv. ital. di Neuropatkol., Psich., cd Elettroter.,
Sett. 1908, p. 401.

NEUNLOFF. Einige Beobachtungen iiber den Bau des Nervengewebes bei
Ganoiden und Knochenfischen. II. Der Bau des Nervenfasem. Arch.f. mikros.
Anat., Bd. 72, H. 3, 1908, S. 575.

LINDAHL. Beitrag zur Kenntnis der sogenannten Grenzfibrillen der Epithel-
zellen. Anat. Hefte, Abt 1, H. 112, 1908, S. 199.

C. T. van VALKENBURG. Beitrag zum Studium der Zellen des Locus coeruleus
und der Substantia nigra. Monatsschr. f. Psychiat. u. Neurol., Okt. 1908, S. 337.

J. H. HARVEY PIRIE. The Middle Cells of the Grey Matter of the Spinal
Cord. Proc . Roy. Soc. of Edin., Vol. xxviii., Part 8, 1908, p. 595.

H. M. JOHNSTON. Cutaneous Branches of the Posterior Primary Divisions of
the Spinal Nerves and their Distribution in the Skin. Journ. Anat. and Physiol
Oct. 1908, p. 80.

MICHAILOW. Die feinere Struktur der sympathetischen Ganglion der Ham-
blase bei den Saiigetieren. ^4rcA. /. mikros. Anat., Bd. 72, H. 3, 1908, S. 554.

MICHAILOW. Zur Frage iiber die Innervation der Blutgefasse. Arch. f.
mibos. Anat., Bd. 72, H. 3, 1908, S. 540.

METHODS—

J. LORRAIN SMITH and W. MAIR. An Investigation of the Principles under¬
lying Weigert’s Method of Staining Medullated Nerve. Joum. Pathol, and
Bacterial., July 1908, p. 14.

GOLGI. Une m€thode pour la prompte et facile demonstration de Tapporeil
r^ticulaire interne des cellules nerveuses. Arch. ital. de Biol., Vol. xlix., No.
II., 1908, p. 269.

FISC HEL. Ueber eine vitale und spezifische Nervenfkrbung. Ztschr. f. unseen.
Mikros ., Bd. 25, H. 2, 1908, S. 154.

93 *

94*

BIBLIOGRAPHY

SCHt'TZ. Die Silberimpr&gnation der Neorofibrillen nach Bielschowaky. Neurol.
tta/ni/W., Okt 1, 1908, S. 909.

WIXXWARTER und SAIXMONT. Erfahrungen liber die Flemmingsche Drei-
farbung. Zt$>:h r. f. tci&sen. JUT* Jrros., Bd. 25, H. 2, 1908, S. 157.

PHYSIOLOGY

FR IE DENT HAL. Arbeiten aus dem Gebiet der experimentellen Physiologie.

Fischer, Jena, 1908, M. 8.

GRUXD. Die Abkuhlungsreaktion dee Warmbllitermuakeis und ihre klinische
Ahnliebkcit mit der Entartungsreaktion. D. Ztschr. f. Nervenheilk., Bd. 35, H.
3*4, 1908, S. 169.

EDM ENDS and ROTH. Concerning the Action of Curare and Physostigmine
upon Xerve Endings or Muscles. Amer. Journ. Physiol. , Bd. 23, No. 1, 1908,

p. 28.

LEFEBURE. Considerations sur la physiologic des terminaisons nerveuses
sensitives de la peau. Journ. de 1‘Anat sept.-oct. 1908, p. 382.

LESBRF. et MAIGXON. Contribution a la physiologie de la branche extern©
du spinal. Innervation des muscles stemo - mastoidien, cl£ido - mastoidien et
trapeze. Journ. de Physiol, et de Path. Gin., sept. 15, 1908, p. 828.

PIPER. I’eher die Leitungsgeschwindigkeit in den markhaltigen menschlichen
Xerven. Arch./, d. yes. Physiol.. Bd. 124, H. 11*12, 1908, S. 591.

J EXSEX. Die Lange des ruhenden Muskels als Tempera turf unktion. Ztschr.f.
ally. Physiol. i Bd. 8, H. 3*4, 1908, S. 291.

CAMCS et XICLOU. La chlorure d’Sthyle dan® les tissus pendant Panesth&ie
et au moment de la mort. et specialement dan® le systfeme nerveux. Journ. de
Physiol, et de Path. Gen., sept. 15, 1908, p. 844.

HALLS DALLY. An Inquiry into the Physiological Mechanism of Respiration,
with especial Reference to * the Movements of the Vertebral Column and
Diaphragm. Journ. Anat. and Physiol.. Oct. 1908, p. 93.

PSYCHOLOGY.

LOVED AY. Studies in the History of British Psychology. I. The Early
Criticism of Hobbes. Mind, Oct. 1908, p. 493.

ALBERTOX1 et F. ROSSI. Bilan nutritif du pays&n des Abruzzes et ses Con¬
ditions phvsiologiquoa, peychologiques et £conomiques. Arch. ital. de Biol.,
Vol. xlix., Xo. 11.. p. 241.

VASCHIDE et MECXIER. La Pathologie de l’attention. Bloud, Paris, 1908.

M‘TAGGART. The Unreality of Time. Mind, Oct. 1908, p. 459.

BEN USSI. Erwartungszeit und subjektive Zeitgrosse. Arch. f. d. gesam. Psuchol ..
Bd. 13, H. 1-2, 1908. S. 71.

E. v. A STEP. Die psvchologische Boobachtung und experimentelle Unter-
suchung von Denkvorgangeu. Ztschr. J. Psychol., Abt. 1, Bd. 49, H. 1-2, 1908,

S. 56.

HEXXIG. Beitriige zur Psychologic des Doppel-Ichs. Ztschr. f. Psychol.,
Abt 1. Bd. 49, H. 1-2, 190S, S. 1.

AXATHOX A ALL. Ueber den Mass tab beim Tiefensehen in Doppelbildern.
Ztschr.f. Psychol., Abt. 1, Bd. 49, H. 1-2, 1908, S. 108.

LI PM AX X. Eine Methode zur Vergleichung von zwei Kollektivgegenstanden.
Ztschr.f Psychol., Abt. 1, Bd. 48. H. 5 6, 1908, S. 421.

BECKER. Energieerhaltung und psvchologische Wechselwirkung. Ztschr. f.
Psychol., Abt. 1, Bd. 48, H. 5-6, 1908, S. 406.

T. J. I)E BOER. Zur gegenseitigen Wortassoziatioa. Ztschr.f. Psychol., Abt. 1,
Bd. 48, H. 5-6, 1908, S. 397.

BIBLIOGRAPHY 95*

ALRCJTZ. Die Funktion der Temperaturrinne in warmen Badem. Ztschr. /.
Psychol ., Abt. 1, Bd. 48, H. 5-6, 1908, 8. 886.

WARSTADT. Das Tragisohe. Eine psychologisch-kritische Untersuehung.
Arch./. d. gesam. Psychol ., Bd. 18, H. 1-2,1908, 8. 1.

G. ARBOUR STEPHENS. Colour Vision and its Relation to the other Senses.
Practitioner, Oct. 1908, p. 640.

CULLERRE. Coup d’oeil m6dico-psychologique sur le monde da la cour au
temps de Louis XIV. L Enctphale, oct. 1908, p. 846.

PETRO et BIANCO. II senso morale nelle intelligenze sovrane. Ann. di
Freniatria , Vol. xviii., f. 2, 1908, p. 142.

INGEGNIEROS. Enrique Ferri ante la psicologia del Genio y del Talento.
Arch, de Psiquiat. y Criminal., Julio-Agosto 1908, p. 885.

HORACIO P. ARECO. Enrique Ferri y el Poeitivismo Penal. A rch. de Psiquiat.
y Criminal., Julio-Agosto 1908, p. 897.

PATHOLOGY

BIANCONB. Contribute alia fisio-patologia del nucleo lenticolare. Riv. di
PcUol. nerv. t ment ., Sett. 1908, p. 890.

KAUFFMANN. Beitrfige zur Pathologic des Stoffwechsels bei Psychosen. Die
Epilepsie. Fischer, Jena, 1908, M. 6.

CAMUS. liJtude de Neuropathologie sur lee Radiculites. Baillihre et fils, Paris,
1908, fr. 3.60.

SCARPINI. Le lesioni primarie delle fibre nervosa nell* urinemia, studiate in
condizioni sperimentali con la oolorazione positiva di Donaggio per le degenera-
zioni. Riv. di Patol. new. e ment., Agosto 1908, p. 349.

GOLDBAUM. Ueber spezifische Neurotoxine. Berl. klin . Wchnschr.,, Okt. 5,
1908, S. 1801.

GUERRINT. Sur les fines modifications de structure de quelques organes dans le
cours de la fatigue. Arch. ital. de Biol., Vol. xlix., No. II., 1908, p. 161.

OUNIOAL NEUROLOGY

GENERAL—

STRtJMPELL. Nervositat und Erziehung. Vogel, Leipzig, 1908, M. 1.60.
SIEGERT. Nervositat und Ernahrung im Kindesalter. Milnch. med. Wchnschr .,
Sept. 22, 1908, S. 1963.

EDINGER. Der Anteil der Funktion bei der Entstehung von Nervenkrankheiten.
Bergmann, Wiesbaden, 1908, M. 1.80.

MORO. Klinische Ueberempfindlichkeit. I. Tuberkulinreaktion und Nerven-
system. Munch, mod. Wchnschr., Sept. 29, 1908, S. 2026.

GUNDLACH. Die schadliche Wirkung des Quecksilbero auf Gehirn, Rlicken-
mark und Nervensystem. Gundlach, Munchen, 1908, M. 8.50.

GUNDLACH. Syphilis und Quecksilbervergiftung als Uraachen der Riicken-
marksBchwindsucht und Gehirnerweichung. Gundlach, Miinchen, 1908, M. 7.

APELT. Der Wert von Schadelkapacitatsmessungen und vergleichenden Hira-
gewichtsbestimmungen fiir die innere Medizin und die Neurologic. D. Ztschr . f.
jtfervenheilk., Bd. 35, H. 3-4, 1908, S. 306.

MUSCLES—

ROASENDA. Ricerche clinico-sperimentali sulle Miastenie di origins nervosa
periferica. Ann. di Freniatria, Vol. xviii., f. 2, 1908, p. 110.

. EDWIN DOWN. Report of a Case of Myotonia. Boston Med. and Sura. Journ.,
Oct. 8,1908, p. 478.

96*

BIBLIOGRAPHY

W. J. FENTON. A Clinical Lecture on some Forms of Cardiac Arrhythmia from
the Point of View of the Myogenic Theory. Brit. Med. Joum., Sept. 26, 1908,
p. 869.

SOPRANA. Contribution ulterieure k la connaissance de Fatrophie musculaire
progressive consecutive k la lesion dee canaux d&ni-circulaires. Arch. ital. de
Biol. , Vol. xlix., No. II., 1908, p. 170.

PKKIP1EIU NKKVE8—

C. J. CUMSTON. Case of Facial Paralysis, with Remarks on the Surgical Treat¬
ment of the Affection. Glasgow Med. Joum., Oct. 1908, p. 285.

BOLTON. Ueber Neuritis ascendens. Berl. klin. Wchnschr., Sept. 28, 1908,
S. 1758.

RAYMOND. Polyntfvrite et my elite subaigue. Joum. dee Prat., Oct. 17, 1908,
p. 659.

HPV1IAI CQKD—

Tabes. —LESSER Tabes und Paralyse im Lichte der neuCre Syphilisforsohung.
Berl. klin. Wchnschr ., Sept 28, 1908, S. 1762.

ARTUR LANG. Ueber lanzinierende Schmerzen im Bereiche dee Kopfes bei
Tabes dorsalis. Wien. klin. Wchnschr., Okt. 15, 1908, S. 1488.

Friedreich's Ataxia. —GEERTS, Deux cas de maladie de Friedreich. Joum. de
Neurol., aoOt 5, 1908, p. 281.

Pelftemyelltis. —W. B. CADWALADER Acute Anterior Poliomyelitis. Med.
Rec., Sept. 19, 1908, p. 482.

CASSIRER und MAAS. Ueber einen Fall von Poliomyelitis anterior chronica.
Monatsschr. f. Psychiat. u. Neurol ., Okt 1908, S. 306.

Amyatrophic Lateral Sclerosis.— GALLETTA. Sclerosi laterals amiotrofica
d’origine emozionale. Riv. di Patol. nerv. e ment. t Sett. 1908, p. 400.

Hemiplegia.— FRAIKIN et GRENIER DE CARDENAL. La Reeducation motrice
chez les h&nipltfgiques. EmpSrauger , Pau, 1908.

Disseminated Sclerosis.—BASCHIERI-SALDADORI. II clono del piede oome
sintoma obbiettivo precoce della sclerosi a piastre. Ann. di Nevrol. t Anno 26.
f. 1-2, 1908, p. 50.

GOSTAV OPPENHEIM. Zur pathologischen Anatomic der multiplen Sklerose
mit besonderer Berucksichtigung der Hirorindenherde. Neurol. Centralbl..
Okt. 1, 1908, S. 898.

flenlngo-vnyelltls.— CLAUDE et LEJONNE. Paralyse ascendants k forme
sensitivo-motrice radiculaire par meningomytflite aigue. Joum. de Physiol, et de
Path. Gin., sept 16, 1908, pp. 882, 900.

Tamonr. —JULES STEINHAUS. L'anatomie pathologique des tumours de la
moelle. Joum. de Neurol ., aodt 20 et sept 5, 1908, pp. 301, 321.

FLATAU und ZYLBERLAST. Beitrag zur chirurgischen Bebandlung der
RUckenmarkstumoren. D. Ztschr.f. Nervenheilk ., Bd. 35, H. 3-4, 1908, sT§34.

Trauma.— HEINRICHSEN. Remarkable Case of Injure to the Spine. Aus.
Med. Gat., Aug. 1908, p. 412.

WINKLER und JOCHMANN. Zur Kenntnis der traumatisohen Riickenmarks-
affektionen. D. Ztschr.f. Nervenheilk., Bd. 35, H. 3-4, 1908, S. 222.

H. W. MITCHELL. Posterior Column Degenerations, following Injury to the
Posterior Roots of the Seventh Cervical Nerves. Joum. Nerv. and Mad. Du..
Sept. 1908, p. 545.

Pott’s Disease.— KIRMISSON. Les parapltfgies dans le mal de Pott Joum. des
Prat., sept 19, 1908, p. 596.

BIBLIOGRAPHY

97*

Bplma Biflda*—JOHN A. C. MACE WEN. Spina Bifida Occulta: Report on a
Case. Joum. Pathol . and Bacteriol., July 1908, p. 61.

€erebro*Spinal Fluid. —ALBERTO ZIYERI. Sulla presenza di oolina nel
liquido cefalorachideo in aloune malattie mentale. Riv. ital. di Ncuropalol .,
Peich ., ed Elettroter ., ottobre 1908, p. 449.

JULIUS DONATH. Bemerkung zum Aufsatz des Herra Dr M. Kauffmann:
“ Uber den angeblichen Befund von Cholin in der Lumbalfliissigkeit" Neurol .
Centralbl. , Okt 16, 1908, S. 964.

MAX KAUFFMANN. Bemerkungen zu der vorstehenden Arbeit. Ibid..
S. 966.

SICARD et DESCOMPS. Syndrome de coagulation massive, de xantoohromie et
d'h&natolymphocytose du liquide c€phalo-rachidien. Oaz. da E6p.. oct. 20.
1908, p. 1431. .

BBAIN—

Meningitis.—RUBIN. Pneumokokken-Meningitis als mittelbare Spatfolge eines
Schiidelunfalles. MUnch. med. Wchntchr., Okt. 18, 1908, a 2127.

REDLICH. Zur Kenntnis der psychischen Storungen bei den verschiedenen
Meningitisformen. Wien. med. Wchntchr., Okt. 10 u. 17, 1908, Sn. 2258, 2317.

WIMMER. Meningitis basilaris occlusiva. Med. Klinih , Okt. 11, 1908, S.
1563.

BRUNS. Zur Frage der idiopathischen Form des u Meningitis spinalis serosa
circumscripta. ” Berl. klin. Wchntchr., Sept. 28, 1908, S. 1735.

C. VINCENT. Deux cas de m&ringite chronique syphilitique. Rev. Neurol .,
oct. 15, 1908, p. 1049.

M*KERRON. Report of a Case of Mastoiditis Complicated with Purulent
Meningitis, etc. Arch. ofOtol ., July-Aug. 1908, p. 183.

G. ALEXANDER. Zur Klinik und Behandlung der labyrinthogenen Meningitis.
Ztsckr.f. Ohrenheilk., Bd. 56, H. 3, 1908, S. 249.

DROZYNSKI. BeitrSge zur Kenntnis der Meningomyelitis syphilitica.
Monatsschr. /. Psychiat . u. Neurol Okt. 1908, S. 354.

TRAUTMANN. Zur Keimtragerfrage bei ubertragbarer Genickstarre. Klin.
Jahrb. t Bd. 19, H. 3, 1908, S. 439.

HERFORD. Bakteriologische und epidemische Beobachtungen bei einer
Genickstarre Epidemie in Altona. Klin. Jahrb., Bd. 19, H. 3, 1908, S. 265.

LIEBERMEISTER. Uber Meningokokkensepsis. Munch, med . Wchntchr. , Sept.
22, 1908, 8. 1978.

WASSERMANN und LEUCHS. Ueber die Serumtherapie bei Genickstarre.
Klin. Jahrb., Bd. 19, H. 3, 1908, S. 426.

KOPLIK. The Serum Treatment and the Prognosis in various forms of Therapy
of Cerebro-spinal Fever. Med. Rec. t Oct. 3, 1908, p. 557.

CLAUDE B. KER. The Treatment of Cerebro-spinal Meningitis with Flexner’s
Serum. Edin. Med . Journ., Oct. 1908, p. 306.

ORTH. Beitrag zur Serumtherapie der Meningitis cerebrospinalis epidemica.
Milnch. med. Wchntchr., Okt. 20, 1908, S. 2183.

J. D. MORGAN and W. WILKINSON. Report of Ten Cases of Epidemic
Cerebro-spinal Meningitis treated with the Anti-Meningitis Serum. Arch. Inter ■
naL Med., Oct 15, 1908, p. 253.

J. R. CURRIE and A. S. M. MACGREGOR. The Serum Treatment of Cerebro¬
spinal Fever in the City of Glasgow Fever Hospital between May 1906 and May
1908. Lancet, Oct 10, 1908, p. 1073. :

Hfemorrhage. —BONNAR. Apoplexy: its Causes. N.Y. Med. Joum., Oct 3,
1908, p. 643.

FOSTER. Apoplexy in the Classification of Diseases. N. Y. MedL Joum.. Oct
3 1908, p. 648.

98 *

BIBLIOGRAPHY

TabcrealMU. —BARCLAY NESS. A Caw of Tuberculosis of the Brain, with Com¬
plete Paralysis of Both Third Nerves. Brit. Jour a. Childrens Dis., Sept. 1908,
p. 878.

*— Discussio n sur 1'Aphssio. (Soc. de NeuroL) Ret. Neurol., eep. 80,
1908, p. 974.

BERNHEIM. Doctrine de l’aphasie. Comment je le comprends. Ret. At Mid.,
No. 9,1908, p. 797.

CORTE8L Un caso di afasia to tale per lesione sottooorticale della soim di
Broca e della aona di Wernicke. Riv. ai Patol. nerv. e menL, Agosto 1908, p.
887.

Agraphia. —SEUI METER. Apraktische A
ZentrxdU. f. Nertenheilk. u. PrgchuU., Nr. 269,

graphie bei einem Bechtahirner.
1908, S. 678.

t .-... —EDWIN BRAMWELL. A Caw of Intracranial Tumour. Ret. Neurol,
and PsychiaL, Oot. 1908, p. 677.

WHARTON SINKLER. Three Caws of Cerebellar Tumour; Operation in Two
Chwa; Recovery in One. Joum Amer. Mtd. Assoc., Sept. 26,1908, p. 1067.

der Tumoren des Kleinhirna und dw
Vchnschr., Okt. 16,1908, S. 1800.

HOMBURGER und BRODNITZ. Zur Diagnose chiruigischen Behandlung und
Symptomatologie der Kleinhirngeechwiilste. Mitt. a. a. Gretugebiet. A Med. u.
Chir., Bd. 19, H. 2, 1908, S. 187.

KLOSTERMANN. Zur Kasuistik der Schkdeldeckentumoren. Minch, med.
Wchnschr., Okt. 20, 1908, S. 2184.

Encephalitis.— LUPINE £tude sur l’enofiphalite subaigug curable des tuber-

ouleuz. Ret. As Mtd., No. 9, 1908, p. 820.

GIERLICH. Zur Symptomatology
Kleinhimbruckenwinkels. D. med. 1

Un, Diseases.— PRICE BROWN. — Notes upon two Unusual Frontal Sinus
Cases. Joum. Laryngol., Oct., 1908, p. 586.

GERBER. Die Komplikationen der Stirnhfihlenentslindungen. Karger, Berlin,
1908, M. 16.

PHILIP HAMMOND. Thrombosis of the Lateral Sinus. Bodon Med. and Burg.
Joum., Sept. 24, 1908, p. 406.

8TUCKY. Septic Thrombosis of Cavernous Sinus following a Radical Mastoid
Operation on the Seventh Day. Joum LaryngoL, Oct 1908, p. 529.

O. ALEXANDER. Otitio Sinus Thrombosis and Pyaemia. Arch, of Otol., July-
Aug* 1908. P- 230. .

OPPENHEIMER. Double Mastoiditis, Sigmoid Sinus, and Jugular Thrombosis.
Arch, of Otol., July*Aug. 1908, p. 197.

DEANE Thrombosis of the Superior Longitudinal and Lateral Sinuses treated
by Opening the Torcular Herophili. Joum. Amer. Med. Assoc., Sept. 19,1908,
p. 997.

Traama.— ERNST BLOCH. Die Kontraktion des Quadriceps bei Schwindelgefuhl
nach Sohfidelbriichen. Neurol. Centralbl., Okt 1, 1908, S. 911.

DEROME Compound Comminuted Fracture of the Skull. Montreal Med. Joum,
Oot 1908, p. 726.

FISCHER Ueber indirekte Orbitaldachfraktur und geschossartige Wirkw*
eines Knochensplitters im Gehirn. Minch, med. Wchnschr., Okt. 18, 1908,
S. 2130.

HENEKU AND FUNCTION Al DISEASES—

Hysteria. —ALFRED GORDON. Troubles vaao-moteura et trophiques de 1’hysWrie.
Rev. Neurol., sept. 30, 1908, p. 946.

SCHWAB. Ein Beitrag sum hysterischen Fieber. Monatsschr. f. Oeburtsk,
Okt. 1908, S. 414.

BIBLIOGRAPHY

99*

GUICHARD. De l’Hysterie 4 forme d’6pilepsie partieUe et dpilepeie jackaoni-
enne ohez une hysterique ; diagnostic differential. Firmin, Montane et Sicardi,
Montpellier, 1908.

CURSCHMANN. Bemerkung zu dem Aufsatz yon J. Kollarits, Wei tore Beitrage
zur Kenntnia des Torticollis mentalis (hystericus) mit einem Sektionsfall. D.
Ztschr.f, Nervctihcilk ., Bd. 85, H. 8-4, 1908, S. 352.

Epilepsy* —VALTORTA Sull* ipertensione nell’ epilessia. Riv. ital. di Neuro -
palhol ., Prick ., ed Elettroter. , Sett. 1908, p. 422.

UGrOLOTTI. Sui rapporti della psicosi manico-depressiva coir epilessia. Riv. di
Patol. nerv. e merit., Sett. 1908, p. 418.

HEINRICH VOGT. Epilepeie und Schwachsinnszust&nde im Kindesalter. Arch,
f. Kinderheilh., Bd. 48, H. 5-6, 1908, a 321.

AUERBACH. Klinisches und Anatomisches zur Operativen Epilepsiebehand-
lung. Mill. a. d. Qremgebiet . d. Med. u. Chir. t Bd. 19, H. 2,1908, S. 257.

Neimei. —JORDAN. Some Faotors in the Causation of the Neuroses. Birming¬
ham Med. Rev., Sept. 1908, p. 141.

Chorea. —J. J. W. EVANS. Observations on a Case of Huntington’s Chorea.
Lancet , Sept. 26, 1908, p. 940.

CURSCHMANN. Eine neue Chorea-Huntingtonfamilie. D. Ztsckr. f. Nerven-
heilk., Bd. 35, H. 3-4, 1908, S. 293.

Neurasthenia. —Sir J. F. BROADBENT. On Neurasthenia. Med. Press, Oct. 7,
1908, p. 394.

HARTENBERG. Psychologic des neurasthtfniques. F. Alcan, Paris, 1908,
fr. 3.50.

R^GIE et LEGRAND. Indications du climat marin atlantique dans la neur¬
asthenia. Vigot frfcres, Paris, 1908.

Neuralgia.— GROVE3. A Case of Severe Trigeminal Neuralgia successfully
treated by the Excision of the Gasserian Ganglion. Bristol Med. Joum. } Sept.
1908, p. 234.

BODINE and KELLER. Injection of Alcohol for the Relief of Trigeminal
Neuralgia. N.Y. Med. Joum., Sept. 26, 1908, p. 680.

Sciatica. —MURPHY. Sciatica; its Surgical Treatment. IntercoL Med. Joum.
of Australia , Aug. 20, 1908, p. 429.

J. BRINDLEY JAMES. Sciatica and its Treatment. (Brit. Med. Assoc.)
Brit. Med. Joum ., Oct 10, 1908, p. 1080.

Torticollis. —ROBERT KENNEDY. Section of the Posterior Primary Divisions
of the Upper Cervical Nerves in Spasmodic Torticollis. (Brit. Med. Assoc.)
Brit. Med. Joum *, Oct. 3, 1908, p. 986.

RICARD. De la Valeur du traitement chirurgical du torticolis congenital selon
le proc6d£ de Mikulicz. Firmin, Montane et Sicardi, Montpellier, 1908.

Blepharospasm* —GEROLAMO M1RTO. Sulla natura psicogena del Blefaro-
spasmo. Ann. di Nevrol ., Anno 26, f. 1-2, 1908, p. 35.

Exophthalmic Goitre* —WARRINGTON. Exophthalmic Goitre. Med. Press,
Oct. 14, 1908, p. 419.

DOCK. The Development of our Knowledge of Exophthalmic Goitre. Joum.
Amer. Med. Assoc., Oct. 3, 1908, p. 1121.

STENGEL. Some Considerations on Exophthalmic Goitre from the Medical
Standpoint. N.Y. Med. Joum., Sept. 26, 1908, p. 577.

CARO. Blutgefunde bei Morbus Basedowii und bei Thyreoidismus. Berl. klin.
Wchnsckr ., Sept. 28, 1908, S. 1755.

APELT. Ein Fall von Basedowscher Krankheit im Anschluss an nichteitrige
Thyreoiditis acuta. Munch, med. Wchnschr. , Okt, 13, 1908, S. 2136.

100*

BIBLIOGRAPHY

CARRIER. Troubles mentaux et maladie de Basedow. L'Endphale, oet 1908,

p. 886.

BOUCHUT. R61e du rhumatisme articulaire aigu et subaigu dans l’6tiologie de
la maladie de Basedow and dans sa terminaison par l’asystolie. Rey, Lyon, 1908,
2 fr.

A. GORDON GULLAN. Pathology and Treatment of Exophthalmic Goitre.
Med. Press , Oct. 21, 1908, p. 445.

M'COSH. Observations on the Treatment of Exophthalmic Goitre. Med, Ree.,
Sept. 19, 1908, p. 476.

ImffcmtilDm.—SANTE DE SANCTIS. Gli Infantilismi. Ann. di Neurol, Anno
26, f. 1-2, 1908, p. 5.

■•iftlliai,—W. BERTRAM HILL Mongolism and its Pathology. Quart.
Jounu Med., Oct. 1908, p. 49.

Te turns. —JERIE. Beitrag zur Serotherapie des Tetanus. Mitt a. d. Qrensgebiei.
d. Med. u. Chir ., Bd. 19, H. 2, 1908, S. 282.

Tetany. —RUDINGER. Zur Aetiologie und Pathogenese der Tetanic. Ztsehr . /.
experiment. Pathol , Bd. 5, H. 2, 1908, S. 205.

Aleeholism.—RONCORONI. Le Sindromi mentali dell* alooolismo. Ann. di
Freniatria, Vol. xviii., f. 2, 1908, p. 121.

Mlseellaaeoas Cases. —ANGLADA. An^vrysme de l’aorte thoradque demeurd
latent malgr6 les reoherches lea plus minutieuses et dont l’unique manifestation
symptomatique fut une paralysis rScurrentielle gauche, suivie secondairement
d’une paralysis de la corde vocale droite. Arch. Gin. de Mid. , sept. 1908, p. 529.

KOHNST AM M. Beziehungen z wise hen Zwangsneurose und Katatonie ! ZentralbL
f. NervtnheUJc. u. Psychiat., Nr. 270, 1908, S. 709.

BABONNEIX. (Jn cas d’astasie-abasie chez une enfant de dix ans. Gas. des
H6p. t oct. 8, 1908, p. 1871.

KRONENBERG. Ueber Claudicatio intermittens an den oberen und unteren
Extremitaten. Wien. klin. Wchnschr. t Okt 8, 1908, S. 1414.

S. LEOPOLD. Osseous Plaques of the Pia-Arachnoid and their Relation to Pain
in Acromegaly. Joum. Ntrv. and Ment. Dis ., Sept. 1908, p. 552.

ZINGERLE. Ueber einen Fall von Hydriencephalocele frontalis. Beitr. zur
Pathol. Anat., Bd. 44, H. 1, 1908, S. 36.

BACKMANN. Ueber Scaphocephalie. Anat. Hefte, Abt 1, H. 112, 1908,
s. 217.

JOHN L. TODD. The Prevention of Sleeping Sickness. Brit. Med. Joum,
Oct 10, 1908, p. 1061.

Reflexes.— VERAGUTH. Das psychogalvanische Reflexphssnomen. Karger,

Berlin, 1908, M. 4.

GOLDFLAM. Cher Abachwachung bzw. Aufhebung des Zehen- und Verkur-
zungsreflexes. Neurol Centralbl. , Okt 16, 1908, S. 94o.

SPECIAL SENSES AND CRANIAL NERVES—

D. M. MACKAY. The General Practitioner and Deaf Mutism. Practitioner,
Oct 1908, p. 586.

PSYCHIATRY

JAMES NEIL. An Address on the Examination and Certification of Mental
Patients. BriX. Med. Joum., Oct. 24, 1908, p. 1226.

RIVANO. Relaadone della visita datta ad alcuni Manicomi italani e dell’ estero
(oont e fine). Ann. di Freniatria, Vol. xviii, f. 2, 1908, p. 97.

BIBLIOGRAPHY

101*

LECHA MARZO. Edad do las Manchas de Sangre. Arch, de Psiquiat. y
Criminal ., Julio-Agoeto 1908, p. 496.

NACKE. t)ber FamDienmord durch Geistsskr&nke. Marhold, Halle, 1908.

DUPUREUX. De l’6ducation et de la psychologic des anormaux en Belgique.
Joum. de Neurol. , oct. 6 et 20, 1908, pp. 861, 381.

E. A. SAGRINI. Rilievi antropologioi su d’una oenturia di pazari in rapporto
all' etnografia. Riv. ital. di Neuropatol. , Psich., td Elettroter ., ottobre 1908,
p. 466.

W. A. POTTS. The Relation of Alcohol to Feeble-mindedness. Med. Press,
Oct. 14, 1908, p. 422.

RAVTART, BRETON, PETIT, GAYET et CANNEC. Reaction de Wassermann
et alienation mentale. Rev. de Mid., 1908, p. 840.

ROBERT JONES. Insanity, Wit and Humour. Med. Press , Oct. 21, 1908,
p. 444.

EUGENE COHN. Hereditary Predispositions : Their Relation to Insanity and
some of our Social Problems. Joum. Amer. Med. Assoc. , Oct. 10, 1908, p. 1224.

SMITH ELY JELLIFFE. The Psychiaters and Psyohiatry of the Augustan Era.
Bull Johns Hopkins Eos., Oct. 1908, p. 308.

STIEDA. Ueber die Beziehungen der practischen Aerate zur Psychiatric. St
Peters. med. Wchnschr ., No. 39, 1908, S. 469.

HILDEBRAND. Ueber den Stand der Irrenfiirsorge in Kurland. St Peters, med .
Wchnschr., No. 36, 1908, S.;419.

OBERSTEINER. Trauma und Psyohiatrie. Wien. med. Wchnschr., Okt. 3,1908,

K 2178.

Ctomeral Paralysis.—JUQUELIER. Agressions et violences r6p£t6es chez deux
paralytiques g6n£raux. Rev. de Psychiat., No. 8, 1908, p. 338.

BENON. Les ictus amn&iques dans la paralysie g£n6rale. Gas. des H6p., oct
1, 1908, p. 1336.

MULLER. Kongenitale Lues und progressive Paralyse. MUnch. med. Wchnschr
Sept. 22,1908, S. 1986.

Dementia Praeox.—WIEG-WICKENTHAL. Zur Klinik der Dementia praeoox.
Marhold, Halle, 1908, M. 3.

HlsceUaneons Cases.—PELMAN. Psychische Grenxzustknde. Cohen, Bonn,
1908, M. 6.

VOGT. Beitrag zur diagnostischen Abgrenzung bestimmter Idiotieformen
(weitere Fklle von tuberoser Sklerose). Munch. med. Wchnschr., Sept 29, 1908,
a 2037.

VOSS. Zur Atiologie der D&mmeraust&nde. Zentrcdbl. f. Nei'venheilh. u.
Psychiat., Nr. 269, 1»8, S. 678.

MAIRET. La Simulation de la folie. Coulet et fils, Montpellier, 1908, fr. 6.60.

LACHLAN GRANT. A Remarkable Case of Malingering. Med. Press, Oct 7.
1908, p. 392.

A. MARIE. Contribution h l*4tude de la toxicitl urinaire dans les maladies
mentales (suite et fin). Arch, de Neurol., sept.-oct. 1908, p. 177.

MIGNARD. Confusion mentale et dlmence. Rev. de Psychiat, No. 8, 1908,
p. 321.

LEOPOLD LI&VI et H. DE ROTHSCHILD. Dee troubles psyohiques par per¬
turbation des glandes k secretion interne. Rev. d? Hygiene, T. 7, No. 4, 1908,
p. 342.

POTTS. Certain Types of Feeble-minded Children and their Significance.
Birmingham Med. Rev., Sept. 1908, p. 127.

GRASS ET. Les maladies mentales dans l’armle et les fugues en psyohiatrie.
L'Enctphale , oct 1908, p. 370.

STOCKTON. Hydrotherapy in the Treatment of the Insane. Med. Rec., Oct

10,1908, p. 612.

BIBLIOGRAPHY

TREATMENT*

ERNST BEYER. Die HeilstSttenbeh and lung der Nervenkranken. Zentralbl. f
Ntrvenheilk. u. PtychicU., Nr. 270, 1908, S. 710.

OLLERENSHAW. A Clinical Research on the Therapeutics of the Newer
Hypnotics and Brain Relievers. Med. Chron., Oct. 1908, p. 1.

LECHNER. Einige Anhaltspunkte zur Behandlung der Schlaflosigkeit Wien.
wted. Wcknschr ., Okt. 3, 1908, S. 2128.

WM. M'KENZIE. The Immediate Treatment of Infantile Paralysis. Intercol.
Med. Joum. of Australia, Aug. 20, 1908, p. 424.

FISHER Electrotherapeutics. N. Y. Med . Joum. , Oct. 10, 1908, p. 689.

Psyefeotlierapy. —A. M. STUART. Psychotherapy. N.Y . Med. Joum.. Sept.
19,1908, p. 542.

BENEDICT. Psychotherapy. Tkcr. Oaz. , Sept 1908, p. 609.

JUAN A. AGRELO. Psicoterapia y Reeducacion Psiquica. ArrA. de Psiquiat.
y. Criminol. , Julio-Agosto 1908, p. 452.

Surgical.—GODIVILLA. La Chirurgia Ortopedica nella cura deUe ParalisL A nn.
di Nevrol ., Anno 26, f. 1-2,1908, p. 25.

CHARLES A. BALLANCE. A Case of Division of the Auditory Nerve for Pain¬
ful Tinnitus. Lancet , Oct. 10, 1908, p. 1070.

H. T1LLMANNS. Something about Puncture of the Brain. (Brit Med. Assoc)
Brit. Med. Joum., Oct. 8, 1908, p. 983, and Lancet, Oct. 24, 1908, p. 1212.

DE MARTEL. Un point de technique oplratoire dans la craniectomie. Preset
MSd., oct. 7,1908, p. 641.

CABANNES. Nouveau Proc6d6 opdratoire du ptArygion. Sur l’herpfee n$v-
ralgique de la cornle. Gounouilhou, Bordeaux, 1908.

WALZBERG. Tenotomie des Musculus ileopeoas am Trochanter minor. MUnck.
med. Wcknschr Okt 13, 1908, S. 2135.

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

Bibliography

ANATOMY

VOGT und RONDONI. Zum Aufbau der Hirurindo. D. med. Wchnschr Okt.
29, 1908, S. 1886.

BRODMANN. tJber Rindenmessungen. Zentralbl.f. Nercenheilk. u. Psychiat .,
Nr. 272, 1908, S. 781.

ARlENS KAPPERS. Eversion and Inversion of the Dorso-Lateral Wall in
Different Parts of the Brain. Joum. Comp. Neurol. and Psychol.. Oct. 1908,
p. 433.

C. JUDSON HERRICK. The Morphological Subdivision of the Brain. Joum.
Comp. Neurol. and Psychol ., Oct. 1908, p. 393.

STERN. Ein Picksches Bundel mit ungewohnlichen Verlauf. Arb. a. d . Neurol.
Instil. Wien , Bd. 14, 1908, S. 16.

HOFFMANN. Die obere Olive der Saugetiere nebst Bemerkungen liber die Lage
der Cochlearisendkerne. Eine vergleichend anatomische Studie. Arb. a. d . Neurol.
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VALETON. Beit rag zur vergleichenden An&tomie des hinteren Vierhiigels des
Menschen und einiger Saugetiere. Arb. a. d. Neurol. Instit. Wien. Bd. 14,
1908, S. 29.

WILLI AMS. Vergleichend anatomische Studien iiber den Bau und die Bedeutung
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Bd. 17, H. 1, 1908, S. 118.

HJRSCH-TABOR. Ueber das Gehim von Proteus angumens. Arch. /. mikros.
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C. JUDSON HERRICK. On the Commissura Infima and its Nuclei in the
Brains of Fishes. Joum. Comp. Neurol, and Psychol Oct. 1908, p. 409.

HENRY H. DONALDSON. Comparison of the Albino Rat with Man in respect
to the Growth of the Brain and of the Spinal Cord. Joum. Comp. Neurol, and
Psychol ., Oct. 1908, p. 345.

BAUER. Vergleichend anatomische Untersuchungen der hinteren Riicken-
markswurzeln der Saugetiere nebst Bemerkungen zur tabischen Hinterstrangs-
erkrankung. Arb. a. d. Neurol. Instit. Wien , Bd. 17, H. 1, 1908, S. 98.

TORATA SANO. Vergleichend-anatomische und phvsiologische Untersuchungen
liber die Substantia gelatinosa des Hinterhoms. Arb. a. a. Neurol. Instit. Wten,
Bd. 17, H. 1, 1908, S. 1.

VAN DER BKOEK. Untersuchungen liber den Bau des sympathischen Nerven-
systems der Saugetiere. Gegenbaurs Morphol. Jahrb ., Bd. 88 ? H. 4, 1908, S. 532.
MATTAUSCHEK. Ein Beitrag zur Kenntnis der Arachnoidea spinalis. Arb.
a. d. Neurol. Instit. Wien , Bd. 17, H. 1, 1908, 8. 150.

W. H. GASKELL. The Origin of Vertebrates. Longmans, Green & Co., Lon¬
don, 1908, £1, Is.

PHYSIOLOGY

MUNK. t)ber die Functionen von Him und Riickenmark. Gesammelte Mitteil-
ungen. Neue Folge. Hirschwald, Berlin, 1909, M. 6.

VINCENZONI. Recherches exp^rimentelles sur lea localisations fonctionliolles
dans le cervelet de la brebis. Airh. ital. de Biol. f T. 49, No. 3, 1908, p. 385.
COUTELA. Essai sur la Coordination des mouvements des Yeux. Steinheil,
Paris, 1908, 4 fr.

PATRIZI. La courbe de fatigue du centre rospiratoire inhibiteur. Arch. ital.
de Biol., T. 49, No. 3, 1908, p. 449.

O ,Q 3*

104*

BIBLIOGRAPHY

SUTHERLAND. The Nature of the Conduction of Nerve Impulse. Amer.
Jour a. Physiol., Vol. xxiiL, No. 11, 1908, p. 115.

FISCHER. Ueber die Wirkung des Muskeln. ZUckr. f. orthopdd . Ckir., Bd. 22,
H. 1 3, 1908, S. 94.

MULLER. Untersuchungen liber die muskularen Kontraktion IIL Ueber die
Zuckungsreihe des mit Veratrin vergifteten Mustek. Pfingers Arch, /. d. get.
Physiol. , Bd. 125, H. 3-4, 1908, S. 137.

HOFMANN und BLAES. Untersuchungen liber die mechanische Reizb&rkeit
der quergestreiften Skelettmuskeln. Pfingers Arch.f. d. yes. Physiol., Bd. 125,
H. 3-4, 1908, S. 137.

TICHORMIROW. Zur Kenntnis des Muskelrhythmus. Pfiugeds Arch. f. d.
gts. Physiol, Bd. 125, H. 3-4, 1908, S. 111.

AULO. Muskelarbeit und Pulsfrequenz. Stand. Arch. f. Physiol ., Bd. 21,
H. 2-3, 1908, S. 146.

PORTER and RICHARDSON. A Comparative Study of the Vaso-motor
Reflexes. Amer. Joum. Physiol ., Vol. xxiii., No. 11, 1908, p. 131.

SHIM A. Experimentelle Untersuchungen liber die Wirkung dee Adrenalin auf
das Zentralnervensystem des Kaninchens. Arh. a. d. Neurol. Instil. Wien,
Bd. 14, 1907, S. 492.

CENI. Sur les rapports fonctionnels intimes entre le cerveau et les testicules.
Arch. ital. de Biol., T. 49, No. 8, 1908, p. 368.

LAIGNEL-LAVASTINE. Introduction k mtude des rapports psycho-
glandulaires. Rev. de Psychiat., No. 9, 1908, p. 373.

PSYCHOLOGY

CHARLES MERCIER. Presidential Address on the Physical Basis of Mind.
(Med.-Psychol. Assoc., London.) Joum. MenL Sc., Oct 1908, p. 619.

PELMAN. Psychische Grenzzustknde. Cohen, Bonn, 1909, M. 6.

CRUCHET. Les p^riodes de Involution psychique au moment de la puberty.
Prog. Mid., oct. 31, 1908, p. 529.

DtRR. Ueber die expenmentelle Untersuchung der Denkvoigknge. Ztschr. f.
Psychol., Abt. 1, Bd. 49, H. 5, 1908, S. 313.

FREEMAN. Fatigue in School Children as tested by the Eigograph. Amer.
Joum. Med. Sc., Nov. 1908, p. 686.

FROUMENT. Les M6thodes de la raison, pr6o£des d'un expos£ complet du
travail c6r£bral. Vigot Freres, Paris, 1908, 2 fr.

ROUX. Les Sensations visuelles esthetiques. Loire Mid., oct. 15, 1908, p. 517.
KOLLNER. Monochromatisches Farbensystem als Reduktionsform angeborener
Dichromasie. Ztschr. f. Sinnesphysiol, Abt. 2, Bd. 43, H. 3, 1908, S. loS.
WOLFFLIN. Untersuchungen liber Farbensinn der Blinden. Ztschr. f.
Sinnesphysiol , Abt. 2, Bd. 43, II. 3, 1908, S. 187.

GUTTMANN. Untersuchungen liber Farbenschw&che. (Forts.) Ztschr. f.
Sinnesphysiol. , Abt. 2, Bd. 43, H. 3, 1908, S. 199.

SAMOJLOFF. Demonstration der objektiven Farbenmiachung. Ztschr. f.
Sinnesphysiol, Abt. 2, Bd. 43, H. 3, 1908, S. 237.

LEONHARD. Ueber das Empfinden gewisser Dickenunterschiede. Ztschr. f.
Sinnesphysiol, Abt. 2, Bd. 43, H. 3, 1908, S. 168.

LAGRIFFE. Guy de Maupassant lUude de psychologic pathologique (suite).
Ann. mid.-psychol., nov.-d^c. 1908, p. 363.

STERNBERG. Die Schmackhaftigkeit und der Appetit Ztschr. f. Sin net -
physiol, Abt. 2, Bd. 43, H. 3, 1908, S. 224.

IOTEYKO et STEFANOWSKA. Psycho-Physiologic de la Douleur. F. Alcan,
Paris, 1909.

ZBINDEN. Die psychologische Auffassung der Nervodtkt Niemeyer, Halle,
1908, M. 2.

PATHOLOGY

RANKE. Ueber den heutigen Stand der Histopathologie der Hirnrinde.
MUnch. med. Wchnschr., Nov. 10, 1908, S. 2319.

HEIDELBERG. Grorahirnbefunde bei heredit&r-syphilitischen Skuglingen.
Jahrb.f. Kinder hcilt., Bd. 18, H. 4, 1908, S. 444.

BIBLIOGRAPHY

105*

MINGAZZINI. Lesioni di anatomia olinioa dei oentri nervosi. Unione typo*

gmpkico , Turin, 1908.

ORZECHOW8KI. Ein Fall von Missbildung des Lateralrecessus Beitrag zur
Onkologie des Kleinhirnbriickenwinkels. Arb. a. d. Neuwl. Instil . Wien, Bd.
xiv., 1908, S. 406.

MIYAKE KOICHT. Zur Frago der Regeneration der Nervenfasern im eentralen
Nervensystem. Arb. a. d. Neurol. Instil. Wien, Bd. 14, 1908, S. 1.
SCHWEIGER. tJber die tabiformon Veranderungen der Hinterstrfinge beim
Diabetes. Arb. a. d. Neurol. Instil. Wien , Bd. 14, 1908, S. 891.

KtfHLMANN. Beitrag zur Frage der Ammonshornveriinderungen bei Epilepsie.
Ztschr. f. Psychiat. u. Neurol., Bd. 44, H. 8, 1908, S. 945.

SHIMA. Ein Teratom in Kaninchenhirn. Arb. a. d. Neurol. Instil. Wien ,
B<L 14, 1908, S. 873.

MARINESCO. Lesions fines des cellules nerveuses produitee par l’injectaon
locale de bile. L'Enctphale , nov. 1908, p. 441.

H. GOUGEROT. Tuberculoses histologiquement atypiques ou bacilloees non
folliculaires du systems nerveux. L'EnciphaU, noy. 1908, p. 497.

NEURATH. Degenerationspathologische Befunde einiger Proiektionsleitungen
bei einem Falls von oerebraler Kmderl&hmung. Arb. a. a. Neurol. Instil.
Wien , Bd. 17, H. 1, 1908, 8. 72.

CLINICAL NEUROLOGY

41KNERAL—

AUVRAY. Maladies du cr&ne et de l’enc^pbale. Baillifere et fils, Paris, 1908,
10 fr. ,

HUBLE et PIGACHE. S&nielles nerveuses constautives au coup de chaleur.
Arch, de Neurol., oct.-nov. 1908, p. 265.

NONNE. Syphilis und Nervensystem. Karger, Berlin, 1909, M. 20.

G. LENTHaL CHEATLE. A Note on the Influence of the Nervous System
upon Infective Processes. Brit. Med. Joum., Nov. 14, 1908, p. 1490.

MUSCLES—

MISSEREY. Contribution h l’ltude de la myatonie conglnitale ou maladie
d’Oppenheim. (Thfese.) Rey, Lyon, 1908, Fr. 1.75.

HENRI CLAUDE. Dystrophie musculaire progressive familiale. L'EnciphaU,
nov. 1908, p. 512.

A NBA LONE. Miopatia primitiva progressiva in imbecille epilettico. Manicomio,
N. 2, 1908, p. 271.

PERIPHERAL NERVES—

FLATAU. Die peripheren Nerven und deren Erkrankungen. Konegen, Leipzig,
1908, M. 3.

J. RAMSAY HUNT. Occupation Neuritis of the Deep Palmar Branch of the
Ulnar Nerve. Joum. Nerv. and Menl. Die., Nov. 1908, p. 678.

KARL OSTERHAUS. Obstetrical Paralysis. N.V. hied. Joum., Nov. 7, 1908,
p. 887.

SPINAL CORD—

Tabes.— W. FORD ROBERTSON. Recent Investigations into the Pathology and
Treatment of General Paralysis and Tabes Dorsalis. Lancet, Nov. 14, 1908,
p. 1488.

MASSARY. Diagnostic prtfcocedu tabes. Tancrfede, Paris, 1908.

Meningeal ftfsemorrfcagcu —VIGNERAS. Les H6morrhagies mening4es Spinales.
(Thfese.) Steinheil, Paris, 1908.

Disseminated feeler#*Is.—RAYMOND. Scl4rose en plaques. Joum. des Prat.,
Oct 20, 1908, p. 680.

W. B. WARRINGTON. Cases Illustrating the Course and Progress in Dissemi¬
nate Sclerosis. Rev. Neurol, and Psychiat., Sept 1908, p. 521.

Landry** Paralysis.— ARTHUR V. SARBO. Zwei Ffille von Landry’scher
Paralyse. Neurol. Centralbl., Nov. 1,1908, S. 1009.

Tnnsanr.— STETNHAUS. Anatomie patbologique des tumeurs de la moelle.

(Congrfee de Gaud.) L'Endphale, nov. 1908, p. 517.

106*

B1BLIOGKAPHY

Trauuu— FRANKL-HOCHWART. Znr Kenntnis des traumatasohen Conus-
lhrionen. Wien. mud. Wchnsckr., Oct SI, 1908, S. 2410.

Cerebrw-gplnal Plaid.— EBRIGHT. Lumbar Puncture and its Diagnosis and
Therapeutics. Joum. Ama\ Med. Atmc., Nov. 7, 1908, p. 1568.

FERRAND. De la reaction du liquid© ccphalo-rachidien au oours da quelquas
dermatoses des jeunes enfants. G'a:. des Hop,, nor, 10, 1908, p. 1589.

B1RVILLE-HOLMES. Lumbar Puncture; its Technique and the Value of
Cytodiagnobis in differentiating Tuberculous Meningitis from the Epidemic
Variety. Arch, of Pediat Oct. 1908, p. 738.

UAIM—

Meningitis. —DOPTER at KOCH. Recherche du m4ningoooque dans les fosses
nasales ; son identification. Preset mid., oct 31, 1908, p. 697.

SPICK. De la mlningite traumatique et de sa curability. Baudoin, Paris, 1908,
E. SCOTT CARMICHAEL. Leptothrix Infections. Pyaemia with Meningitis,
and Notes of Two Similar Cases. Rev. Neut'ol. and PsychiaL, Nov. 1908, p. 681.
J. P. STURROCK. Acute Furious Mania in Cerebro-spinal Meningitis. Jo wa
Meni. Sc., Oct. 1908, p. 734.

ROYER. Epidemic Cerebro-spinal Fever; its Clinical and Pathological Phases.
Arch, of Pediat., Oct. 1908, p. 721.

KNOX and SLADEN. Hydrocephalus of Meningoooocus Origin, with a Summary
of Recent Cases of Meningitis treated by Anti-meningococcus Serum. Arch, qf
Pediat., Oct. 1908, p. 761.

FLEXNER and JOBLING. Analysis of 400 Cases of Epidemic Meningitis
treated with Anti-Meningitis Serum. Arch, of Pediat., Oct. 1908, p. 747.
CHURCHILL. On the Serum Treatment of Meningococcic Meningitis. Arch.
of Pediat., Oct. 1908, p. 754.

C. H. DUNN. The Serum Treatment of Epidemic Cerebro-spinal Meningitis,
based on a Series of 40 Consecutive Cases. Arch, of Pediat., Oct. 1908, p. 756.
CURRIE. Abnormal Reactions to Horse Serum in the Serum Treatment of
Cerebro-spinal Fever. Joum. of Hygiene, Vol. viii., No. 4, 1908, p. 457.
FULTON. The Serum Treatment of Epidemic Cerebro-spinal Meningitis, with
Report of 22 Cases. Boston Med. and Surg. Joum., Oct. 22 and 29, pp. 587, 572.

Maeaserrhage.—CHAUFFARD. Les hlmorrhagies meningdes. Joum. des PraL 9
oct 20,1908, p. 676.

Caisson Disease.—BOYCOTT and DAM ANT. Experiments on the Influeooe of
Fatness on Susceptibility to Caisson Disease. Joum. of Hygiene , VoL viii.,
No. 4, 1908, p. 445.

Hemiplegia.— J. D. ROLLESTON. Three Cases of Hemiplegia following Soariet
Fever. Rev. Nenrol, and Piychiat Sept. 1908, p. 530.

MALAISE. Cber familifire infantile Cerebralerkr&nkung. Nenrol. Centralbl .,
Nov. 1, 1908, S. 1018.

Hussar.— CARRIERS. Tumeur du cervelet ches un enfant. Difficulty du
diagnostic. Joum. des PraL , oct. 24, 1908, p. 695.

SPiLLER. Tumour of the Gasserian Ganglion. A Report of Two Cases, with
Necropsy. Amer. Joum. Med. Sc., Nov. 1908, p. 712.

OPPENHEIM und KRAUSE. Operativ entfemte Himgeschwulst aus dsr
Gegend der linken Insel und ersten Schlafenwindung. Bad. Hin. Wchnsckr.,
Nov. 16, 1908, S. 2058.

TO RATA SANO. Beitrag zur Kenntnis des Baues der Hirngliome mit Berttok-
sichtigung der Zellformen. Arb. a. d. Neurol. Instil. Wien, Bd. 17, H. 1,
1908, S. 159.

Abscess.— M10DOWSKI. Beitrttge sur Pathogen©*© und pathologischen Histologic
des Hirnabscesses. Aixh.f Okrenkeilk., Bd. 77, H. 8-4, 1908, S. 239.
GRtfNWALD. Otitischer Suboccipitalabssess oder oonsensueller Mastoiditis?
Arch. f. OhrenhcHk., Bd. 77, H. 8-4, 1908, S. 220.

Mans Diseases.— L. P. PHILLIPS and G. ELLIOT SMITH. On a Remarkable
Case of Vsnous Accommodation after Compression of the Superior Longitudinal
Sinus by a Glioma. Lancet , Nov. 7, 1908, p, 1864.

GERBER. Die Komplikationen der Stirnhdhlenentstindungen. Beitrfige sur
Anatomic, Pathologic, und Klinik der Stirnhtfhlen. Karger, Berlin, M. In.

BIBLIOGRAPHY

107*

HERZFELD. Ueber Spontanheilung von Thrombose des Sinus sigmoideus durch
Obliteration desselben. Beit, z. Anat., Physiol., etc., des Ohres der Nose u. des
Halses, Bd. 11, H. 1-2, 1908, 8. 141.

Trams*.—SCHABAD. Ein Fall Yon durch SchSdeltrauma bedingtem Zweigwuohs
im jugendlichen Alter. Berl. Hi*. Wcknschr ., Nor. 9, 1908, S. 2018.

fiENKKlL AND FIINCTIONAIi DISEASES—

Hysteria.— STEYERTHAL. Was 1st Hysteric ? Marhold, Halle, 1908, M. 1.80.
VAN DER ELST. Contribution apportee k la Notion d’hystlrie par l’6tude de
rhypnose special e ment considered dans son histoire, dans son essence, dans ses
effets. Vigot Frfcres, Paris, 1908, 4 fr.

BABINSKI. Quelquee remarques sur le mtfmoire de M. Alfred Qordon, intitule:
“ Troubles vaso-moteurs et trophiques de rhysterie.” Rev. Neurol ., oct. 80,1908,
p. 1089.

Epilepsy.— KAUFFMANN. Zur Pathologic der Epilepsie. Milnch. med. Wchnschr.,
Nov. 10,1908, S. 2316.

PIERCE CLARK. The Epileptic Voice Sign. Med. Rec.,Oob. 31.1908, p. 762.
H. VOGT. Epilepsie und Schwachsinnszustande im itindersalter. Arch. j.
Kinderheilk., Bd. 4$, H. 5-6, 1908, S. 321.

ROUBI NOV ITCH. Du Dermatographisme chez les 6pileptiquee au point de vue
diagnostique et m$dico-l£gal. Tancrede, Paris, 1908.

JOHN TURNER. Some Further Observations Bearing on the Supposed Throm¬
botic Origin of Epileptic Fits. Joum. Ment. Sc. t Oct. 1908, p. 638.

TOMASINI. Stato epilettico ed acetonemia. Contribute alia patogenesi dell'
epilessia Manicomio , N. 2, 1908, p. 219.

ALAN M‘DOUGALL. On the Principles of the Treatment of Epilepsy. Joum.
Ment. Sc., Oct. 1908, p. 718.

LUND BORG. Ueber dio sogennante metatrophische Behand lungs methods nach
Toulouse-Richet gegen Epilepsie. (Schluss.) Airh. f. Psychiat. u. Neurol .,
Bd. 44, H. 3, 1908, S. 1107.

HILDEBRANDT. The Surgical Treatment of Basedow's Disease. Med. Press,
Nov. 4, 1908, p. 497.

Nemroses.—JORDAN. Some Factors in the Causation of the Neuroses. Brit.
Joum. Child. Bis., Oct. 1908, p. 432.

ZIEGLER.. Reflex Neuroses arising from Ocular and Nasal Abnormalities. N. Y.
Med. Joum , Nov. 7, 1908, i>. 869.

CASS1RER. Prognose una Behandlung der vasomotorisch-trophischen Neurosen.
D. med. Wchnschr. , Okt 29, 1908, S. 1881.

Chorea. —BURNET. The Treatment of Chorea. Brit. Jonrn. Child. Bis., Oct,
1908, p. 424.

Neurasthenia.— DUBOIS et LUPINE. Pathog6nie des Itats neurasth&iiques.
(Congrfes de Gand.) LEndphale, nov. 1908, p. 626.

Neuralgia.— TERRIEN. Origino oculaire de oertaines nlvralgies du trijumeau.
La Clinique , No. 41, 1908, p. 660.

Discussion des rapports sur le “Traitement chirurgical des ndvralgies faci&les.”
(XXIe Congrbs de 1’Assoc, fran^aise de Chir.) Oaz. des H6p ., oct 24, 1908, p.
1460.

S1CARD. Le traitement de la nevralgie faciale devant le Congrfes de Chirurgie
de 1908. ^ Presse mid. , oct. 24, 1908, p. 682.

MARQUES et CHEVAS. R&ultats obtenus par le traitement 6lectrique dans
la nevralgie faciale. Aixh. d'Elect, mid. , oct. 26, 1908, p. 842.

Myasthenia Gravis.— J. ARTHUR BOOTH. Report of a Case of Myasthenia
Gravis Pseudo-Paralytica, with Negative Pathological Findings. Joum. Na*v. and
Ment. Bis., Nov. 1908, p. 690.

Exophthalmic Goitre.— STERN. Differentialdiagnose und Verlauf des Morbue
Basedowii und seiner unvollkommenen Formen. Deuticke, Wien, 1909, M. 2.

RUDINGER. Ueber den Eiweissumsatz bei Morbus Basedowii. Wien. klin.
Wchnschr., Nov. 12, 1908, S. 1581.

PRIBRAM und POROUS. Ueber den Einfluss verschiedenartiger Di&tformen
auf den Grundumsatz bei Morbus Basedowii. Wien. klin. Wchnschr., Nov. 12,
1908, S. 1684.

108*

BIBLIOGRAPHY

GORDON und JAUlC. Ueber Blutbild bei Morbus Basedowii und Base-
dowoid. Il'iVu- IfVAiucAr., Nov. 12, 1908, S. 1589.

PFAHLER. Summary of the Results obtained by the X-ray Treatment of Ex¬
ophthalmic Goitre. S'. V. Med . Jour Oct. 24, 1908, p. 781.

CretfmftuB. — BIRCHER. Zur Pathogen ase der kretinischen Degeneration.

Urban k Schwarsenberg, Wien, 1908, M. 1.

M‘CARRISON. Observations on Endemic Cretinism in the Chitr&l and Gilgifc
Valieva. Lancet, Oct. 31, 1908, p. 1275.

MASS AG LI A. Contribution k la pathogenfese du myxoedeme. Arch. %tal. dt
Biol.. T. 49, Xa 3. 190S, p. 343.

Al ofci llm.—LADY HENRY SOMERSET. Some Aspects of Inebriety. Joum.
Ment. Sc., Oct. 1908, p. 704.

SCHWARTZ. Auto-denonciation che* un alcooliqne et mythomane. Ann. mid.-
psvchnt., nov.-d4c. 1908, p. 383.

WASSERMEYER. Delirium tremens. Eine klinische Studie. Arch. f.
Psychxat. k. Seui'oL, Bd. 44, H. 3, 1908, & 861.

SMITH ELY JELLIFFE. Alcoholic Psychoses; Chronic Alcoholic Delirium
(Kors&kow’s Psychosis). S.Y. Med. Jonm., Oct 24, 1908, p. 769.

MARY S. P. STRANGMAN. The Atropine Treatment of Morphinomania and
Inebriety. Joxnn. Ment. Sc., Oct 1908, p. 727.

Kdkieft. ETTORE LEVI. Nouvelies recherchee graphiques sur le phdnomfeoe
de la trepidation du pied (?uite et fin). L'Enetphme^ nov. 1908, p. 453.
JACOBSOHN. Ueber den Fingerbeugereflex. I). med. JFcAmcAr., Nov. 12, 1908,
S. 1871.

NlMdlaacsu Cases.—W AN DE L. Ueber nervdse Storungen der oberen Ex¬
tremist bei Arteri**slderose. (Dyskinesia und Paraesthesia intermittent.)
Munch, med. Wchnschr., Nov. 3, 1908, S. 2268.

ME1NHAKDT. Die nervbsen Angstgefuhle. Wendel, Leipzig, 1908, M. 3.

F. J. POYNTON. Some Unusual Sequela* of Convulsive Seizures in Childhood.
Lancet, Oct. 31, 1908. p. 1291.

BOURNEVILLE, R1CHET, et SAINT GIRONS. Note sur la microsphygmia.
Prog. Med., oct. 31, 1908, p. 529.

ARTHUR J. WHITING. Post-Graduate l ecture on Angioneurotic (Edema as a
Familial Cause of Sudden Death. Lancet , Nov. 7, 1908, p. 1356.
WOLFF-EISNER Die Bedeutung der Koniunktiv&lreaktion nach 4000klinischen
Beohachtungen. Munch, med. Wchnschr., Nov. 10, 1908, S. 2313.

REHBERG. Ueber mange lhafte arte riel le Blutversorgung des Gehims und der
oberen Extremitiiten bei Aneurvsma arcus aortae. D. med. Wchnschr ., Nov. 5,
190S. S. 1928.

DIEULAFOY. Polioenc6phalite syphilitique ; ophtalmoplggie total# et bilattirale,
accompagn^e de symptomes bulbaires, etc. Presse mid., nov. 11, 1908, p. 721.
FELIX ROSE et*MAX EGGER. St£n5ognosie et asymbolie tactile. Simaine
mid, oct. 28, 1908, p. 517.

ZENNER. A New Sign for the Detection of Malingering and Functional Paresis
of the Lower Extremities. Joum. Amer. Med. Assoc., Oct. 17, 1908, p. 1309.
0RBISON. Trophic Hemiatrophy : Complete. Jonm. Here. and Menu. DU.,
Nov. 1908, p. 695.

PA ILH AS. Rides occi pi tales. Observations sur quelques suites h6r€ditaires des
deformations artificielles du cr&ne dans TAlbigeois. Arch, (f Anlhtvp. crm., oct-
uov. 1908, p. 722.

KIPROFF. Quanta tire Messung des kaloruchen Nystagmus bei Labyrinth-
gesunden. Beit. z. A not., Physiol., etc., des (Mi rs, der Nose u. des Halses, fci 11,
H. 1-2, 1908, S. 129.

APRCIAL SE.^E8 ASB MAXIM NERVES—

MAG1TOT. Contribution h T6tude de la circulation art£rielle et lymphatique du
nerf optique et du chiaama. Vigot Frfcres, Paris, 1908, 6 fr.

J. LOCKHART GIBSON. Plumbic Ocular Neuritis in Queensland Children.
Brit. Med. Joum., Nov. 14, 1908, p. 1488.

BOUCHAUD. Reactions pupillaires provoqu£es par la lumihre agiasant sur un
ceil amaurotique. Jonm. de Neurol ., nov. 5, 1908, p. 401.

BIBLIOGRAPHY

109*

BABONNEIX et HARVIER. Paralysie faciale unilat4rale et ophtalmoplegie ex-
terae bilat4rale conglnitales. Gaz. aes H6p., nov. 5, 1908, p. 1515.

SOUCHON. Des paralysies facial es du nouveau-n6 conskcutivee k l’aooouche-
ment spontan4. (Th&se.) Imprimeries unies, Lyon, 1908.

KANASUGl. Phonation nacn Durchtrennung des Gehirnstammes. Arch. f.
Laryngol. «. Rhinol ., Bd. 21, H. 2, 1908, S. 334.

GRABOWER. Ueber die Vercindorungen in gel&hmten Kehlkopfmuskeln.
Arch. f. Laryngol. u. Rhinol Bd. 21, H. 2, 1908, S. 340.

SCHULTER. Nachtrag zur Mittheilung liber einen Fall von Larynxhemiplegie
aus wahrscheinlich zerebraler Ursache. Arch. f. Laiyngol. u. Rhinol ., Bki. 21,
H. 2, 1908, S. 380.

PSYCHIATRY

W. H. B. STODDART. Mind and Its Disorders. A Text-Book for Students
and Practitioners. H. K. Lewis, London, 1908, 12s. 6d.

F. A. ELKINS. Asylum Officials : Is it necessaiy or advisable for so many to
live on the Premises? Journ. Merit. Sc ., Oct. 1908, p. 691.

WEYGANDT. Forensische Psychiatric. Deuticke, Wien, 1908, M. 1.

EMIL KRAEPELIN. Zur Entartungsfrage. Zentralbl. f. Nervenheilk. u.
Psychiat. , Nr. 271, S. 747.

G. H. SAVAGE. An Address on Mental Cripples. Brit. Metl. Journ., Nov.
14, 1908, p. 1492.

ZWERG. Zur Lehre von der Amentia. Alla. Ztschr. f. Psychiat , Bd. 65,

H. 5, 1908, S. 709.

GRIMALDI. II Museo Ciaramella. Relazione di Perizia psicbiatrica sullo
stato di mente di Ciaramella imputato di truffa e falso. Manicomio » N. 2, 1908,
p. 287.

GUCCI. Ritmo del moto e pazzia periodica Manicomio , N. 2, 1908, p. 261.
HILDEBRAND. Ueber Beziehungen zwischen psychischen und korperlichen
Erkrankungen. St Peters, med. Wchnschr ., No. 40, 1908, S. 481.
ALEXANDROFF. Ein Fall von Hyperemesis gravidarum kompliziert mit
einer Korsakow’s Psychose. Monatsschr. /. Geburtshiilfe t Nov. 1908,8. 542.
POTTS. Certain Types of Feeble-minded Children and their Significance. Bint.
Journ . Child. Dis ., Oct. 1908, p. 439.

HERZ. Die sexuolle psychogene Herzneuroee (Phrenokardie). BraumUUer,
Wien, 1908, M. 1.20.

BIRNBAUM. Psychosen mit Wahnbildung und wahnhafte Einbildungen bei
Degenerativen. Marhold, Halle, 1909, M. 6.

MEDEA. Lesions histologiques des nerfs periph6riquee dans les maladies
mentales. Arch, de Neurol ., oct.-nov. 1908, p. 308.

COLIN F. F. M‘DOWALL. Leucocytosis : its Relation to, and Significance in,
Acute Mental Disorders. Journ. Ment. Sc. , Oct. 1908, p. 669.

PIN I. Ricerche sul potere riducente delle urine nella frenosi maniaco-depreesiva.

Manicomio , N. 2, 1908, p. 155.

GOLDSTEIN. Zur Theorie der Hallucinationen. Studien fiber normale und
pathologische Wahmehmung. (Schluss.) Arch. f. Psychiat. u. Neurol Bd. 44,
H. 3, 1908, S. 1036.

BREDER. Sur la situation actuelle dee aH&i&s. Rapport pr&entl au Hie
Congres international de l'assistance des ali6n6s. Ann. mSd.-psychol. , nov.-d4c.
1908, p. 405.

Geaeral Paralysis.— JOLLY. Zur Statistik der Aetiologie und Symptomatologie
der ^progressiven Paralyse. Arch. f. Psychiat. u. Neurol ., Bd. 44, H. 3, 1908,

COPREAUX. De la dur4e de la paralyse g6n4rale. Vigot Frkres, Paris, 1908,
3 fr. 50.

JUNIUS und ARNDT. Beitrkge zur Statistik, Aetiologie, Symptomatologie,
und pathologischen Anatomie der nrogressiven Paralyse. (Schluss.) Arch. f.
Psycniat. u. Neurol ., Bd. 44, H. 3, 1908, S. 971.

GtTSTAV OPPENHEIM. Plasmazellenbefunde im Rlickenmark bei progreesiver
Paralyse. Arch./. Psychiat. u. Neurol ., Bd. 44, H. 3, 1908, S. 938.

HAMILTON C. MARK. The Examination of Cerebro-Spinal Fluid in General
Paralysis for Purposes of Diagnosis. Rev. Neurol, and Psychiat ., Nov. 1908,
p. 635.

VALTORTA. Sull’ importanza dell’ elemento individual© nella sindrome di un
caso di poralisi progressiva. Manicomio , N. 2, 1908, p. 247.

110*

BIBLIOGRAPHY

icBCBiU Ptmx. —A. R. URQUHART. Dementia Pracox. Joum. Ment. Sc.,
Oct 1908, p. 661.

ROBERT JONES. The Question of Dementia Pnecox. Joum. Ment. Sc., Oct.
1908, p. 661.

ZWEIG. Dementia praecox jenseits des 80 Lebensjahres. Ai'ck.f. PsychiaL u.
Neurol., Bd. 44, H. 3, 1908, S. 1015.

TOMASCHNY. Der Kopfechmen bei der Dementia praecox. Allg. Ztschr. f.
Psychiat ., Bd. 45, H. 5, 1908, S. 778.

P. C. KNAPP. Confusional Insanity and Dementia Praecox. Joum. Ntrv. and
Ment. Du., Oct. 1908, p. 619.

MIsMllmeou Cases.—HART (GAN. Traumatic Insanity. N. Y. Med. Joum .,

Oct 17, 1908, p. 743.

BAR. La folie des nourrices. Joum. des Prat., oct. 20 et 24, 1908, pp.
673, 689.

JOFFROY. Un dtflirede persecution. Joum. des Prai., oct. 20, 1908, p. 678,
LENER. Le malattie mentali e le correnti migratorie dell’ Italia meridionals.
Manicomio , N. 2, 1908, p. 183.

Lt)WEN STEIN. Beitrag zur Differential - Diagnose des katatonischen und
hysterischen Stupors. Allg . Ztschr. f. Psychiat., Bd. 65, H. 5, 1908, S. 790.
IMBODEN. Ein Boitrag zur Frage der Kombin&tion des manisch-depreasiven
Irreseins mit der Hysterie. Aug. Ztschr. f. Psychiat., Bd., 65, H. 5, 1908,
S. 731.

BERNDT. Schuchternheit, nervbse Angst- und Furchtxustande sowie andere
seelische Leiden und ihre dauemde Heilung. Modem-med. Verlag., Leipzig,
1908, M. 3.

TREATMENT*

BOWERS. Hydrotherapy; Methods of Application, with Results, as used in the
Philadelphia Hospital for the Insane. Joum. Amer. Med. Assoc., Oct 24, 1908,
p. 1420.

L£VY. Inutility de l’isolement dans la neurasthenia et les n6vroses; superiority
de la cure libre. Joum. des Prat., nov. 14, 1908, p. 739.

MANDY. Traitement des paralysies diphtfcriques par les injections de sfirum
anti-diphtbrique. (Th&se.) Imp)'. rlunies, Lyon, 1908.

REIFFERSCHEID. Die Behandlung der Eklampsie. Wien, med . Wchnschr.,
Nov. 7, 1908, S. 2458.

POP-AVRAMESCO. L’anesth^sie r^gionate par la rachistovainisation. Rev.
Neurol., oct. 30, 1908, p. 1090.

KNOPF. Die Prophylaxe des Stotterns. Konegen, Leipzig, 1908, M. 1.
GUL1CK. Neuro-muscular Co-ordinations having Educational Value. N.Y.
Med. Joum., Oct. 17, 1908, p. 732.

FREELAND FERGUS. Headache and Ocular Treatment Glasgow Med. Joum.,
Nov. 1908, p. 321.

FRANCIS BIRAUD. Traitement radiothlrapique de la n^vralgie du cordon.
Arch, d'Elect, raid., nov. 10, 1908, p. 897.

Psychotherapy. —THAYER Work Cure. Psychotherapy and its Value. Joum.
Amer. Med. Assoc., Oct 31, 1908, p. 1485.

LIPMANN. Die Wirkung von Suggestivfragen. Barth, Leipzig, 1908, M. 5.

ftmrgtcal.—KRAUSE. Chirurgie des Gehirns und RUckenmarks. L Bd. Urban
A Schwarzenberg, Wien, 1908, M. 12.

FORSTER. Ueber eine neue operative Methode der Behandlung spastischer
L&hmungen mittels Resektion hinterer Riickenmarkswurzeln. ZtscKr. f. orthopad.
Chir., Bd. 22, H. 1-3, 1908, S. 203.

PAYR. Drainage der Hirnventrikel mittelst frei transplantirter Blutgefttsse.
Bemerkungen Uber Hydrocephalus. Arch. f. klin. Chir., Bd. 87, H. 4, 1908,
S. 801.

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

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