this striking opposition between the effects produced upon the muscles by the atrophy of the spinal nerves and by that of the cranial nerves; he endeavored to give an explanation, and he invoked the functional difference of the anterior roots of the rachidian nerves and the cranial motor nerves. Now, gentlemen, it is to anatomy that we must go to demand the reason of this remarkable opposition, and it will respond to us, and this this response will suffice of itself to justify our localization of the malady in the sympathetic system. It is by the ganglia of Gasser and the trigeminals that the sympathetic distributes itself to the face. Now, in the preceding instance the nerves of the fifth pair were sound, that was expressly noted; on the other side the facial nerve, it is true, contained vaso-motor filaments; but these filaments were coming from the pneumogastric, and not the sympathetic. This fact, discovered by Schiff, shows conjointly with the preceding, that despite the atrophy of the facial nerves, the hypoglossal, and the spinal, the sympathetic was not interested, there was then no reason for the muscles becoming atrophied; indeed, they were not atrophied. In return, the anterior roots of the rachidian nerves, containing a great number of sympathetic filaments, it is by them that the filaments are distributed to the trunk and members, their lesion has had its ordinary effect-to wit, a generalized muscular atrophy; and as the lesion of the roots-that is to say, of the sympathetic, I again repeat it, predominate on the left side, it is also on the left that the muscular degradation is most advanced.

A third objection has been drawn from the variability of the nervous lesion as to its seat. The fact is true, and I have cited you to the very contradictory observations thereupon. But what does this prove? Simply that the nutritive nervous system can be affected in divers points of its extent, and there is nothing in this surprising to us. It is known that the sympathetic has its roots in the grey substance of the spinal marrow, and that these roots are in echelon in all the height of the spinal axis; we know, besides, that to gain the cord and the periphe

ral ganglia, the radical filaments of the sympathetic gain a passage-way from the anterior and posterior spinal roots; it is then easy to foresee that the nutritive nervous elements can be altered, either in their interspinal track or after their emergence, and the argument drawn from the inconstancy of the seat of lesion is by this singularly compromised. I am not returning again to the objection drawn from the absence of the lesion; I have already shown you that the autopsies called dumb could never have well been negative, excepting because they were incomplete.

The preceding pathogenetic doctrine has already been formulated: Barwinkel, Remak, and Benedikt, have themselves localized progressive muscular atrophy in the sympathetic system, I would tell you; but I can say, also, that this interpretation has up to now been based solely upon inductive reasoning, and that it had not been demonstrated; the anatomical, physiological, and pathological proofs which I present you, constitute this demonstration, and, I hope, establish it completely and definitively.

I would, besides, remark to you, gentlemen, that this doctrine renders an admirable soluton of certain symptoms more or less frequently found in muscular atrophy; it only can explain the pains and enlargement of the bones pointed out by Remak; the variable disturbances of temperature; the contraction of the pupils observed by Barwinkel, Voisin, and Bergmann; it alone permits the conception and coupling of the paralysis or troubles of sensibility from atrophy, properly so called, and the production of muscular atrophy in the course of certain limited lesions of the posterior system of the marrow, in tabes dorsalis, for example; it suffices for the first phenomenon, that the alteration passing from the sympathetic system encroaches upon the motor or sensitive elements; it suffices for the second fact, that the posterior spinal atrophy passing from the white cords, affects either the grey cornua or the sympathetic radical filaments, which take the course of the posterior roots. One comprehends also, by this, how it is that the clini

cal picture of progressive muscular atrophy should not always be so clear or so uniform as the first descriptions might have led us to suppose, since it is sufficient to disturb this uniformity and to obscure these characteristic traits, that the striking lesion of the sympathetic system, in its intra-medullary portion, should only in a slight degree extend beyond its limits.

The prognosis which I enunciated in the commencement of this study frees me from any long development of the treatment of the malady; nevertheless, I wish to direct your attention to the relation which has existed in certain cases between muscular atrophy and syphilis; a cure then has been obtained by means of iodide of potassium; the facts of Niepce, and of Rodet† relate to this category. In two other cases reported by Taylor‡ the same medication gave a complete success and a sensible amelioration, although the patients did not appear to have had syphilis. These results ought not to be lost sight of in practice. An individual treated by Jakob || was cured by the use of codliver oil and tonics; but the atrophy in this case was generalized, and furthermore it appeared to have followed onanism and seminal losses, so that it might have been that he was suffering simply from an emaciation. As to common progressive muscular atrophy, that which is developed under cold or humidity and excessive fatigue, that defies all pharmacetic agents; only electricity has sometimes succeeded. M. M. Duchenne and Gros, (of Moscow)§ have had some success with localized Faradization; but now that we are certain regarding the anatomical seat and the pathogeny of the disease, it would be best to resort from the beginning to the employment of the constant current, applied according to the method of Remak, which * Niepce, Union Medicale, 1853.

† Rodet, Eoden loco., 1859.

Taylor, Cases of Wasting Palsy. (Med. Times and Gaz., 1863.)

|| Jakob, Fall von gehuller all gemeiner atrophie. (Schweizereische Leits. from Heilkunde, 1865.

Gros, (de Moscow), De l'atrophie musculaire progressive au point de vue de traitement. (Gaz. hop., 1855).

consists in placing the copper pole upon the cervical vertebræ, and the zinc pole upon the region of the sympathetic of the neck. Some cures have been obtained by this treatment; they have been the cases of Remak and Benedikt.*

At the time of these pages going to prees, the 12th of December, that is to say eight months after the preceding lecture, I have again seen this patient, her state has become greatly worse; the groups of muscles primitively spared by the atrophy are affected, but in a less degree than the others; those which have become affected from the beginning are scarcely recognizable through the skin. The clawed condition always exists in the right hand, it has disappeared in the left, which is to be attributed to atrophy of the flexors; this hand is inert, and remains in a state of passive extension; the intercostals are commencing to be lost. Besides, the phemonena of paralysis, properly so called, are manifest; whilst the patient can still mantain herself upon her legs and take a few steps, she can execute no movements with the upper limb. The muscles which have preserved most of their volume remain inert under the excitation of the will. As the electric contractility is good, it is clear that the. origin of these additional paralytic phemonena is in the marrow, and not in the periphoric nerves, and this tends also to prove the perfect conservation of sensibility. Since these new symptoms, I think that this case belongs to the second group which I have established in pathological anatomy. The first lesion affected the sympathetic system in its intra-spinal regions; hence atrophy, which alone existed for several months; then passing the these limits it affected the motor elements which enter into the composition of the brachial plexus, and hence the secondary paralysis of the upper limbs. The cold persists, as in the past, more marked on the right than the left side.

† Remak, Benedikt, Loco citato.

PROCEEDINGS OF SOCIETIES.

"Etsi non prosunt singula, juncta juvant."

PROCEEDINGS OF LOUISVILLE OBSTETRICAL SOCIETY.

by W. H. NEWMAN, M. D.

Reported

Dr. Octerlony reported a case of great interest, which gave rise to the remarks following:

The report will be published in full next month. The points of greatest importance were these: vaginismus and sterility, afterwards, pregnancy complicated with whooping-cough, for which belladonna was administered; profuse leucorrhoea, etc. The child did not suffer from ophthalmia.

Dr. Newman thought that Dr. Marion Simes attributed vaginismus in all, or most all, of the cases to a hyperæsthesia of the hymen, and claimed to cure his cases by removing every portion of the irritable hymen. Dr. Newman has at this time a patient under treatment, a young girl sixteen years of age, who has such an extreme hyperæsthesia of the vulva that she cannot bear to be touched without the most agonizing pain; so much so that she will scream and almost jump from the bed or table when the hand touches the vulva. He thought there was no spasmodic contraction of the sphincter vaginæ in this case, but only an extremely morbid sensibility of the parts. She had white-of-egg-like discharge and copious menstruation. There was no redness, he thought, no inflammation of the vulva. He did not know how to account for this hyperæthesia.

Dr. Octerlony thought the most interesting fact in the case he had reported related to the action of the belladonna in rendering the labor comparatively painless and easy. He further remarked that he had entertained some fears lest the child, in passing through the vagina, might get ophthalmia from the discharges of the mother; but no such accident had occurred.