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EXPERIMENTAL NEURITIS.
1245 membranes and the cord examined, a tumour about the size of the tip of the little finger being eventually found on the posterior root of the nerve about the level of the third dorsal vertebra. This had pressed the cord forwards and to the right, producing a deep depression in its substance. It was removed with the nerve to which it was attached. The incision through the membranes, which was at least three inches long, was not sutured; the wound in the soft parts was closed with sutures and drained. Strict antiseptic precautions were taken at the operation. Since the operation there has been no rise of temperature, and the pain has diminished. The painful spasmodic action of the muscles of the lower extremities from which the patient suffered has diminished, and there has been less rigidity of the legs, but the paraplegia continues. The growth, which was of a pinkish colour, elastic and vascular, has not yet been submitted to microscopical
through the
investigation.
-
EXPERIMENTAL NEURITIS. HYPODERMIC injections of ether are now so frequently employed, and with such good effect, that we are apt to forget that occasionally nervous lesions result from their use. Cutaneous anaesthesia, disorders of motility, and even serious trophic lesions have been observed, and the experimental researches of Arnozan and Salvat proved that the mechanism of these lesions was a peripheral neuritis. MM. Pitres and Vaillard find, however, that some of the peculiarities of the action of ether on the peripheral nerves must have escaped the attention of the last-mentioned observers.1 We reproduce the salient points of this interesting communication. When an injection of half a cubic centimetre of sulphuric ether is made deeply into the cellular tissue which separates the muscles on the back of the thigh of a guinea-pig, there always results a paralysis of sensation and motion in the parts of the limb situated below the level of the injection. Generally the anaesthesia occupies the two outer toes and the outer aspect of the leg, but it may sometimes affect all three toes and the whole of the skin of the leg, probably because the injection has traversed the muscular interstices and attacked the crural nerve. After a few days these phenomena may be accompanied by cedematous swelling of the foot, ulceration of the toes and tarsus, falling off of the nails, &c. The anaesthesia and the paralysis are manifested immediately after the injection, and in a short time they have reached their fullest extent, and, once developed, they persist for several weeks or even months without either increasing or decreasing in severity. In order to study the mechanism of the action of ether, M.M. Pitres and Vaillard have made a histological examination of the segments of the nerve situated above, below, and at the level of the injection of ether, and these examinations have been made on the sciatic nervefrom animals after a survival of some hours, days, or several weeks. Above the zone of injection the nerve has always appeared absolutely normal; nothing like an ascending neuritis has been observed. At the level of injection the alterations varied according to the length of survival of the animal. When the nerve was examined some hours only after the injection, the nerve being teased after maceration for twenty-four hours in a solution of osmic acid, and coloured by picrocarmine, eosine, or bsematoxylon, the myeline is found to have become blackened, and rather different from the bluish-black tint of normal nerve fibres. Further, the lateralfissures are no longer to be seen, the axis cylinder and nuclei of the interannular segments are not distinct, and it seems as though the nervous elements had become altered in their chemical composition. If the animal be killed six, eight, or ten days after the experiment, the 1
Gazette Médicale de Paris, No. 22, 1837.
segment of affected
nerve shows the same changes; it is the after fifteenth day that the altered fibres begin to only modifications: the myeline breaks up, and notable undergo is slowly absorbed. Below the level of the injection the nervous tubules rroceeding from the nerve trunk affected by the ether undergo the Wallerian degeneration, which is well marked on the fourth day. The ether is therefore regarded as causing an immediate necrosis of the nerve trunk at the site of injection. This was also shown by an experiment in which the nerve was first divided at its exit from the pelvis, and on the same day ether was injected into the lower part of the thigh of the paralysed leg. Wallerian degeneration was found eight days after in the nerve, between the point of section and that of injection, and also below the latter, but in the area of injection the nerve had not undergone degeneration; the myeline was continuous and confounded with tbeaxis cylinder, and there were no traces of nuclear multiplication. 0 ther experiments showed that an injection of the sulphuric ether could arrest the Wallerian degeneration at any point in its career. The same facts hold good with nitric and acetic ethers for guinea-pigs, rabbits, and cats. Hydrochloric ether has less severe effects. Formic and valerianic ethers have caused considerable local swellings and gangrene, thus preventing a proper examination of their action on nerves. The authors suggest that, in cases in which neurectomy or neurotomy is needed, injection of ether in the neighbourhood of the nerve trunk might serve equally well.
THE HOVE INFECTIOUS HOSPITAL. WE have received a further communication from Mr. Henriques as to the Hove Infectious Hospital. We do not publish it because it no longer deals with the defects referred to previously; it merely brings forward a few fresh points of objection to the institution. One relates to the use of earth-closets, it being alleged that the contents are not buried "at anything approaching to a sufficient depth to be safe." Surely such a trivial point of local administration can be altered by an order that the man in charge is to dig deeper. Then it is stated that there is no system of drains. The drains themselves we believe to be well and properly laid, but we agree with Mr. Henriques in so far as the absence of a proper system for disposing of their contents is concerned. There is ample ground for this, and here amendment is certainly wanted. Then the water supply is complained of. The supply is derived from a neighbouring public reservoir, and, owing to the levels, it has to be stored in a second reservoir on the hospital site, and to be pumped by horse-power into the hospital cisterns. We are sorry that, owing to the position of the buildings, such an expense should be necessary, but we fail to see why such a matter should be held up as an objection to the hospital itself. "Stored water," we now learn, "is never pure," and it "maybecome contammated. These are not grounds of objection which merit the publicity which this question has received. In every way we regret the action taken by Mr. Henriques and his supporter General Shute, and in one respect it has been scarcely courteous. Thus, the latter publicly asserts that our comments were inspired by a loca of partisan, and hence to quote them in favour of the views the medical officer of health as to the hospital is " simply giving the public credit for being idiots." And Mr. Henriques, referring to the suspicious character of certain dates, regards our comments as "inspired ab extra." We may state that our comments have been the result of a personal visit to this partial hospital provision for infectious diseases in Hove, and of a knowledge as to the principles properly governing such provision-which, we believe, is not inferior to that possessed by those who have done so much to bring the institution into public disrepute.
through the
investigation.
-
EXPERIMENTAL NEURITIS. HYPODERMIC injections of ether are now so frequently employed, and with such good effect, that we are apt to forget that occasionally nervous lesions result from their use. Cutaneous anaesthesia, disorders of motility, and even serious trophic lesions have been observed, and the experimental researches of Arnozan and Salvat proved that the mechanism of these lesions was a peripheral neuritis. MM. Pitres and Vaillard find, however, that some of the peculiarities of the action of ether on the peripheral nerves must have escaped the attention of the last-mentioned observers.1 We reproduce the salient points of this interesting communication. When an injection of half a cubic centimetre of sulphuric ether is made deeply into the cellular tissue which separates the muscles on the back of the thigh of a guinea-pig, there always results a paralysis of sensation and motion in the parts of the limb situated below the level of the injection. Generally the anaesthesia occupies the two outer toes and the outer aspect of the leg, but it may sometimes affect all three toes and the whole of the skin of the leg, probably because the injection has traversed the muscular interstices and attacked the crural nerve. After a few days these phenomena may be accompanied by cedematous swelling of the foot, ulceration of the toes and tarsus, falling off of the nails, &c. The anaesthesia and the paralysis are manifested immediately after the injection, and in a short time they have reached their fullest extent, and, once developed, they persist for several weeks or even months without either increasing or decreasing in severity. In order to study the mechanism of the action of ether, M.M. Pitres and Vaillard have made a histological examination of the segments of the nerve situated above, below, and at the level of the injection of ether, and these examinations have been made on the sciatic nervefrom animals after a survival of some hours, days, or several weeks. Above the zone of injection the nerve has always appeared absolutely normal; nothing like an ascending neuritis has been observed. At the level of injection the alterations varied according to the length of survival of the animal. When the nerve was examined some hours only after the injection, the nerve being teased after maceration for twenty-four hours in a solution of osmic acid, and coloured by picrocarmine, eosine, or bsematoxylon, the myeline is found to have become blackened, and rather different from the bluish-black tint of normal nerve fibres. Further, the lateralfissures are no longer to be seen, the axis cylinder and nuclei of the interannular segments are not distinct, and it seems as though the nervous elements had become altered in their chemical composition. If the animal be killed six, eight, or ten days after the experiment, the 1
Gazette Médicale de Paris, No. 22, 1837.
segment of affected
nerve shows the same changes; it is the after fifteenth day that the altered fibres begin to only modifications: the myeline breaks up, and notable undergo is slowly absorbed. Below the level of the injection the nervous tubules rroceeding from the nerve trunk affected by the ether undergo the Wallerian degeneration, which is well marked on the fourth day. The ether is therefore regarded as causing an immediate necrosis of the nerve trunk at the site of injection. This was also shown by an experiment in which the nerve was first divided at its exit from the pelvis, and on the same day ether was injected into the lower part of the thigh of the paralysed leg. Wallerian degeneration was found eight days after in the nerve, between the point of section and that of injection, and also below the latter, but in the area of injection the nerve had not undergone degeneration; the myeline was continuous and confounded with tbeaxis cylinder, and there were no traces of nuclear multiplication. 0 ther experiments showed that an injection of the sulphuric ether could arrest the Wallerian degeneration at any point in its career. The same facts hold good with nitric and acetic ethers for guinea-pigs, rabbits, and cats. Hydrochloric ether has less severe effects. Formic and valerianic ethers have caused considerable local swellings and gangrene, thus preventing a proper examination of their action on nerves. The authors suggest that, in cases in which neurectomy or neurotomy is needed, injection of ether in the neighbourhood of the nerve trunk might serve equally well.
THE HOVE INFECTIOUS HOSPITAL. WE have received a further communication from Mr. Henriques as to the Hove Infectious Hospital. We do not publish it because it no longer deals with the defects referred to previously; it merely brings forward a few fresh points of objection to the institution. One relates to the use of earth-closets, it being alleged that the contents are not buried "at anything approaching to a sufficient depth to be safe." Surely such a trivial point of local administration can be altered by an order that the man in charge is to dig deeper. Then it is stated that there is no system of drains. The drains themselves we believe to be well and properly laid, but we agree with Mr. Henriques in so far as the absence of a proper system for disposing of their contents is concerned. There is ample ground for this, and here amendment is certainly wanted. Then the water supply is complained of. The supply is derived from a neighbouring public reservoir, and, owing to the levels, it has to be stored in a second reservoir on the hospital site, and to be pumped by horse-power into the hospital cisterns. We are sorry that, owing to the position of the buildings, such an expense should be necessary, but we fail to see why such a matter should be held up as an objection to the hospital itself. "Stored water," we now learn, "is never pure," and it "maybecome contammated. These are not grounds of objection which merit the publicity which this question has received. In every way we regret the action taken by Mr. Henriques and his supporter General Shute, and in one respect it has been scarcely courteous. Thus, the latter publicly asserts that our comments were inspired by a loca of partisan, and hence to quote them in favour of the views the medical officer of health as to the hospital is " simply giving the public credit for being idiots." And Mr. Henriques, referring to the suspicious character of certain dates, regards our comments as "inspired ab extra." We may state that our comments have been the result of a personal visit to this partial hospital provision for infectious diseases in Hove, and of a knowledge as to the principles properly governing such provision-which, we believe, is not inferior to that possessed by those who have done so much to bring the institution into public disrepute.