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CONSIDERATIONS RESPECTING PARALYSIS OF THE SYMPATHETIC, AND ITS RELATION TO NEURALGIA, AGUE, AND SOME ASTHENIC INFLAMMATIONS.
of Southern Africa, I fancied that as regards the dentition there existed a clear distinction between those with poison fangs and those without; and, in a practical sense, there is. But when I began to dissect the serpents of the globe, and not those of any particular region, I quickly found that the universal alone was true : that Nature admits or recognises no such gaps in her works as man chooses to discover. That certain species of serpents carry poison fangs alone on the upper maxillary bones is true; but as there are many which carry harmless teeth as well on the same bones, the fact becomes of little or no value scientifically or practically. Human bones, in a strictly fossil condition, have not as yet been found, though some have been discovered in situations, arguing on modern geological views, a vast antiquity. This matter I may discuss hereafter. But what I chiefly insist on here is this, the human bones discovered in regions now temperate, resemble those races. at present inhabiting the hottest regions of the earth; and it has been hastily inferred from a comparison of the cranium, that these fossils must have been the forefathers of the now existing coloured races; and eertce they were no doubt, but not specifically, any more than the fossil carnivora were the direct special predecessors of the nowexisting tigers, panthers, and leopards. The Esquimaux cranium unmistakably belongs to the dark races of men; well, had the race been extinct, and these bones alone discovered in the Polar arch, it would have been inferred that they could not have lived there, but must have migrated from a hotter region and thereperished. Now, nothing of this is true. Their centre of creation, using the expression as I have explained it, is the Arctic circle, within and near to which they live. That circle has undergone great changes no doubt, and man may have changed with them; but no species of man has ever yet been discovered with clearly marked pithecian forms, and the anatomy which finds strong resemblances between man and apes, is, to say the least of it, singularly coarse. The connecting links, or natural families between them, have not been found; they may not haveexisted as yet, though sure to As to human embryonic forms allied so closely to the come. lower specialities, I speak not of them here; instead of being composed of one great natural family not divisible into others, it is quite probable that in the human family there are sub. families in a fossil or recent state not yet discovered; all which species, the embryo of every species comprises within its structure, ready to be developed under favourable circumstances. But, this is certain, these species cannot be produced under the existing order of things, nor are they direct descendants of each other. Thus species would seem to be excluded from Nature’s plan,
pents
but the idea remains in man’s conception; and, after all, it may turn out that species is a distinct manifestation of the real, but to be observed by man when the characteristics are so minute as to escape his powers of observation. But be it as it may, nothing in either view affects the great laws of unity of type-unity of organization-of all, the past, the present, and the future. ’’ All the parts of an animal, taken together or separately, ought to be found in all animals." This was the doctrine formuled by Goethe, in 1780, from an instinctive conviction, sixty years before its admission into France-where it is not yet generally received-and ninety years before ib had gained as adherents three or four scientific men in Britain; the mass reject it as pure nonsense. " Peut on deduire les os de crane de ceux des vertebres, et expliquer ainsi leur formes et leur fonctions." Here is the whole question formuled. In 1790 he arrives at the determination that the cranium is composed of six vertebrea:-
ceases
3
Posteriorly1. Occipital 2. Posterior Sphenoid 3. Anterior Sphenoid
1 I
3
Anteriorly-
1. Palatine Bones 2. Superior Maxillary 3. Inter Maxillary
These agree with the elaborate inquiry of Agassiz’ collaborateur, Voght. Goethe mentions that the thought first struck him whilst looking at a portion of the backbone and cranium of a sheep in the Jews’ Cemetery of Weimar. Happy and immortal thought suggested the emblems of death. Whilst Goethe thus placed on a sure and unalterable foundation the basis of the transcendental in anatomy, as derived from the study of the adult and specialized individual form, he quickly saw that a study of the embryo was also essential to complete his views. Cuvier in the meantime, adhering to the
comparative anatomy of the adult, mode his grand discovery of the signification of the ossemens fossiles-a discovery entitling
him to the thanks of all mankind. He fancied that he had the basis of a new system of zoology; but this was a mistake. Linne and Buffon had left but little to be sleaned
also laid
46
But, pergisting in this route, and neglecting or misunderstanding the lights shed by embryology over the philosophy of zoology, he left to Geoffroy and other followers of the German school the pursuit of the transcendental, aloneequal to explain the meaning of forms. As a natural consein that field.
quence, he, as Hunter had done, wandered into that boundless region of detail, which Geoffroy early discovered to be without bounds as without result. But even in this remarkable discovery, (for it is one,) Geoffroy was long anticipated by Goethe, who characterized the attempt as "Un travail impossible, infini, que si par miracle il s’accomplira un jour, sera sans resultat comme sans limites." This early occurred to Geoffroy, to myself, to others. Cuvier’s pupils did not see this; they were his pupils. Meckel followed in the same track, and his’ great work on Comparative Anatomy fell dead from the press. In Cuvier’s
hands, Comparative Anatomy assumed a new philosophic form ; with him it meant the descriptive anatomy of the adult of all species. He discovered the value of this new element of science, and by its means explained the meaning of the fossil remains-a discovery which has no equal. By its means he became the founder of true geology and palaeontology, explaining the past by the present. But he declined explaining the present by the past ; this was reserved for Goethe, Oken, Geoffroy, and others. With Cuvier closed an oera-the sera of comparative anatomy as he viewed it. It had performed its mission, and therefore cannot be resuscitated, at and
more
least for the same purposes. Another element of science threw it into the shade-embryology. It is true that Goethe, with an inspiration almost divine, had shown that, in the comparative anatomy of adult forms, the secrets of embryology and of palaeontology were wrapped up ; and discovered, in fact, the transcendental. But it required a more exact embryology than was known to him to give the new doctrine a basis, and this
followed. The aera, of Cuvier, then, was closed-wound up by a higher generalization. But the influence of his grand discoveries will and piust continue for ages. The thanks of mankind are for ever due to him who, next to Galileo, has the most contributed to extend the sphere of human mental vision. He belonged eminently to the positive age, the age of facts; by them he stood, reckless of consequences, at least for a time. He gave to man a new and a true History of the Globe. soon
CONSIDERATIONS RESPECTING
PARALYSIS
OF
THE
SYMPATHETIC,
AND ITS RELATION TO
NEURALGIA, AGUE, AND BY C. HANDFIELD
SOME ASTHENIC INFLAMMATIONS.
JONES, M.B., F.R.C.P., F.R.S.,
ASSISTANT-PHYSICIAN TO ST.
MARY’S
HOSPITAL.
THE reflection must often occur to those who are best instructed in the science, and most skilled in the practice, of their profession, that there exists a sadly-wide hiatus in too many points between the one and the other. Very far are we, too often, from being able to give a sound reason as to why we follow such or such a plan of treatment, or give such or such a remedy. The sound practitioner, who abhors the idea of quackery, will hail every gleam of light that tends to show more clearly the nature of various disorders which his practical skill enables him to deal with more or less successfully, although he cannot tell exactly on what principle his treatment is based. I do not pretend, in the following observations, to do more than to attempt to throw a little additional light on the pathology and treatment of some rather obscure affections. In Dr. Graves’ "Clinical Medicine," (lst edition, p. 868,) there is a very interesting case recorded, of which the prominent symptoms were severe paroxysmal attacks of pain, heat, and vascular congestion of both feet and legs as high as the calf. The attacks generally commenced at night, with heat and tingling of the sole of the foot; as it proceeded, the parts affected became more and more hypersemic, till at length they were swollen, smooth, and shining, and almost the colour of a ripe black cherry. "When the hot fit ceases, the slight swelling and this discoloration subside, and the affected parts remain during the next stage, pale, deadly cold, and comparatively free from pain. While one leg is in the hot stage, the opposite leg is cold and pale, but free from pain; but as soon as the pain and heat have disappeared in the limb first affected, the same series of phenomena commence in the other leg, and last for the same length of time; after which both limbs are in their natural state, and for two or three hours she
is comparatively free from suffering, although some uneasiness becomes wider than natural, the depressed eye projects, the still remains, which she compares to a numbness, or some such hypersemic parts become pale, and the temperature sinks below morbid sensation not easily defined." The paroxysms occurred the normal figure. What would not have been expected is, daily, but the period and the duration of them varied, the that the ear of the sound side, during the application of the intermission, which had been only three hours, being prolonged galvanic stimulus, rises in temperature almost as much as the to eight at a later date. The affection came on after an attack other had done after the division of the sympathetic. The of diarrhoea, which caused much debility; but she had pre- same may be said of the results observed during the adminisviously been in a bad state of health, and the catamenia were tration of chloroform; when anaesthesia was complete, the ear suppressed. Improvement in health, and restoration of the of the operated side became cold and pale, while the other benatural secretion did not, however, induce any alleviation of came more hot and injected. This alternation of phenomena No treatment was of any avail, though all seems to indicate something like an association in action of the the disorder. possible measures were adopted. No paralysis, or impairment two sympathetic cords, as if the throwing of one into an unof motion or sensation, or alteration of structure, took place in usual state caused an opposite state of the other. It seems six years, during which time the patient was under observa- natural to suppose that the elevation of the temperature, cointion. ciding as it does with hyperoemia of the part, stands to the In his introductory remarks to the case, Dr. Graves ex- latter in the relation of effect to cause; that, in fact, the part presses his opinion that " the power residing in the capillaries is hotter because it contains more blood. Bernard, however, and smaller arteries"is concerned in carrying on the circula- opposes this view, because the temperature does not vary tion, and that the same power has much influence in the pro- when the hyperaemia declines, because hyperasmia occurs when He also refers to the erectile tissues as the fifth nerve is divided, but is attended with a diminished cess of inflammation. exhibiting striking instances" of the power possessed by the temperature, because ligature of the veins of each ear, and connerves and arteries of a part in producing a great and insequent gorging of the vessels with blood, lowers the temperastantaneous change in its circulation, independent of any ture of the parts, which again rises on the side on which the impulse derived from the heart." Of the correctness of Dr. sympathetic is subsequently divided. It is true that if the opinion, so far as it goes, there can be no doubt. The carotid is tied, and the sympathetic afterwards divided on the time, however, seems to have come when, by the aid of recent same side, no calorification takes place; but if the sympathetic researches in physiology, we are able to render these anticipa- be first divided, and calorification have come on, ligature of tions more exact and definite, and to comprehend the true the carotid does not lower the temperature to that of the sound nature of the foregoing case, which to Dr. Graves and other side. Much yet remains to be made out before a full explanation can be given of the various phenomena just mentioned, high authorities appeared utterly obscure. M. Cl. Bernard, to whom science is so much indebted, has even supposing that they are all found to be of constant occurextended and confirmed the knowledge which we previously rence ; but for the present it may be stated that section or depossessed relativeto the effect of dividing or destroying the struction of the sympathetic filaments proceeding to a pant sympathetic nerve in a part. His results are, briefly, that while causes increase of heat which is constant, and hypersemic insection of the sensory or motor nerves lowers the temperature of jection more or less considerable, not always persistent, but the parts to which they are distributed, a similar lesion of the capable of arriving at the condition of severe inflammation in sympathetic causes à constant and considerable increase of heat states of debility or depression of the general system. That in the region which is under its influence. When the opera- the hyperaemia. is the result of dilatation of the arteries, in contion is performed in the neck, the result is the same, whether sequence of paralysis of their contractile coats, is not so certain, the superior cervical ganglion be extirpated, or the cord of though it seems to me the most probable opinion. Bernard communication between it and the next ganglion be divided. states that the first effect of the division is contraction of the The elevation of temperature is observed not only in the skin, carotid, and he looks upon the subsequent distension of the but in the deeper parts, as in the substance of the brain, and vessels as the result of afnx of blood to the part. - However, in the blood returning by the jugular vein. Vascular conges- the contraction of the pupil, which is doubtless occasioned by tion takes place immediately after the operation, but is not the paralysis of the radiating fibres of the iris, seems to indipermanent, (according to Bernard,) as the increase of tempera- cate that the loss of the influence of the sympathetic does ture is; it subsides considerably in a day or two. In weakly tend to paralyse contractile tissues, and the result above menanimals severe conjunctivitis, with copious muco-purulent tioned, of galvanizing the divided nerve, supports the same secretion, takes place; this is not observed in stronger, and it idea. Mr. Wharton Jones relates an observation in his paper, disappears if the weakly animal regain strength and health. contained in the thirty-sixth volume of the Medico-Chirurgical Sloughing of the cornea does not occur; the pupil of the eye "Transactions,"which is further corroborative. He finds that on the operated side is contracted. after removal of the lower part of the spinal cord and the I have repeated the experiment recently on a cat, and have roots of the nerves, the arteries of the webs retain all their observed the same phenomena nearly as they are described by contractility, or are even more than usually disposed to be Bernard. The temperature of the left ear (the side operated constricted. If now the ischiatic nerve be divided on one side, on) immediately after the operation was 93° Fahr. ; of the right, " the result is that the skin of the extremity subjected to the 91.5°. The next morning the sound ear was 86°; the left, 97’5°.. experiment becomes, even to the naked eye, redder from vasThere was a mucous secretion from the inner canthus of the cular congestion than that of the opposite extremity, and on left eye, but the conjunctiva was not much injected; the left examination of the web under the microscope the arteries are pupil was contracted much more than the other. On the right found considerably dilated. In the web of the opposite extreside, close to the axilla at the root of the neck, the temperature mity, on the contrary, the arteries are seen still much conFor the stricted, some even to closure." was 970; on the left at the corresponding spot, 96°. next four or five days there was considerable conjunctivitis, Observation of the action of tonic and astringent remedies with copious muco-purulent discharge, but after this date the seems also decidedly to favour the idea that relaxation of the conjunctival inflammation and mucous secretion diminished small arteries is a frequent cause of hyperaemia of a part, especonsiderably. At the present date-i. e., sixteen days after cially when the tone of the general system is low. Thus a the operation-the left ear is 15° higher than the right; there patient may have an attack of bronchitis, which at first reare red vessels in it distinct to the naked eye; the conjunctiquires, and is materially benefited by, doses of antimony; but vitis has almost entirely subsided, but the fold of mucous mem- if this remedy be continued too long, the symptoms recur, and brane at the inner canthus is very prominent. The pupil is are then to be met by nitric acid, squill, and bitters, by which inuch contracted. She takes food well now, which was not the they are rapidly removed. In such cases, I have observed the case for the first five or six days after the operation. I should pulse at the wrist become smaller and firmer under the use of mention that before dividing the nerves in the neck I endea- tonics, the circular coat of the vessel contracting around the voured to divide those going to the left kidney, but failed to do column of blood more than it did before. An uncontracted, this satisfactorily. The shock and depression of a severe double lax-walled vessel, containing a large quantity of blood, may operation would naturally induce a state of debility, which, as give a false impression of strength, misleading the practitioner Bernard states, promotes the occurrence of conjunctival inflam- in his treatment. The beneficial action of copaiba in vesical mation. In my experiment the hyperaemia of the ear has cer- catarrh and similar states of the rectum, of turpentine in tainly been a very constant and noticeable phenomenon; it has haemorrhage and in asthenic iritis, and of arsenic in skin not as yet appeared to decline at all. It is a very interesting diseases, depends no doubt on their rousing the contractility of fact, stated by Bernard, and conformable to what might have the small arteries, and diminishing the supply of blood to the been anticipated, that galvanizing the upper end of the divided part. It cannot be affirmed that these remedies act through sympathetic causes the disappearance of the phenomena pro- the medium of the sympathetic nerves, though this, duced by its division, and not only so, but actually the de- in the case of arsenic, is extremely probable. With regard, velrmment of the ponverse state- Thus the contracted nunil however. to ouinine. or its combination with iron. it is notorious
Graves’
especially
47
that it exerts
very considerable influence on the nerves, both and sympathetic, and there is evidence that this influence is of the same kind as that of the remedies just mentioned-viz., that it increases or rouses the contractility of the bloodvessels, and diminishes morbid hypersemia or flux, if it exist. The paroxysm of ague seems to be essentially a disordered innervation of the vessels, those supplying the internal organs being first affected, and afterwards those of the surface. The poison in this case fixes itself on the sympathetic tracts, while in neuralgia it torments the cerebro-spinal. The same remedies are efficient in both cases for the cure of the disordered action. In cases of neuralgia, one may sometimes observe a transference of the morbid action from the external (sensory) nerves, to the internal, (sympathetic or organic.) Thus, a lady who has had repeated attacks of neuralgia, on two occasions, while under my care, has been suddenly affected with nausea, flatulent distension of the stomach and-intestines, accompanied, in one attack, with palpitation and irregular action of the heart. There seem to be all grades of diversity, from pure neuralgia-i. e., mere pain of sensitive nerves-to hypersemia, and disorder of secretion or nutrition. Sometimes the pain is the sole phenomenon, sometimes the derangement of the circulation and secretion; more often, the pathological state is a complex one, approximating to one or other type. It may be well to cite some examples. Dr. Vernon has mentioned a case to me which fell under his notice, where, during attacks of pain of neuralgic character, the eye and cheek became the seat of extravasation. The patient was affected with syphilis. The pain would last very severely for forty-eight hours, then begin to remit, and at the same time a blush would appear in the part, which increased up to actual extravasation. Black and blue discoloration subsequently occurred. In this case, which has some resemblance to Dr. Graves’s, there was hypersemia of such intensity as to cause actual haemorrhage. Minor degrees of hypersemia are common in frontal neuralgia ; the eye becomes red from injection of conjunctival vessels. Hypersemia sometimes occurs in one part as the result of altered innervation of another at a distance. This is exemplified in the flushing of the face which so often occurs in persons of weak digestive power after meals. The following instance of this state is interesting, from its association with other indications of disordered nervous a
cerebro-spinal
action:- Mrs. C-, of rather
large, lax habit, about mid-age, mother of five children, daughter of a lady who has had repeated attacks of severe neuralgia, had chorea herself at the age of fourteen. She has much exertion with domestic cares, and her energies are overtasked; she feels that she could sleep much longer than she allows herself to do. Lately her face has begun to twitch, the mouth being frequently drawn awry, so much so that she is observed sometimes to hold it with her hand to steady it. Immediately on eating, her face and neck become quite suffused with blood-crimson-so that she does not venture to dine out. She is wonderfully better in frosty weather. At times she has sensations as if the top of her head were held by tense cords. In this case, there is evidence of disorder of the whole nervous system, the cerebral centre, the sensory, motor, and sympathetic nerves being all affected. The pathological state is one of defective nervous power, with undue excitability, and the tonic influence of cold weather seems to be the most effective remedy. (To
be concdudedJ
ON THE
USE OF SALT-WATER BATHS IN CHOLERA.
STARR, M.D. EDIN. HAVING observed some interesting remarks in THE LANCET respecting the virtues of salt as a prophylactic to epidemic cholera, and as the views there published in connexion with that important subject coincide, in a great measure, with my own, I am induced to carry on the argument by furnishing the results of my recent experience thereon, as being indicative of the power and property possessed by salt, not only of warding off the assaults of the pestilence, but likewise, when properly BY THOS. HENRY
applied, of preventing the fatal effects after it has seized upon the human body. I should have tendered this communication for publication at an earlier period had I not been led to transmit my statements to the General Board of Health in October last, in compliance with the requisition which was individually addressed to the profession a short time before, urging them to furnish special 48
information to do.
on
the disease wherever it
was
in their power
so
doubt it will be allowed that I ha.d reason to feel upon examining the Report of the Treatment Committee of the Medical Council, and the classification of the 2749 cases therein contained, I could find no reference whatever made to my contribution, or to any therapeutic method bearing the least resemblance to that which I had adopted with such signal advantage. I did not fail to remonstrate in the proper quarter; but hitherto the omission remains without any satisfactory explanation. Granting that my whole course of reasoning on the matter might emanate from too humble a source to be deemed worthy of official consideration, still I might claim a fair representation of the facts as they occurred to me, with a concise statement of the principles which guided me in the employment of a remedy which proved so eminently I have
no
surprise when,
successful.
As it is generally admitted that the treatment of Asiatic cholera in the stage of collapse is a questio vexata, still open to inquiry, any practical information which tends to bring that fearful malady under subjection must needs be regarded amongst. the most important and valuable contributions to medical science. As long since as the year 1849 I had reasons for entertaining the opinion, which I made known at the time, that the systematic and persevering use of the strong salt-water bath, at a specific temperature, ranging from 106° Fahr. to 112° Fahr., (the latter being the degree which comes under the denomination of fever heat,) would be found an expedient of uniform and great practical value in the worst forms of collapse, and more especially so when, from our earliest attendance, we find we have to deal with the disease after it has reached the point at which the intolerance of the stomach to the normal action of internal remedies renders their administration futile or even worse than useless. The course of reasoning which drew me to this conviction was founded, to say nothing of the laws of. endosmose, on the vital property residing in the skin, of permitting the absorption of fluids into the circulating vessels, as proved by physiological experiments of admitted authenticity, as well as by the many familiar examples of the endemic transmission of therapeutic agents when partially applied. It has been ascertained, moreover, that nutriment may be conveyed through the same channel; and Mr. Erasmus Wilson, in his valuable work on the Skin, says, at page 45, that ’’ instances are on record, in which bathing in warm milk has been successfully employed as a means of supporting life, when the communication between the mouth and stomach was impervious.’ The remedial measure which I have tested and found so practically efficacious has the advantage of not requiring internal administration. Indeed I am convinced that those practitioners who exclusively or chiefly rely upon internal treat ment in the collapse of cholera will ever be doomed to disappointment in the great majority of such cases, for this obvious. reason, that the stomach rejects them in liraine; and as the blood, from the impetus of the disease, has already parted with the greater portion of its saline and watery constituents, whilst the residue has become cold and stagnant in the heart and vascular system, it stands to reason that our best chance for reaction and recovery depends upon a prompt, vigorous, and well-sustained restoration of its heat, its saline impregnation, and its fluidity. Without further comment I will adduce the evidence which has confirmed my belief, that a favourable result may be almost uniformly accomplished under the worst symptoms of collapse by the comparatively simple and easy process which I have tried and recommend. The proportion of salt I use is about half a pound to each gallon of water. The sectional outbreak of the pestilence which supplied mewith material for this communication occurred here on Sunday, the 30th September, 1854. Its invasion and phenomena were characterized by a peculiar intensity and virulence; its distribution was circumscribed, whilst its existence was transient in the locality where it took place. The houses in which it appeared-viz., Nos. 2, 3, and 21-were crowded with inmates, and probably the least cleanly in the whole street, which is a. comparatively obscure one, intersected by the boimdary which separates the two parishes of Brighton and Hove. Two children living on the first floor of 21, Cross-street, respectively named Wm. Moses Glover, aged nine, and John Glover, aged four, were suddenly seized with the epidemic about one o’clock r.M. on Saturday, Sept. 30th, 1854. They both died shortly after midnight, little or no medical aid having been obtained for them. The next case happened the following day-viz., Sunday, Oct. 1st. The name of the victim was ElizaStevenson, aged
pents
but the idea remains in man’s conception; and, after all, it may turn out that species is a distinct manifestation of the real, but to be observed by man when the characteristics are so minute as to escape his powers of observation. But be it as it may, nothing in either view affects the great laws of unity of type-unity of organization-of all, the past, the present, and the future. ’’ All the parts of an animal, taken together or separately, ought to be found in all animals." This was the doctrine formuled by Goethe, in 1780, from an instinctive conviction, sixty years before its admission into France-where it is not yet generally received-and ninety years before ib had gained as adherents three or four scientific men in Britain; the mass reject it as pure nonsense. " Peut on deduire les os de crane de ceux des vertebres, et expliquer ainsi leur formes et leur fonctions." Here is the whole question formuled. In 1790 he arrives at the determination that the cranium is composed of six vertebrea:-
ceases
3
Posteriorly1. Occipital 2. Posterior Sphenoid 3. Anterior Sphenoid
1 I
3
Anteriorly-
1. Palatine Bones 2. Superior Maxillary 3. Inter Maxillary
These agree with the elaborate inquiry of Agassiz’ collaborateur, Voght. Goethe mentions that the thought first struck him whilst looking at a portion of the backbone and cranium of a sheep in the Jews’ Cemetery of Weimar. Happy and immortal thought suggested the emblems of death. Whilst Goethe thus placed on a sure and unalterable foundation the basis of the transcendental in anatomy, as derived from the study of the adult and specialized individual form, he quickly saw that a study of the embryo was also essential to complete his views. Cuvier in the meantime, adhering to the
comparative anatomy of the adult, mode his grand discovery of the signification of the ossemens fossiles-a discovery entitling
him to the thanks of all mankind. He fancied that he had the basis of a new system of zoology; but this was a mistake. Linne and Buffon had left but little to be sleaned
also laid
46
But, pergisting in this route, and neglecting or misunderstanding the lights shed by embryology over the philosophy of zoology, he left to Geoffroy and other followers of the German school the pursuit of the transcendental, aloneequal to explain the meaning of forms. As a natural consein that field.
quence, he, as Hunter had done, wandered into that boundless region of detail, which Geoffroy early discovered to be without bounds as without result. But even in this remarkable discovery, (for it is one,) Geoffroy was long anticipated by Goethe, who characterized the attempt as "Un travail impossible, infini, que si par miracle il s’accomplira un jour, sera sans resultat comme sans limites." This early occurred to Geoffroy, to myself, to others. Cuvier’s pupils did not see this; they were his pupils. Meckel followed in the same track, and his’ great work on Comparative Anatomy fell dead from the press. In Cuvier’s
hands, Comparative Anatomy assumed a new philosophic form ; with him it meant the descriptive anatomy of the adult of all species. He discovered the value of this new element of science, and by its means explained the meaning of the fossil remains-a discovery which has no equal. By its means he became the founder of true geology and palaeontology, explaining the past by the present. But he declined explaining the present by the past ; this was reserved for Goethe, Oken, Geoffroy, and others. With Cuvier closed an oera-the sera of comparative anatomy as he viewed it. It had performed its mission, and therefore cannot be resuscitated, at and
more
least for the same purposes. Another element of science threw it into the shade-embryology. It is true that Goethe, with an inspiration almost divine, had shown that, in the comparative anatomy of adult forms, the secrets of embryology and of palaeontology were wrapped up ; and discovered, in fact, the transcendental. But it required a more exact embryology than was known to him to give the new doctrine a basis, and this
followed. The aera, of Cuvier, then, was closed-wound up by a higher generalization. But the influence of his grand discoveries will and piust continue for ages. The thanks of mankind are for ever due to him who, next to Galileo, has the most contributed to extend the sphere of human mental vision. He belonged eminently to the positive age, the age of facts; by them he stood, reckless of consequences, at least for a time. He gave to man a new and a true History of the Globe. soon
CONSIDERATIONS RESPECTING
PARALYSIS
OF
THE
SYMPATHETIC,
AND ITS RELATION TO
NEURALGIA, AGUE, AND BY C. HANDFIELD
SOME ASTHENIC INFLAMMATIONS.
JONES, M.B., F.R.C.P., F.R.S.,
ASSISTANT-PHYSICIAN TO ST.
MARY’S
HOSPITAL.
THE reflection must often occur to those who are best instructed in the science, and most skilled in the practice, of their profession, that there exists a sadly-wide hiatus in too many points between the one and the other. Very far are we, too often, from being able to give a sound reason as to why we follow such or such a plan of treatment, or give such or such a remedy. The sound practitioner, who abhors the idea of quackery, will hail every gleam of light that tends to show more clearly the nature of various disorders which his practical skill enables him to deal with more or less successfully, although he cannot tell exactly on what principle his treatment is based. I do not pretend, in the following observations, to do more than to attempt to throw a little additional light on the pathology and treatment of some rather obscure affections. In Dr. Graves’ "Clinical Medicine," (lst edition, p. 868,) there is a very interesting case recorded, of which the prominent symptoms were severe paroxysmal attacks of pain, heat, and vascular congestion of both feet and legs as high as the calf. The attacks generally commenced at night, with heat and tingling of the sole of the foot; as it proceeded, the parts affected became more and more hypersemic, till at length they were swollen, smooth, and shining, and almost the colour of a ripe black cherry. "When the hot fit ceases, the slight swelling and this discoloration subside, and the affected parts remain during the next stage, pale, deadly cold, and comparatively free from pain. While one leg is in the hot stage, the opposite leg is cold and pale, but free from pain; but as soon as the pain and heat have disappeared in the limb first affected, the same series of phenomena commence in the other leg, and last for the same length of time; after which both limbs are in their natural state, and for two or three hours she
is comparatively free from suffering, although some uneasiness becomes wider than natural, the depressed eye projects, the still remains, which she compares to a numbness, or some such hypersemic parts become pale, and the temperature sinks below morbid sensation not easily defined." The paroxysms occurred the normal figure. What would not have been expected is, daily, but the period and the duration of them varied, the that the ear of the sound side, during the application of the intermission, which had been only three hours, being prolonged galvanic stimulus, rises in temperature almost as much as the to eight at a later date. The affection came on after an attack other had done after the division of the sympathetic. The of diarrhoea, which caused much debility; but she had pre- same may be said of the results observed during the adminisviously been in a bad state of health, and the catamenia were tration of chloroform; when anaesthesia was complete, the ear suppressed. Improvement in health, and restoration of the of the operated side became cold and pale, while the other benatural secretion did not, however, induce any alleviation of came more hot and injected. This alternation of phenomena No treatment was of any avail, though all seems to indicate something like an association in action of the the disorder. possible measures were adopted. No paralysis, or impairment two sympathetic cords, as if the throwing of one into an unof motion or sensation, or alteration of structure, took place in usual state caused an opposite state of the other. It seems six years, during which time the patient was under observa- natural to suppose that the elevation of the temperature, cointion. ciding as it does with hyperoemia of the part, stands to the In his introductory remarks to the case, Dr. Graves ex- latter in the relation of effect to cause; that, in fact, the part presses his opinion that " the power residing in the capillaries is hotter because it contains more blood. Bernard, however, and smaller arteries"is concerned in carrying on the circula- opposes this view, because the temperature does not vary tion, and that the same power has much influence in the pro- when the hyperaemia declines, because hyperasmia occurs when He also refers to the erectile tissues as the fifth nerve is divided, but is attended with a diminished cess of inflammation. exhibiting striking instances" of the power possessed by the temperature, because ligature of the veins of each ear, and connerves and arteries of a part in producing a great and insequent gorging of the vessels with blood, lowers the temperastantaneous change in its circulation, independent of any ture of the parts, which again rises on the side on which the impulse derived from the heart." Of the correctness of Dr. sympathetic is subsequently divided. It is true that if the opinion, so far as it goes, there can be no doubt. The carotid is tied, and the sympathetic afterwards divided on the time, however, seems to have come when, by the aid of recent same side, no calorification takes place; but if the sympathetic researches in physiology, we are able to render these anticipa- be first divided, and calorification have come on, ligature of tions more exact and definite, and to comprehend the true the carotid does not lower the temperature to that of the sound nature of the foregoing case, which to Dr. Graves and other side. Much yet remains to be made out before a full explanation can be given of the various phenomena just mentioned, high authorities appeared utterly obscure. M. Cl. Bernard, to whom science is so much indebted, has even supposing that they are all found to be of constant occurextended and confirmed the knowledge which we previously rence ; but for the present it may be stated that section or depossessed relativeto the effect of dividing or destroying the struction of the sympathetic filaments proceeding to a pant sympathetic nerve in a part. His results are, briefly, that while causes increase of heat which is constant, and hypersemic insection of the sensory or motor nerves lowers the temperature of jection more or less considerable, not always persistent, but the parts to which they are distributed, a similar lesion of the capable of arriving at the condition of severe inflammation in sympathetic causes à constant and considerable increase of heat states of debility or depression of the general system. That in the region which is under its influence. When the opera- the hyperaemia. is the result of dilatation of the arteries, in contion is performed in the neck, the result is the same, whether sequence of paralysis of their contractile coats, is not so certain, the superior cervical ganglion be extirpated, or the cord of though it seems to me the most probable opinion. Bernard communication between it and the next ganglion be divided. states that the first effect of the division is contraction of the The elevation of temperature is observed not only in the skin, carotid, and he looks upon the subsequent distension of the but in the deeper parts, as in the substance of the brain, and vessels as the result of afnx of blood to the part. - However, in the blood returning by the jugular vein. Vascular conges- the contraction of the pupil, which is doubtless occasioned by tion takes place immediately after the operation, but is not the paralysis of the radiating fibres of the iris, seems to indipermanent, (according to Bernard,) as the increase of tempera- cate that the loss of the influence of the sympathetic does ture is; it subsides considerably in a day or two. In weakly tend to paralyse contractile tissues, and the result above menanimals severe conjunctivitis, with copious muco-purulent tioned, of galvanizing the divided nerve, supports the same secretion, takes place; this is not observed in stronger, and it idea. Mr. Wharton Jones relates an observation in his paper, disappears if the weakly animal regain strength and health. contained in the thirty-sixth volume of the Medico-Chirurgical Sloughing of the cornea does not occur; the pupil of the eye "Transactions,"which is further corroborative. He finds that on the operated side is contracted. after removal of the lower part of the spinal cord and the I have repeated the experiment recently on a cat, and have roots of the nerves, the arteries of the webs retain all their observed the same phenomena nearly as they are described by contractility, or are even more than usually disposed to be Bernard. The temperature of the left ear (the side operated constricted. If now the ischiatic nerve be divided on one side, on) immediately after the operation was 93° Fahr. ; of the right, " the result is that the skin of the extremity subjected to the 91.5°. The next morning the sound ear was 86°; the left, 97’5°.. experiment becomes, even to the naked eye, redder from vasThere was a mucous secretion from the inner canthus of the cular congestion than that of the opposite extremity, and on left eye, but the conjunctiva was not much injected; the left examination of the web under the microscope the arteries are pupil was contracted much more than the other. On the right found considerably dilated. In the web of the opposite extreside, close to the axilla at the root of the neck, the temperature mity, on the contrary, the arteries are seen still much conFor the stricted, some even to closure." was 970; on the left at the corresponding spot, 96°. next four or five days there was considerable conjunctivitis, Observation of the action of tonic and astringent remedies with copious muco-purulent discharge, but after this date the seems also decidedly to favour the idea that relaxation of the conjunctival inflammation and mucous secretion diminished small arteries is a frequent cause of hyperaemia of a part, especonsiderably. At the present date-i. e., sixteen days after cially when the tone of the general system is low. Thus a the operation-the left ear is 15° higher than the right; there patient may have an attack of bronchitis, which at first reare red vessels in it distinct to the naked eye; the conjunctiquires, and is materially benefited by, doses of antimony; but vitis has almost entirely subsided, but the fold of mucous mem- if this remedy be continued too long, the symptoms recur, and brane at the inner canthus is very prominent. The pupil is are then to be met by nitric acid, squill, and bitters, by which inuch contracted. She takes food well now, which was not the they are rapidly removed. In such cases, I have observed the case for the first five or six days after the operation. I should pulse at the wrist become smaller and firmer under the use of mention that before dividing the nerves in the neck I endea- tonics, the circular coat of the vessel contracting around the voured to divide those going to the left kidney, but failed to do column of blood more than it did before. An uncontracted, this satisfactorily. The shock and depression of a severe double lax-walled vessel, containing a large quantity of blood, may operation would naturally induce a state of debility, which, as give a false impression of strength, misleading the practitioner Bernard states, promotes the occurrence of conjunctival inflam- in his treatment. The beneficial action of copaiba in vesical mation. In my experiment the hyperaemia of the ear has cer- catarrh and similar states of the rectum, of turpentine in tainly been a very constant and noticeable phenomenon; it has haemorrhage and in asthenic iritis, and of arsenic in skin not as yet appeared to decline at all. It is a very interesting diseases, depends no doubt on their rousing the contractility of fact, stated by Bernard, and conformable to what might have the small arteries, and diminishing the supply of blood to the been anticipated, that galvanizing the upper end of the divided part. It cannot be affirmed that these remedies act through sympathetic causes the disappearance of the phenomena pro- the medium of the sympathetic nerves, though this, duced by its division, and not only so, but actually the de- in the case of arsenic, is extremely probable. With regard, velrmment of the ponverse state- Thus the contracted nunil however. to ouinine. or its combination with iron. it is notorious
Graves’
especially
47
that it exerts
very considerable influence on the nerves, both and sympathetic, and there is evidence that this influence is of the same kind as that of the remedies just mentioned-viz., that it increases or rouses the contractility of the bloodvessels, and diminishes morbid hypersemia or flux, if it exist. The paroxysm of ague seems to be essentially a disordered innervation of the vessels, those supplying the internal organs being first affected, and afterwards those of the surface. The poison in this case fixes itself on the sympathetic tracts, while in neuralgia it torments the cerebro-spinal. The same remedies are efficient in both cases for the cure of the disordered action. In cases of neuralgia, one may sometimes observe a transference of the morbid action from the external (sensory) nerves, to the internal, (sympathetic or organic.) Thus, a lady who has had repeated attacks of neuralgia, on two occasions, while under my care, has been suddenly affected with nausea, flatulent distension of the stomach and-intestines, accompanied, in one attack, with palpitation and irregular action of the heart. There seem to be all grades of diversity, from pure neuralgia-i. e., mere pain of sensitive nerves-to hypersemia, and disorder of secretion or nutrition. Sometimes the pain is the sole phenomenon, sometimes the derangement of the circulation and secretion; more often, the pathological state is a complex one, approximating to one or other type. It may be well to cite some examples. Dr. Vernon has mentioned a case to me which fell under his notice, where, during attacks of pain of neuralgic character, the eye and cheek became the seat of extravasation. The patient was affected with syphilis. The pain would last very severely for forty-eight hours, then begin to remit, and at the same time a blush would appear in the part, which increased up to actual extravasation. Black and blue discoloration subsequently occurred. In this case, which has some resemblance to Dr. Graves’s, there was hypersemia of such intensity as to cause actual haemorrhage. Minor degrees of hypersemia are common in frontal neuralgia ; the eye becomes red from injection of conjunctival vessels. Hypersemia sometimes occurs in one part as the result of altered innervation of another at a distance. This is exemplified in the flushing of the face which so often occurs in persons of weak digestive power after meals. The following instance of this state is interesting, from its association with other indications of disordered nervous a
cerebro-spinal
action:- Mrs. C-, of rather
large, lax habit, about mid-age, mother of five children, daughter of a lady who has had repeated attacks of severe neuralgia, had chorea herself at the age of fourteen. She has much exertion with domestic cares, and her energies are overtasked; she feels that she could sleep much longer than she allows herself to do. Lately her face has begun to twitch, the mouth being frequently drawn awry, so much so that she is observed sometimes to hold it with her hand to steady it. Immediately on eating, her face and neck become quite suffused with blood-crimson-so that she does not venture to dine out. She is wonderfully better in frosty weather. At times she has sensations as if the top of her head were held by tense cords. In this case, there is evidence of disorder of the whole nervous system, the cerebral centre, the sensory, motor, and sympathetic nerves being all affected. The pathological state is one of defective nervous power, with undue excitability, and the tonic influence of cold weather seems to be the most effective remedy. (To
be concdudedJ
ON THE
USE OF SALT-WATER BATHS IN CHOLERA.
STARR, M.D. EDIN. HAVING observed some interesting remarks in THE LANCET respecting the virtues of salt as a prophylactic to epidemic cholera, and as the views there published in connexion with that important subject coincide, in a great measure, with my own, I am induced to carry on the argument by furnishing the results of my recent experience thereon, as being indicative of the power and property possessed by salt, not only of warding off the assaults of the pestilence, but likewise, when properly BY THOS. HENRY
applied, of preventing the fatal effects after it has seized upon the human body. I should have tendered this communication for publication at an earlier period had I not been led to transmit my statements to the General Board of Health in October last, in compliance with the requisition which was individually addressed to the profession a short time before, urging them to furnish special 48
information to do.
on
the disease wherever it
was
in their power
so
doubt it will be allowed that I ha.d reason to feel upon examining the Report of the Treatment Committee of the Medical Council, and the classification of the 2749 cases therein contained, I could find no reference whatever made to my contribution, or to any therapeutic method bearing the least resemblance to that which I had adopted with such signal advantage. I did not fail to remonstrate in the proper quarter; but hitherto the omission remains without any satisfactory explanation. Granting that my whole course of reasoning on the matter might emanate from too humble a source to be deemed worthy of official consideration, still I might claim a fair representation of the facts as they occurred to me, with a concise statement of the principles which guided me in the employment of a remedy which proved so eminently I have
no
surprise when,
successful.
As it is generally admitted that the treatment of Asiatic cholera in the stage of collapse is a questio vexata, still open to inquiry, any practical information which tends to bring that fearful malady under subjection must needs be regarded amongst. the most important and valuable contributions to medical science. As long since as the year 1849 I had reasons for entertaining the opinion, which I made known at the time, that the systematic and persevering use of the strong salt-water bath, at a specific temperature, ranging from 106° Fahr. to 112° Fahr., (the latter being the degree which comes under the denomination of fever heat,) would be found an expedient of uniform and great practical value in the worst forms of collapse, and more especially so when, from our earliest attendance, we find we have to deal with the disease after it has reached the point at which the intolerance of the stomach to the normal action of internal remedies renders their administration futile or even worse than useless. The course of reasoning which drew me to this conviction was founded, to say nothing of the laws of. endosmose, on the vital property residing in the skin, of permitting the absorption of fluids into the circulating vessels, as proved by physiological experiments of admitted authenticity, as well as by the many familiar examples of the endemic transmission of therapeutic agents when partially applied. It has been ascertained, moreover, that nutriment may be conveyed through the same channel; and Mr. Erasmus Wilson, in his valuable work on the Skin, says, at page 45, that ’’ instances are on record, in which bathing in warm milk has been successfully employed as a means of supporting life, when the communication between the mouth and stomach was impervious.’ The remedial measure which I have tested and found so practically efficacious has the advantage of not requiring internal administration. Indeed I am convinced that those practitioners who exclusively or chiefly rely upon internal treat ment in the collapse of cholera will ever be doomed to disappointment in the great majority of such cases, for this obvious. reason, that the stomach rejects them in liraine; and as the blood, from the impetus of the disease, has already parted with the greater portion of its saline and watery constituents, whilst the residue has become cold and stagnant in the heart and vascular system, it stands to reason that our best chance for reaction and recovery depends upon a prompt, vigorous, and well-sustained restoration of its heat, its saline impregnation, and its fluidity. Without further comment I will adduce the evidence which has confirmed my belief, that a favourable result may be almost uniformly accomplished under the worst symptoms of collapse by the comparatively simple and easy process which I have tried and recommend. The proportion of salt I use is about half a pound to each gallon of water. The sectional outbreak of the pestilence which supplied mewith material for this communication occurred here on Sunday, the 30th September, 1854. Its invasion and phenomena were characterized by a peculiar intensity and virulence; its distribution was circumscribed, whilst its existence was transient in the locality where it took place. The houses in which it appeared-viz., Nos. 2, 3, and 21-were crowded with inmates, and probably the least cleanly in the whole street, which is a. comparatively obscure one, intersected by the boimdary which separates the two parishes of Brighton and Hove. Two children living on the first floor of 21, Cross-street, respectively named Wm. Moses Glover, aged nine, and John Glover, aged four, were suddenly seized with the epidemic about one o’clock r.M. on Saturday, Sept. 30th, 1854. They both died shortly after midnight, little or no medical aid having been obtained for them. The next case happened the following day-viz., Sunday, Oct. 1st. The name of the victim was ElizaStevenson, aged