LECTURES ON THE PHYSIOLOGY OF THE NERVOUS SYSTEM,

463

LECTURES

horizontally; and I find this method so convenient, that I propose adopting it in all the autopsies I shall have occasion to make

ON THE

for the future. This section shows at once that effusion of blood has also taken place between the striated bodies and optic thalami. SYSTEM, Ihave also another digression to make, DELIVERED IN 1836, IN THE COLLEGE OF FRANCE but on so interesting a subject in pathology, that I am sure you will excuse my deferring BY M. MAGENDIE. I have our experiments for a few minutes. I here before me, on the table, the body of a LECTURE XXII. young girl, who died in my wards at the ; TASTE (continued) :-Examination of a dog, Hotel Dieu, while labouring under nymphodeceased accidentally during experiment. Imania. ’1’his is an extremely curious case,-perLecturer’s mode of examining the brain.Unique case of nymphomania before puberty. Ihaps unique in the history of medicine; at I I am unacquainted with any example Examination of the body. Opinions on theleast false membranes which occupy the seat of the4of a female having been affected with this cerearo-spinal fluid. Purulent matter in 4distressing disease before the period of the cavity of the subamchnoid, conveyed there puberty. 1 This young child, scarcely 12years herself to’the practice of by imbibition. Normal state of the cere- ’of age, abandoned bellum in the present case. The seat of masturbation, of which she was guilty sevetimes in the course of the day, and that nymphomania. Case of a Pole, in whomthe ral ivind ofa ball destroyed thefunctions ofheal’- in the most open and undisguised manner. ing, speech, and taste, but not of smell. This child, of gentle and engaging disposition, and endowed with a considerable share Gatranictreatmeiit. Seittof the disease. of intelligence, was so powerfully influencGENTLEMEN :-In my last lecture I told ed by the fatal passion which dominated, you that the organ of taste received three while it undermined, her existence, that she principal nerves from the brain, but that at length became an object of horror to her the lingual branch of the fifth nerve was parents and friends, to whom she frequently the only one which, considering its mode of detailed in the morning, and with the utmost origin and distribution, could be considered frankness, the excesses committed during an as exercising an influence over the produc- agitated and imperfect sleep. The child tion of the sense of taste. As to the gene- was brought to the Hotel Dieu, where she ral sensibility of the tongue, that is derived soon died with all the symptoms of comfrom distinct filaments which that organ pression of the brain. Immediately on her receives from the fifth pair. According, arrival I ordered her to take some cold however, to the method which we follow, baths, hoping to calm the nervous system, these considerations can only be regarded and diminish the irritation of the genital as so many simple assertions, until direct organs. One or two baths only were adexperiment on the living body shall have ministered when the little patient was demonstrated their accuracy. To this method seized with 0. species of hallucination, and I shall now appeal, and endeavour to show an exaltation of the intellectual faculties, you, experimentally, that the lingual branch manifesting itself by an incessant loquacity. of the fifth pair is the special nerve of the At the following visit the child answered sense of taste, with which the hypoglossal rationally enough all the questions which and glossopharyngeal have no connection were addressed to her, and I was unable to whatever. discover any of the symptoms which ordiBefore entering more particularly on this narily accompany acute inflammation of the subject, I shall devote a few minutes to the brain or of its membranes. I ordered sinaexamination of the carcass of the dog on pisms to the feet. On the following day, which I endeavoured, for the first time, to however, I found the child labouring under divide the glossopharyngeal nerve ; the ani- the symptoms of compression of the brain, mal died suddenly, and, as you must re- which gradually became more profound, member, I then practised the section of and finally terminated in coma and death. the same nerve on its dead body. I shall The autopsy was commenced 48 hours first open the cavity of the cranium, to as- after death, and it required but a very sucertain the cause of the animal’s death; and perficial examination to show how closely this is evident at once:an effusion of blood connected the nervous system was with the has taken place on the surface of the brain. disordered phenomena, in the midst of which Let us now examine the internal parts. You the patient’s life terminated. The first thing may remark that, in dissecting the brain, I done was to expose the anterior surface of proceed after a method which differs from the spinal marrow, and collect with care the the one commonly pursued ; I divide the cerebro spinal fluid ; the quantity of this cerebral mass directly from above down- latter obtained amounted to about two or wards into two parts, instead of slicing itthree drachms, which you see here. Instead

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of being clear and transparent, as it should be, and as you have seen it when extracted

error, which depends on want of attention, more than anything else, on the part of those from a healthy animal, the fluid resembles who make autopsies ; however, it must be an exhalation of sernm, and is of a dull confessed that in some cases it is difficult to yellowish colour. You know, from what determine the precise seat of the lesion, has been already said at an early part of the or the nature of the change which the fluid course, how profoundly the functions are has undergone. I regard these false memderanged by any remarkable modification branes, for the most part, as depending on a of the cephalo rachidian fluid, which is change in the consistency of the cerebrosometimes found not only altered in colour, spinal fluid, and so far we advance a step but more or less deviating from its normal beyond modern pathologists : inflammation degree of fluidity. Here, then, the altera- is their resource, but it is frequently insuftion in the colour of the cerebro spinal fluid ficient to explain the cause of death; while, puts us on the trace of the cause of this on the contrary, I have demonstrated, by a child’s death, which evidently must be the series of experiments which you have all same that produced the alteration of the witnessed, that any notable alteration in the fluid ; and this leads us to examine the state physical properties of the cerebro-spinal of the cerebro-spinal axis itself, and of the fluid is followed by a profound disturbance membranes enveloping it. But first let us i of the functions of the nervous system, and determine the condition of the fluid in the generally terminates in death. Look now at the state of the pia mater, various parts of the cranium and vertebral and observe how the injected vessels form a canal. distinguishable underneath the [Here M. MAGENDrE directed the atten- net-work for let me impress you with the arachnoid, tion of the pupils to a layer of idea that in all these cases the alteration ocliquid, mixed with albuminous flocci, which cupies the subarachnoid cavity, and not the extended over the whole surface of the spi- free, smooth surface of that membrane. I now exposed, in all directions, the nal marrow, and was contained between the great cavity of the arachnoid, and you see arachnoid and pia mater.] that it contains a quantity of purulent-lookWhen I remove (continued the Professor) ing matter: this, however, is not produced the fibrous membrane, you may observe how by the serous surface of the arachnoid ; the the arachnoid is elevated at several points latter is a tissue enjoying a very high degree by the effusion of fluid beneath it; the bril- of permeability, and the effused fluid you liancy and smoothness of the surface suf- see here has made its way by imbibition ficiently indicate that the effused matter lies from the cellular membrane lining the cerebeneath the arachnoid, and, consequently, bral anfractuosities. The oeseous envelop occupies the seat of the cerebro-spinal fluid. of the brain does not present any particularity Most physicians would regard the patholo- worthy of notice; however, the cavity on gical changes now before us as simply an the left side seems somewhat more developed effect of arachnitis, but for my part I see an than that of the right side. The region of alteration, a degeneration, of the cerebro- the cerebellum is but moderately developspinal fluid, produced by some special lesion ed, a fact which is in contradiction of the of the pia mater; the disease probably com- doctrine of GALL, who placed, as you know, menced by an obstacle to the venous circula- the seat of amativeness in that organ; now, tion in that membrane, which was soon fol- the present subject, affected with this paslowed by alterations of its normal secretion, sion or instinct in a very high degree, should and consequent derangement of the functions have presented a corresponding development in that part of the nervous system in which of the whole nervous system. A physician, who has devoted a good deal GALL supposed the instinct to reside. The of attention to diseases of the brain as cou- only remarkable circumstance connected nected with mental derangement, lately with this portion of the head is the excessive published a memoir on the false membranes thickness of the skull where it covers the which, according to him, are formed between cerebellum. I am far from wishing to deny the two free surfaces of the arachnoid, or, the possibility of any relation existinl- bein other words, within the great cavity of tween the cerebellum and generative system, that membrane. This is in opposition to but, on the other hand, I cannot prevent what you have just seen in the case before myself from thinking that such relation is us, but I do not hesitate to say, that the anything but constant when I find in so many author of the memoir alluded to has fallen cases high irritation of the genital apparatus into an error; he has mistaken, altogether, coinciding with atrophy or more or less dethe seat of these false membranes, which, struction of the cerebellum. The back part like purulent effusion, transudatioii of serum, of the brain, then, is, as I said, but slightly &c., almost invariably exist in the sub- developed in the present case: on the conarachnoid cavity, i. e. between the arachnoid trary, the whole mass of the cerebrum preand pia mater. Indeed, many writers, and sents a greater volume than lye usually find especially the older ones, fall into the sameat this age. The same purulent effusion,

’puriform

have

465

already noticed, may be observed on the vulgarly called the wind"of a cannonsuperior and inferior surfaces of the cere- ball, during one of the numerous combats bellum; the cerebral pulp itself is of good in which he was engaged for the indepenconsistency, and much injected with blood; dence of his native land. The ball which it is probable that we shall find more or less affected him killed two of his friends at his effusion of serum in the lateral ventricles. I have now exposed the central parts of the cerebrum; the ventricles contain some clear fluid, but in small quantity. Let us now direct our attention to the state of the genital organs. The external parts are red and injected : on separating the external labia the hymen appears in a state of perfect integrity, a circumstance which is excessively curious when we remember the practices to which this child constantly abandoned herself. The clitoris is very small, scarcely developed; it does not present anything worthy of notice; the vagina appears normal, without any marks of irritation, injection, &c. On arriving at the uterus we find that instead of being developed it is actually smaller in dimensions than the organ usually is at the age of 15, The neck of the uterus does not present the least prominence. The only parts of the reproductive system which exhibit any deviation from the normal state are the ovaries, Those bodies are much more developed than they should be, and, what is very remarkable, some of the vessels of GRAEFF can be distinguished with the utmost facility; here is one that is highly developed. You know that these vesicles are considered as a

proof that puberty has arrived, but this child was far from affording external signs of puberty. The conformation of the bladder and rectum presents nothing extraordinary. Here

we

may stop for

a

moment to ask

ourselves, did the existence of the nymphomania depend on the development of the ovaries, or the presence of the vescicles just alluded to? This terrible disease has occupied the attention of several writers, who have put forward a variety of theories, and, in fact, what is more easily made than a theory, provided you are not asked to furnish proofs of what is advanced: thus some authors place the seat of nymphomania in the uterus, others in the clitoris, others again in the ovaries; finally, others place it in the cerebellum. For my own part, without presuming to decide a question which is still involved in obscurity, I am inclined to connect the nymphomania of the present case with an abnormal development of the ovaries, and with the presence of vesicles in those bodies. However, nothing certain can be concluded from a single case : if I have occupied so much of your 4yne with its details, it is with the hope that at some future time it may serve to throw Itghton a disputed question in physiology. I shall now take the liberty of shewing you a case which is more immediately connected with our subject. Here is a young Pole who was knocked by what is

down

side. The young man rose up from the field immediately after the accident ; at first he thought nothing was the matter, but in a few seconds he perceived that he was completely deaf, and unable to hear the musket shots fired along side of him. The power of vision was troubled only for a short time, but he had entirely lost the faculty of speech, and that of taste; yet, strange enough, the sense of smell remained intact. The lesions just described have continued with little modification up to the arrival of the young soldier at Paris. I have just made an experiment which demonstrates that the special sensibility of the palate and tongue no longer exist : I placed some mustard on the anterior part of the tongue, but the patient remained unconscious of its presence until the mustard descended as far back as the pharynx and top of the oesophagus. The sensibility of the integuments of the head and face is limited on either side by the sterno cleido mastoid muscles. The muscles which act during deglutition, enjoy their full force ; hence we cannot admit any affection of the glossopharyngeal nerve. The paralyzed state of the tongue, the impossibility of communicating to it any motion from behind forwards, demonstrates a loss of power in the genioglossal muscles, and hence the ninth pair of nerves also participates in the lesion. By analyzing, then, the symptoms under which this unfortunate young man suffers, we arrive at the diagnostic of a lesion of the fifth pair of nerves, giving rise to all the phenomena connected with loss of sensibility; moreover the eighth pair is paralyzed on both sides, together with a portion of the ninth pair. Here we have a practical illust.ration of the utility of experimental physiology. A correct knowledge of the connection existing between functions and organs, leads at once to a knowledge at least of the seat of disease, if not of its nature. In the present case the lesion occupies the three nerves just mentioned, and it is to them that a rational method of treatment must be addressed. I commenced by trying the galvano-puncture ; I introduced a platinaneedle through some of the filaments of the supraorbital nerve, and a second into the superior maxillary branch of the fifth, but this produced such strong convulsive movements of the eye-])all, that I was forced to desist. I shall, however, repeat the trial again. The same means also determined convulsive movements in the muscles of the face and tongue, but without any permanent benefit ; the latter organ still lies motionless in the interior of the mouth. We are now inclined to ask, what portion

466 of the central nervous system is more im"95th day. The inflammation of the right mediately affected ? for we cannot suppose eye, noticed on the 90th day, is increased. that the same accident injured separately There is a preternatural vascularity of both the fifth, eighth, and ninth nerves : the the conjunctiva and selerotica, particularly lesion evidently occupies the cerebro spinal at the circumference of the cornea. The lids axis, and, we have every reason for thinking, are a little tumid, the pupil dilated, and the that part of the medulla oblongata and iris slightly green. There is intolerance of pores from which the nerves mentioned light, and considerable lachrymation, parabove, arise. The cannon-ball probably ticularly at night, when she looks at a burnpassed obliquely along the back of the ing candle. The air also pains her eye, but head and neck, without injuring the integu- she has no pain in her head. She says, that ments, but merely producing one of those when her eye first became inflamed it was concussions which are frequently mentioned very itchy. She has been living for some in the annals of military surgery. I pro- days in a cellar, the walls of which are very pose continuing the use of galvanism, and damp. From this she supposes she got when the patient returns, in fifteen or twenty cold, and that hence her eye became inflamed. days, I trust we shall have a more favoura- A livid red patch, the size of a large pea, ble account to give of him. having rather a deep root, has formed on the Time will not permit me to enter into any outside of her right leg. She remarks that details on this curious case, from which, it was burning and itchy when it commenced, however, you are now sufficiently advanced like the spot formerly on her cheek. She to draw some conclusions for yourselves : says her throat is " as well as ever,"—that I shall therefore terminate the lecture by she does not feel it sore. It looks, however, reminding you, how absolutely necessary it red, and a little whitish. She also says she is for the physician to possess correct ana- feels no soreness about the anus. The fistomical and physiological ideas, if he aim sure there is apparently healed, and the at understandil’lg the various lesions which diseased patches on the pudenda are less the nervous system may present to him, and prominent. " 96th day. She considers her eye worse, is desirous of really advancing the science of medicine, instead of building up theo- and its vascularity is increased. The colour ries which never can produce, as they of the iris is deeper. The cornea appears never have produced, any solid advantage. clear, and the pupil not affected. Habeat. Foment. flor. an. nob., et Mist: purgantem. Omit. Mist. Hyd. Pot. "98th day. The pupil is more dilated than CLINICAL that of the sound eye, and is oval from above, LECTURES AND REMARKS, downwards. The vascularity of the eye seems increased, and there is a great flow of DELIVERED ON water to yet she considers it better, or DISEASES OF THE SKIN, VENEREAL less sore. it; The other symptoms as before. "100th day. The inflammation of the eye, DISEASES, AND seems unaltered, the iris is perhaps a little SURGICAL CASES, more green. She says the pain is not great, AT THE except when she looks at a candle. SKIN INFIRMARY, AND AT THE JERVIS"101st day. Her eye is more inflamed ; STREET HOSPITAL, DUBLIN. the lids more tumid or oedematous; the iris more green; and the pupil slightly irregular BY DR. WALLACE, and obscured. Its edge is turned forwards. SURGEON TO THOSE INSTITUTIONS. She has great intolerance of candle light, but no pain of her head. She says there is Reports of tlae third and last period of the case ’, great discharge of water from her eye, parof M. D. Iritis.-REMARKS.-The con- ticularly at night, that she is sorer « below," nection of iritis with the scaly form ’-If vene- that she has been lately "indisposed." The real eruption. Existiaeg erroneous views on do not appear so well as they have pudenda this subject. Difference between syphilitic been; and a raised par-boiled looking patch and idiopathic iritis. Et-7-orinsul)posi?ig that has formed near the anus. the deposition of lymph is a patleogaioanmaic "103rd day. The eye is not improved. symptom of syphylitic iritis. On the com- The edge of the pupil seems thicker. Her partitive power of nitrous acid, of the hydrio- throat is not better. The anus and pudenda date of potash, and of mercury, in the mild are worse. She had pain in’ her forehead jorms of exanthematic syphilis. Use of ni- and profuse lachrymation last night. She trate qf silver as an application to gums spontaneously remarks that she has become ulcerated by salivation.—Conclusion. sore below in consequence of having omitGENTLEMEN:—I shall now read to you the ted her " old medicine," (the Hyd. Pot.) "106th day. The iris appears, perhaps, reports of the third and last period of the case of M. D.-(See LANCET, page 428.) more green, and the pupil a little more irThis period commenced en the regular. The eye looks glassy and its red-

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