Original Papers. ON SOME POINTS CONNECTED WITH THE GENERAL PA THOLOGY OF HTE NERV- BY J. L. TEED, M. D., KANSAS CITY, MO [Continued from our last issue.] When the brain is not properly supplied with arterial blood it cannot receive its due supply of nutritive matter from the plasma, nor its due supply of oxygen. There is therefore a lack of functional activity. The neurine also becomes watery and otherwise ill-nourished, and consequently at first becomes abnormally mobile; at the same time the proper molecular changes not being accomplished, other molecular changes take place, and thus abnormal movements in the neurine, and abnormal waves of nerve force give rise to abnormal manifestations of nerve function. No. 4. the subject of disorder coincident with its first development. Every body has its weak part. In one it is in some of the cell elements of its tissues; in another it is in its vascular element, whether it be in the manufacture of the blood, or in direct conditions of the blood or of the vessels; while in another it is in the nerve element, and in this latter we have the basis of the nervous temperament . of the older, and of the insane temperament of more modern writers; and this nervous temperament, though most frequently derived from the same, may spring from either of the other temperaments, a material disorder in the parent giving rise to a dynamic disorder in the offspring under certain deteriorating influences. Just as we find that molecular changes in one part may give rise not to structural change, but to dynamic changes, which, being conveyed to the central parts of the nervous system, may occasion dynamic changes either in it, or by reflection in some other part of the periphery; so we find that molecular changes which do give rise to structural change in the parent, may be potentially transmitted to the offspring so as to appear in an alterWhen the blood becomes loaded with cer- nate generation; or they may give rise to tain forms of effete matter, or with certain changes which ultimate in dynamic changes toxic mat.ers from external sources, the rein the offspring without the apparent interlations between the blood and the cells may vention of any structural change. And in be very considerably modified so as to in- this way insanity may be not only apparently duce a condition of inactivity, which may take the form of stupor or coma, and intrinsic molecular movements being at the same time established in the neurine, convulsion may also occur. At the time of death, molecular changes occur, which gradually progressing, ultimate in the condition of muscular spasm known as rigor mortis. As the nervous system is one of the decendants from the embryonic cell, it may be but also actually on the increase, not only by propagation from insane parents, but by faulty intrinsic condition of the nervous system, being the result of an intrinsic faulty condition of some other system in the parent. The function of the nervous system being either sensory, ideational, or motor, an abnormal condition of this system may be manifested in either of these modes, so that Metaphysics finds no place in the practice of medicine. The diseases of the nervous system may be classified as follows: in one person the disturbance may be sen- broad general principles which govern the sory, in another it will be ideational, and in treatment of diseases of other systems or oranother motor, the cause of such disturb- gans. ance being in each person the same. Moreover, the disturbance may be manifested in the same individual at one time in one mode, at another time in another mode. In the same way an affection in one mode in the parent may be manifested in a different mode in the offspring. Further, the affection of other lines of neurine, so that the function of the nervous system may be disturbed at one and the same time in various modes, and these also in various degrees. First-Diseases depending on derangement in the cells of which the nervous system is composed; whether of the nerve cells proper. or of those of the neuroglia or of the appendages. Secondly-Diseases depending on derangement in its vascular element; whether this relate to the quanity or the quality of the blood itself, or to the structure of its vessels. Thirdly Diseases which are functional or dynamic in their character, whether the ・ cause be central or peripheral. As external or ordinary force may be correlated into various forms, so internal or nerve force, being the continuation of external force, may be correlated into forms of force not, perhaps, properly falling under the term nerve force; thus it may suffer alteration in form. As force when liberated cannot become latent, without a transmutaBut disease may commence by functional tion of matter from a more simple to a more derangement, then involve the vascular elecomplex condition, and as no such transmu-ment, and finally the cell element of the tation occurs in the body of man, at least to nervous system. any great extent, if the ordinary line of trans- Like all classifications, however, this is mission should be suspended in its action, the chiefly useful for purposes of description and force will seek other lines of transmission, study. I have thus endeavored, Mr. Presi and in this way an abnormal correlation of dent, with as much brevity as the nature force may occur, giving rise to correspond of the subject would permit, to draw ing somatic disturbance. Thus when the the attention of this society to those eleforce usually expended as motion, is no mentary principles, which in my opinlonger expended in this way, it may become correlated into heat, and being generally diffused throughout the system in this form will occasion the phenomenon of pyrexia. ion, will be found to lie at the very foundation of all real advancement as regards the disorders of the nervous system, whether these take the form of ordinary tal aberrations. The importance of this subject has in your immediate neighborhood, Mr. President, such a practical illustration that no words of mine can add to that consideration any addi If the conditions of origin and growth of somatic disorder or paralysis or spasm. the nervous system are somatic conditions, Hyperesthesia or anæsthesia, or whether and if the properties of the nervous system they assume any form of the so-called menare somatic properties, the disordered conditions of the nervous system are also somatic diseases. All medical questions, therefore, relating to the nervous system are somatic questions; they have no necessary relation to the questions of dual or spiritual tional weight. The extent of this subject existence, and absolutely none at all, from a medical standpoint only. Disorders of the nervous system are like disorders of any other system, the natural results of natural causes, and are to be treated on the same embraces every physician, for it is to the profession at large that the people must look for the treatment of all cases of this kind in their earlier stages, while they are not sufficiently disordered to require removal from their usual surroundings, just as they look to ARGENTI NITRAS IN TRACHOMA. the profession at large for the treatment of the disorders of any other organ. BY W. C. TYREE, M. D., ADJUNCT PROFESSOR OF THE KANSAS CITY MEDIGAL COLLEGE. The necessities of the subject also embrace every physician; for any of us may at any moment be required to give an opinion as regards mental sanity or insanity, either in criminal or in testamentary cases, and still more frequently when the subject of such disorder is no longer a safe person to be allowed at large. How can an expert opinI limit myself in this short paper to the ion of value be given without a more than consideration of the use of nitrate of silver superficial acquaintance with the subject. as a local application in the treatment of The supposed intricacy and difficulty of trachoma for the reason that experience has the subject should be no hindrance to its taught me to believe it to be the best as study. The race is not always to the swift well as one of the most agreeable remedies nor the battle to the strong; the man of or- with which to attain the desired end. dinary mind by constant and persevering And while I lay no claims to any new diswork is the man who generally makes ad- covery in this direction, I think that satisfacvancement. The meteor of genius may tory reasons can be given why it is preferaflash and dazzle for a moment, but its light ble to certain other remedies which are popdoes not endure; it may gleam at a fortunate instant and illumine the gem lying in ular in eye practice and are recommended by its path; but gems do not always lie in its high authorities. path, and when so lying its light may not be gleaming. Master the subject step by step, and its difficulties will gradually lessen. Materia medica and therapeutics still remain far behind all other branches of medical science, and that part of this branch which relates to the action of remedies on the nerv-. ous system is perhaps the most obscure of many other causes, with their concomall. But the pathology of the nervous sys- mitant ills, such as photophobia, increased tem was at one time as dark as is now its lachrymation and the like, which can be therapeutics; the one has received some speedily reduced by a few applications of light, let us work on in the hope that perpet- a solution of this drug in its varied strengths. ual darkness will not always enshroud the other. Nor will I allow that these gratifying It is pleasing to me to note the large proportion of those cases seeking our advice for conjunctival irritation produced by granulations, or those afflicted with chronic or subacute inflammation of the lids from found it to possess superiority over copper and have thought that a smoother lid and less scar tissue were left after the re But, Mr. President, there is a reason results cease after the irritations have deeper far than any which I have mentioned, been subdued, and the more acute sympor than any of a similar kind, why the medical profession and every member of it toms have subsided, but in the greatly should devote himself to a more full and roughened state of the lid, I have ever complete study of the disorders of the nervous system; and this reason is the humanitarian aspect of the subject. We all know, Mr. President, that the more abstruse and difficult the subject, the greater the charm it has for a scientific mind. Shall it be said, Mr. President and. Gentlemen, that our noble profession are neither scientists nor philanthropists, but mere traders in human ills? May God forbid, Mr. President and Gentlemen, that either through you or through me shall such stigma be ever brought on our vocation, whose proud motto is, "Opiferque per orbem dicor.' [THE END.] moval of the growth by gentle stimulation afforded by the use of this agent than by any other means. And again, while the weakest dilutions which we ever use might give discomfort or pain when applied to the ocular conjunctiva and allowed to trickle down over the cornea, when properly applied in the stronger solutions to the everted lid and then quickly and thoroughly washed off, it will scarcely be ob- ures. All things considered, it seems to me jected to by the most delicate and sensitive of your patients. I do not claim that it would be advisable to use the caustic in such strengths as would enable us to directly attack the neoplasm and destroy it, for I think that any sudden destruction of the growth will usually involve the surrounding healthy tissue in the same process and will often result in cicitrization, leaving the lid in a condition little preferable to the disease itself. Yet in the light of ophthalmic surgery probably no greater boon could be accorded suffering humanity than the possession by the profession of some means whereby the hasty elimination of the granulations might be accomplished. For it is most discouraging to the surgeon, as wel as to the patient, for the latter to be compelled to return day after day, for weeks and months, as I have seen both in dispensary and private practice, to have the same monotonous process repeated. Hence, it is that numerous experiments have been resorted to by ingenious surgeons to shorten the ordinary period necessary for the proper cure of trachoma, but they have utterly failed in their object. It is hardly necessary for me to mention the practice of inoculating the conjunctiva with gonorrhoeal pus, for it is loathesome and revolting in its nature and destructive in its tendencies. The Jequirity bean has promised more than anything yet to this end, but it has been found by experience, limited though it be, that it is only in desperate cases, such as have resisted milder attempts that the risks of so high a degree of inflammation as is produced by this drug should be incurred. The latest experiments with this drug have demonstrated that it is rather a swelling of the conjunctiva hiding the granulation than a destruction of the growth that is produced by these inoculations. that the only rational way of treating trachoma is to combine constitutional treatment, with mild and gentle local stimulation. That local and general treatment should go hand in hand we have abundant proof. This being the case, we should place our patient under the very best conditions for recovery, and with good hygiene, tonics, it needed, cod liver oil and the like, we think we will succeed in doing this and shorten the ordinary period of treatment necessary, without such measures. Of these general measures there is no one of such importance as good hygiene, and by this I mean fresh air. I was struck with this fact in a case as related to me by a physician a few days since who had exhausted his patience in the treatment of this condition where there were corneal complications, which he thought demanded the confinement of the sufferer to bed. This confinement was continued for at number of weeks, when the experiment of keeping the patient out of doors was tried and resulted in a rapid and favorable termination. It has fallen to my lot to meet the same experience, and I think a comparison of the two methods will always result in favor of fresh air. I have recently had the impòrtance of these general measures impressed upon me in the case of a laundryman in Kansas City, whose condition in life would not admit of any cessation from work, for a great length of time, for repeatedly his lids. became almost smooth and the irritation subdued only to revive with increased fury almost immediately upon the resumption of work amid soiled linens and the foul air of illy ventilated rooms, and with equal certainty was the salutary power of the nitrate felt in every relapse in the speedy reduction of the thickened lids. As we scarcely see a single case of eye Still there are those high in authority who disease arise from defects of shape or funcclaim in Jequirity a most potent agent in the tion in which we do not have to weigh efficient and thorough elimination of these the question, Is it syphilitic, so in trachoma offending masses. Until something more the number of instances will be very large definite is determined with regard to the in which the balance of probability will inpracticability of the use of this drug we cline to an affirmative answer to this quesshall content ourselves with milder meas- tion. Who, with any experience, has not met |