corresponding hip-joint and down course of sciatic nerve.. Then a large zinc plate over hip-joint and wet sponge over sacral plexus. The current (both primary and secondary being used) was applied for ten or fifteen minutes and was sufficiently powerful to redden the skin over joint. Massages, kneading of muscles, and passive motion was practiced once, and sometimes twice, every day. After two weeks of this treatment he could, with help, get on his crutches and walk across his room several times before stopping. In two months he could, for the first time in eighteen months, turn on either side and sleep soundly, and could get out of and into his bed without assistance. His muscles have regained their normal nutrition and action, and his limbs their former rotundity. He walks to his store where he had not been for two years, takes exercise in his buggy, goes up and down stairs, eats well, sleeps well, and suffers no pain from his old trouble.

REFLEX NERVOUS MANIFESTATIONS,

BY FRANK WARNER, M. D., COLUMBUS, OHIO.

Read before the Ohio Central Medical Society, April 3, 1884.

Reflex action was very imperfectly understood until the early part of the present century, though it is true something was known of its action more than a century before.

As defined by Milne Edwards, "reflex action is the movement due to excito-motor force of which the manifestation is determined by unconscious functional activity of the sensitive nerves.' "But," he continues, "it would be more correct to call them movements determined by a reflex nervous action, for it is not a movement of which the direction changes, it is a nervous force on which depends the putting in play of the muscular contractility, which is considered as having been in some way reflected in the interior of the organism, in a manner to become centrifugal after having been centripetal."

As early as the middle of the seventeenth century, the great French philosopher, Descartes, had an obscure insight into some of the essential characters of the reflexes, but his descriptions are confined largely, it is true, to the sensorial automatic movements. He speaks of the relations which are established in the organism in the case of a sensitive impression

resulting in excito-motor influence, as the pupil of the eye contracting under the influence of light, or the closing of the eyelids on the approach of an object to the eye.

I translate from the French a paragraph showing how Descartes expresses himself on the subject: "It is easy," he says, "to conceive that sounds, odors, savors, warmth, pain, hunger, thirst, and all objects in general excite in us some movement in our nerves, which pass by their means to the brain; and besides these different movements of the brain in causing the mind to see different senses. Or, without this movement passing to the brain, it may take its course toward certain muscles rather than toward others, there setting up an action in our members, which I shall prove by an example." Here he goes on to relate a few familiar examples of reflex action, which I will not occupy your time in repeating.

In 1743, Jean Astrue, a celebrated Parisian physician of his time, had a much clearer understanding of reflex action and expressed himself with great exactness and force on the subject, and it is plainly seen he had some ideas on the mode of production of the reflexes differing little from the views held to-day.

Robert Whytt, a surgeon of Edinborough, a little later contributed some facts on the subject. But neither Whytt nor Astrue contributed so much to this subject as Unzer, in 1784. But his papers attracted very little attention until 1854, at which time they were translated into English by Mr. Laycock and published by order of the Linderhaus Society in London. The full exposition of the subject, as well as the laws regulating it, was left for Marshall Hall to develop, and the facts which he then presented, which was in 1833, are well known to the medical world. The fact that reflex action is in no wise concerned with volition was finally shown with certainty, for it would not be philosophical to assume that the movements of the beheaded animal were divested of its will power. Occasional examples that prove this point were finally furnished in the human subject, by accidents occurring in which was produced a dislocation of the neck along about the fourth or fifth cervical vertebra. In cases of this kind it was clearly shown that the reflexes were independent of the will power.

The influence of an irritant making its way through one of the sensory nerves, enters the spinal cord through the posterior roots and from the nerve cells here situated is generated the nerve force which passes out through the motor nerves to make itself manifest in the parts to which

these are distributed; but it is not universal by any means, for the excitation to manifest itself direct, for in all probability the posterior columns are only bands of fibres cementing together the different segments of the cord, and in no wise concerned in the transmission of sensations to the brain or the conduction of motor impulses from the central organ, and these fibres act not only to secure proper co-ordination of the muscular elements, but as well in conducting reflex impressions, and it is in this way that many times irritants produce a reflex influence in very remote parts of the body.

Reflex influence is augmented or diminished in various ways.

1. Severing connection of reflex centres from the brain.

2. Alterations in terminal filaments of sensory and motor nerves either by disease or administration of medicines, with reference to their capability of receiving and disposing of impressions.

3. A change in the continuity of the motor or sensory nerves with reference to their power of conduction.

4. A changed condition of the reflex ganglia.

5. An altered condition of the muscular fibres to which the motor filaments are distributed.

We will now proceed to discuss the modifications of the reflexes in the order which we have named in the above classification.

I. A partial or total severing of the connection of the spinal cord with the brain always produces an increased capacity for reflex action. In the physiological way we notice this phenomenon to the best advantage in decapitating a frog, when it will be found that muscular contraction is much greater on the application of a stimulus than before. In man we observe the same thing where the spinal cord has been severed from its connection with the brain by a dislocation of the vertebra in the middle cervical region. This phenomenon has been supposed to be due to the fact that in the ordinary condition of affairs, an irritant applied to the periphery and finding its way over the sensory nerves to the spinal centres is not all reflected over the motor nerves, but a portion is diffused through the cord to the brain, manifesting itself there as pain. While it is true that pathological growths in the brain, meninges or cord, do not give so much heightening of the reflexes, yet in the majority of them no doubt a considerable increase could be noticed by careful observation.

2. The second way in which I have spoken of the reflexes being altered is by a change in the terminal sensory or motor nerves; and we

can refer to nothing more striking than to the ravages which lead poisoning produces; and while it is true that the pathology of the subject, as to whether the affection is central, peripheral or myopathic in all cases, yet it is sufficiently clear that in many cases the peripheral sensory and motor nerves are affected; for it occasionally happens that while the electrical excitability of the affected muscles, on direct stimulation, is only slightly affected, a perfect analgesia and anesthesia exists. But under these same conditions, if the irritant were applied to the motor nerve distributed to the affected region, the muscles would not respond.

3. Another way in which the reflexes will be modified is by a change in the continuity of the nerve fibre interfering with their power of conduction.

Some of the most frequent ways in which this change is produced are by contusions, stretching, external pressure from tumors, or by an organic change taking place in the nerve itself. One of the prominent and frequent causes is the syphilitic nervous affections. A neuritis seated in a sensory nerve gives rise to pain extending all along the distribution of that nerve, but while this is true with reference to the sensation of pain, the reflexes remain unimpaired above the seat of the neuritis, but impaired between there and the terminal distribution. If the neuritis be situated in a mixed nerve, because in the previous case just cited we referred to a sensory nerve, a diminished reflex excitability is observed, both with reference to motion and sensation.

A neuritis situated in a motor nerve, or in a nerve containing motor fibres, may give rise to muscular contractions, which may subsequently be followed by paralysis of motion. The reflex and electrical excitability may become lost, and what is a peculiar but well settled fact is, that the muscles under these circumstances rapidly undergo degeneration. One of the prominent points relating to the differentiation of a neuritis from a neuralgia is the 'fact of the loss of reflex excitability in the one case and its normal retention in neuralgia.

Syphilitic gummata often affect the nerves in their continuity, and the cerebro-spinal nerves may be involved in the various affections of the meninges, producing anesthesia, analgesia, paralysis, or disturbance of the special senses. The manner in which this paralysis is produced we will notice a little further along.

4. The next way in which reflex action is modified is by functional or structural change in the reflex ganglia.

these are distributed; but it is not universal by any means, for the excitation to manifest itself direct, for in all probability the posterior columns are only bands of fibres cementing together the different segments of the cord, and in no wise concerned in the transmission of sensations to the brain or the conduction of motor impulses from the central organ, and these fibres act not only to secure proper co-ordination of the muscular elements, but as well in conducting reflex impressions, and it is in this way that many times irritants produce a reflex influence in very remote parts of the body.

Reflex influence is augmented or diminished in various ways.

I.

2.

Severing connection of reflex centres from the brain.

Alterations in terminal filaments of sensory and motor nerves either by disease or administration of medicines, with reference to their capability of receiving and disposing of impressions.

3. A change in the continuity of the motor or sensory nerves with reference to their power of conduction.

4. A changed condition of the reflex ganglia.

5. An altered condition of the muscular fibres to which the motor filaments are distributed.

We will now proceed to discuss the modifications of the reflexes in the order which we have named in the above classification.

I. A partial or total severing of the connection of the spinal cord with the brain always produces an increased capacity for reflex action. In the physiological way we notice this phenomenon to the best advantage in decapitating a frog, when it will be found that muscular contraction is much greater on the application of a stimulus than before. In man we observe the same thing where the spinal cord has been severed from its connection with the brain by a dislocation of the vertebra in the middle cervical region. This phenomenon has been supposed to be due to the fact that in the ordinary condition of affairs, an irritant applied to the periphery and finding its way over the sensory nerves to the spinal centres is not all reflected over the motor nerves, but a portion is diffused through the cord to the brain, manifesting itself there as pain. While it is true that pathological growths in the brain, meninges or cord, do not give so much heightening of the reflexes, yet in the majority of them no doubt a considerable increase could be noticed by careful observation.

2. The second way in which I have spoken of the reflexes being altered is by a change in the terminal sensory or motor nerves; and we