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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.

Structural or functional changes in the nervous centres often take place to such a degree as to greatly modify the reflexes. In acute anterior poliomyelitis the nerve cells in the anterior cornu of the cord rapidly undergo inflammatory degeneration, and pari passu, reflex action is impaired or abolished. At first the muscles rapidly respond to direct irritation, feebly to indirect. Soon, however, they respond neither to a galvanic nor faradic current, nor to the reflected stimulus through the The muscles rapidly undergo degeneration. It is interesting to watch the behavior of these muscles as the nerve cells return again to their normal condition, and by so doing we see the muscles first respond to the will, next to the galvanic and finally to the faradic current. In locomotor ataxia, the reflex excitability is usually lessened, though this is not uniform.

centres.

In myelitis, symptoms relating to reflex movements are of significance as regards the localization and the extent of the lesions. The continuance or the increase of reflex movements shows either that disorganizing changes have not taken place, or that the disorganization has not extended to the lower part of the spinal cord. On the other hand, loss of reflex excitability is an effect of the destruction of the gray matter in the lower part of the cord. This extension is shown by loss of reflex excitability after the occurrence of the motor paralysis.

5. The last type of disorder, in our classification, affecting reflex movements is a disturbance in the nutrition of the muscular fibres; the nerve centers, the nerve fibres and terminal filaments remaining normal.

In certain cases of progressive muscular atrophy we see this disturbance in reflex action just in proportion to the degree of the atrophy of the muscular fibres. Here is a very important distinction in a diagnostic point of view, for in anterior poliomyelitis, which we have just considered, we saw that reflex excitability is soon lost while the muscular fibres were still in a good state of nutrition; that a loss of the reflexes was due to an inflammatory destruction of the motor cells in the anterior nerves of the cord. However, it is true that some cases of progressive muscular atrophy present their initial lesion in the cord: an atrophy of a noninflammatory character of these same motor cells; but even here there is sufficient of the nerve cells unimpaired to translate an irritation into motion.

Probably in certain cases of lead poisoning, of a chronic character, the muscles are affected to such a degree, without the impairment of the nerves or cells, as to impair reflex action.

my classifi

An interesting kind of nervous disturbance not included in cation is a form of paralysis termed reflex. This is seen after many injuries, and more especially following certain diseases of the bladder, ovaries, kidneys, etc. The kind of paralysis following is usually paraplegia, but this is not always the case, for it occasionally happens the reflex manifestation is hemiplegia. This subject has been quite fully investigated and written upon by Brown- Sequard and Weir Mitchell. The pathology of the subject is still obscure. Brown-Sequard thought the cause of the paralysis in these cases traceable to a congestion of the cord, and Weir Mitchell felt quite sure that in cases which he examined post-mortem, he found an inflammatory condition of the nerve extending from the point of injury to the nerve cells. This form of reflex paralysis is occasionally functional, and the pathology here becomes still more obscure.

NOTES IN OTOLOGY.

BY FRANCIS N. MATTOON, M. D., PLAIN CITY, OHIO.

A paper read before the Madison County Medical Society.

Deafness is no trifling affliction; its existence involving not merely individual happiness, but the happiness often of families, and even communities. Once established it lasts, not merely for a day, but as long as life lasts. Yet the ear is subject to many maladies which are within the control of therapeutical science, and curable. Even at this late day, however, there is perhaps a greater amount of lukewarmness among general practitioners, respocting aural surgery, than respecting any other branch of science. The great reformer of the science of Otology (Wilde) wrote as late as 1853, that "The affections of the ear, whether functional or organic, are spoken of, lectured on, written of, and described, (even at the present day in great part) not according to the laws of Pathology, which regulate other diseases, but by single symptom, that of deafness." It has remained almost for our day and generation to place the science of otology, or the knowledge of the anatomy, physiology and diseases of the ear, on a level with those of other fields of labor in medicine, and to day it stands on a foundation worthy of all honor.

In this connection, and as exemplifying what may be sometimes accomplished in aural therapeutics by simple means, I desire to report briefly a few cases.

Case 1. In January, 1877, Anna W., aged 14, tall and slender, timid and bashful, came to my office complaining of earache, which kept her from school. Examining the ear, I discovered it impacted with wax; on washing this out, I could see by the aid of an ear mirror a small, irregular stone, which she had placed in her ear years before. Earache was relieved by the removal of the wax, and the hearing found much impaired. Patient would not at that time submit to an attempt to have the pebble removed. (I learned from her mother that two physicians of high standing, had made several painful and fruitless attempts to remove it soon after it was placed there, hence her timidity.) On the 12th of the following March she returned to have the stone removed. I assured her I would cause her no pain, and proceeded to use a syringe and warm water. After a short time she complained of dizziness, when I told her to go home and return the next day, which she did for two succeeding days. At the third sitting, after syringing a few minutes, the stone came out. Its weight was four grains. After its removal the hearing distance for the tick of a watch was two feet. I then inflated the ear through the eustachian tube, by the use of the bellows and eustachian catheter, when the hearing distance for the watch was four feet. After catheterization three days, I pronounced her hearing normal, and discharged her.

Case 2. Mrs. H., a farmer's wife, came to consult me May 15, 1873, for impaired hearing of the left ear. Upon examination I discovered quite a quantity of hardened wax. The history she gave me was as follows: In July previous upon retiring one evening, a flying-bug ran into her ear. It seemed to her as large as a cat and could scratch equally as fierce. Immediately she was frantic with pain, when her husband, on very short deliberation, concluded that to fill her ear with coal oil would dispatch the bug and give relief; whereupon she submitted to the remedy, which stopped the career of the bug, but resulted in an external otorrhea, of a few weeks standing, but the bug did not come out of the ear. She consulted a prominent physician in Sidney, O., who examined her ear with his unaided eye, and with a forceps made several gropings in her ear, but failing to get hold of anything, assured and reassured her there was nothing in her ear. Upon using the syringe and warm water, I removed the wax, and also the bug in pieces. I used the bellows and eustachian catheter in her case, but not with the former gratifying result; her hearing was permanently impaired.

Case 3. Mr. W. called at my office in the evening of July 6, 1878, wishing me to come in haste to see his little daughter, aged 12, who was suf fering extreme torture on account of a bug which flew into her ear, while playing. Before I arrived, however, a good neighbor lady, with more consideration than the husband in the former case, had filled her ear with sweet oil instead of coal oil, which drowned the bug and hence stopped the pain. I syringed the ear thoroughly, but the bug would not come out. Upon examination with the mirror the bug was easily seen, and with long slender curved forceps I had no trouble in extracting it. Hearing in this case was not in the least affected.

SOCIETY PROCEEDINGS.

OHIO STATE MEDICAL SOCIETY.

This Society convened at Columbus, as announced in our last issue, President C. P. Landon in the chair.

Rev. Colonel Anderson opened the session with prayer, after which the President read a brief introductory address.

The Chairman of the Committee on Arrangements reported that they had decided to hold a special meeting Tuesday evening to consider the Board of Health bills and matters in connection with medical education, and that Drs. Loving and Hamilton would entertain the delegates Wednesday evening at their respective residences.

Dr. Collamore, Secretary of the Society, presented his annual report. By correspondence he had learned that the following auxiliary societies have abandoned their organizations: Athens, Morgan and Washington County Medical Associations, Belmont County Medical Society, Cleveland Academy of Medicine, Columbus Academy of Medicine, Columbus Pathological Society, Delaware Medical Society, Delaware Medical Institute, Drake Medical Society, Guernsey County Medical Society, Hamilton County Medical, Hardin County Medical Society, Lancaster Medical Institute, Medico-Chirurgical Society of Northeastern Ohio, Medina County Medical Lyceum, Medical Association of Adams, Brown and Clermont Counties, Preble County Medical Society, Putnam County Medical Society, Richland Medical and Surgical Societies, Scioto County Medical Society, Union Medical Society of Alliance, Zanesville Academy af Medicine. It was recommended and decided to drop these organizations from the list of auxiliaries.

The following members have died since 1882: W. B. Carson, Bucyrus; John Davis, Dayton; J. C. Hubbard, Ashtabula; J. O. Kemp, Dayton; A. G. Leland, Trumbull; A. C. McLaughlin, Tremont City; J. A. McFarland, Tiffin; H. Senseman, Tremont City; N. H. Sidwell, Wilmington; W. H. Mussey, Cincinnati, and Benjamin Tappan, Steubenville. Honorary members, not previously noted, H. H. Childs, Pittsfield, Mass.; G. S. B. Hempstead, Portsmouth; J. Knight, New Haven, Conn.; Willard Parker, New York City, and L. W. Moe, Ottawa.

The existence of the Allen County, the Greene County and the Hocking Valley Medical Societies is in doubt, as catalogues have not been received for two years.

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