months old,-all of which are very nutritious, but the digestive ability is not sufficiently developed to prepare them for absorption. Such foods are adapted to nourish older children and strengthen the adult, but the infant cannot called our attention to "a hard lump on the | consisting of bread, meat, and vegetables are jaw" (adenitis) which had developed. The sometimes given to babies a few weeks or little fellow was prescribed for, and instructions again given to his mother as to the necessity of regularity of diet, hygienic improvements, etc. One week later we saw the baby for the third time, when aphtha stomatitis had developed; an antiseptic alkaline mouth-appropriate them; thus, he starves as surely, wash was ordered, and the trouble eventually disappeared. He has gained, by simply regulating his hygienic surroundings and food, four ounces in weight in two weeks. This is a case, gentlemen, of simple atrophy, or, as it is sometimes termed, marasmus, -a wasting disease. The condition presented here, and one which we are expected to improve,—yes, to build up to a healthy state, is one of extreme wasting,—a wasting of the soft tissues of the body, with a catarrhal inflammation of the mucous membrane of the gastro-intestinal tract. A large percentage of this class of cases die, and post-mortem examinations have shown a total disappearance of normal fat from the body, the tissues in a state of atrophy (waste). Fatty degenerations of the brain, lungs, and kidneys have been discovered; hæmorrhagic effusions into the cranium are not at all uncommon, and the stomach is sometimes ulcerated. Simple atrophy is most frequently seen among children of the poor, and generally occurs during the first year of life, though it may begin later. We find it in the breast-fed, and in those fed otherwise,—in either case due to a lack of sufficient nourishment. There are two ways in which food can be insufficient. First, when the amount supplied is too limited to meet the demands of the system. Second, when the amount applied contains a minimum only of the elements essential to nutrition, or given in a form badly adapted to the weak digestive powers of the infant. For instance, and I would ask you to make note of this,—the nursing infant wastes by feed ing from a breast that yields too little good milk, or from one that gives abundantly a poor, watery secretion, entirely unfit for proper nourishment. On the other hand, it hardly ever happens with artificially-fed babies that the quantity of food is too limited; indeed, it is more probable in the lack of quality. Cows' milk undiluted, milk thickened with starchy substances, and table food but more slowly, than if he took no food at all. Fermentation, with irritant products from the remaining undigested material in the stomach and intestines, causes vomiting or diarrhoea,conditions that hasten the disease we have now before us. A want of cleanliness in the feeding apparatus may be the cause of the disease. In this case it is quite evident that the lack of quality of the mother's milk is the cause of the present trouble. The body and extremities, you can see, have lost their plumpness, the muscles are flabby, and there has been arrest of growth. Observe how very white the face is; the lips quite pale and thin, and there is not that moisture of the skin we look for in the healthy child. The mother states that he is irritable and restless, and the bowels are frequently constipated. With the exception of a hernia recently developed at the umbilicus there is no indication of any organic trouble. Bemember, when making a diagnosis in a case of atrophy, pronounced emaciation may be the result of acute tuberculosis or inherited syphilis,-conditions attended, however, by characteristic symptoms which render their diagnosis a matter of little difficulty. The caution I have just given you is not applicable in the present case. To prevent wasting from insufficient nourishment the first thing to be attended to is the diet. Generally children under twelve months, who have to be either partially or entirely artificially fed, do well upon cows' milk, with lime-water or with barley-water. The food should be administered from a bottle capable of containing half a pint, made of glass without color, so that the least particle of dirt can be detected and removed, and provided with a soft India-rubber tip. A sufficient amount of food for one feeding only should be prepared at one time. A mixture as follows-cream, f3ss; milk, f3iiss; aquæ, f3j; sugar of milk, 3j-is one I often recommend, and one which I would advise you to copy in your note-books. The bottle containing the food must be placed in hot water until the contents become warm, | sensory fibres which run to the bladder by when it is ready for the child. This child is bathed daily in warm salt water, and every morning and evening a warm codliver oil inunction is rubbed over the abdomen and chest. A flannel binder covers the belly, and the feet are kept warm by the use of stockings. ORIGINAL COMMUNICATIONS. A VESICAL DETRUSOR CENTRE BY ISAAC OTT, M.D., THE way of the hypogastric nerves have their reflex centre in the hypogastric ganglion. This has been confirmed by several observers, among whom are Langley and Stevenson. Von Zeissl* found that (1) the nervus erigens is the motor nerve of the detrusor; (2) irritation of the nervus erigens opens the sphincter, and this opening ensues independent of the detrusor; (3) irritation of the hypogastric nerves causes a closure of the bladder against pressure from the urethral side; (4) in the nervus erigens there are motor fibres for the detrusor which may be likened to longitudinal fibres and inhibitory fibres for the sphincter or circular fibres, and in the hypogastric nerves there are motor fibres for the sphincter and inhibitory fibres for the detrusor. In other experiments to determine if the detrusor and sphincter acted simultaneously, he found that the sphincter opened independently, without the accessory help of the detrusor. By irritation of the cerebral ends of nerves he was able to cause opening of the sphincter or contraction of the detrusor. In simultaneous irritation of the nervus erigens and hypogastric nerves he found that the effect of the erigens, as regards the detrusor, was weakened or inhibited. As to the opening of the sphincter, this act can also be completely depressed. The inhibitory action of irritations of the hypogastric is not only exerted during the simultaneous irritation of both nerves, but it outlasts it for some time. As is well known, in the spinal cord a genito-spinal centre is lo HE movements of the bladder have been studied by various observers. Among the earliest was Valentin, who found that electric irritation of the cerebellum, cerebral peduncles, corpora striata, and optic thalamus always produced a contraction of the bladder, but that irritation of the cerebral hemispheres did not do so in a constant manner. Budge's experiments restricted the sphere of activity of the nerve-centres upon the bladder. Budge killed the animal, opened the abdomen, the cranium, and the spinal cord. By electric irritation he found no movements of the bladder after excitation of the cerebral hemispheres, optic thalami, corpora striata, or corpora quadrigemina; but when he irritated the cerebellum and the cerebral crura he was able to call out vesical movements. He also ob-cated. served vesical action when he irritated the spinal cord, especially its anterior lower part. Volkman did not observe any movement of the bladder on irritating the central nervous system, thus throwing doubt upon the experiments of Valentin and Budge. Schiff found that irritation of the pedunculi cerebri caused movements of the bowels, stomach, and bladder. Mosso and Pellacani* believe that fibres pass from the brain through the posterior columns and posterior part of lateral columns to the motor fibres of the sphincter urethræ. They also found that extirpation of the sympa thetic filaments in the dog caused no loss of either sensibility or movement in the bladder. They noted no antagonisms between the sphincter and detrusor. Sokownin found that * Sulle Funzione della vescica, Roma, 1882. In some experiments published some years ago, in the Journal of Physiology, I noted that cross-section of the crura in cats was always followed by exit of urine. To make further experiments upon this subject I selected the same animals. They were bound down, etherized, carotids tied, and tracheotomy performed; then the skull was trephined and the top of the skull removed by the bone-forceps, when the brain lay like a map before me. The bladder was turned out by an abdominal section; its normal movements were noted and section of the brain commenced. After slicing away the hemispheres, removing (piece by piece) the corpora striata and optic thalami or the corpora quadrigemina, no action upon the bladder was seen. Then the tuber * Pflüger's Archiv, Bd. liii, p. 566. cinereum was broken up; still no movement | what I shall call "normal curves," as in ensued. When, however, with the blunt Fig. 1. When the crura were punctured the "seeker," I cut into the crura, the bladder invariably contracted and expelled its contents. To study this movement more accurately I attached the bladder, by means of a cannula inserted through the urethra into its cavity, to a Marey polygraph. The tubing and bladder were filled by a T-shaped cannula curve was as in Fig. 2. The star denotes the time of injury to the crura. As is seen, it is a much more prolonged action than normally takes place. Here the mechanical irritation is the best to use, for the space is narrow and electric irritation would necessarily spread and confuse the results. This is the most anterior ward, which is denoted by the star. That the pressure of the urine and opens to expel the secretion. The spinal detrusor and the spinal sphincter are under the control of the detrusor of the cerebral crura, which is set in activity by the cerebral hemispheres in voluntary micturition. That an act of inhibition comes into play is true, but its central connection is still to be explained. this centre is not inhibitory is proven by the fact that when I applied the faradic current the bladder contracted, whilst if it were inhibitory it ought to have kept it quiet or relaxed it. Besides, in the puncture of the thermotaxic centres we know that the "seeker" acts there as an excitant, and not as a paralyzant. To determine the path of this irritation in the spinal cord I used the same animals. They were etherized, the cord bared at the ninth dorsal vertebra, and the dura mater divided. Then Woroschiloff's instrument was used to divide the spinal cord. After waiting a short time the animal was prepared as before and a section of the crura made. When the gray matter of the spinal The number of experiments performed was thirty six. PHYSIOLOGICAL LABORATORY. SOME OBSERVATIONS UPON THE By M. MILTON WEILL, M.D., American Electro-Therapeutical Association, etc., cord was completely divided, puncture of the Formerly Physician to German West-Side Clinic; Member of crura still produced vesical contractions, as in Fig. 4. The star denotes the period of punct ure. When the posterior columns were alone divided, crural irritation still caused a contraction of the bladder; when the anterior columns of the spinal cord were only divided, a contraction ensued upon injury to the crura; but when both lateral columns were divided, no result ensued from puncture of the crura. These experiments conclusively showed that the influence transmitted from the gray matter in the cerebral peduncles to the vesical detrusor went through the lateral columns of the spinal cord. The theory of the action of the bladder is assumed to be as follows: An automatic centre in the spinal cord which keeps up the tonic action of the sphincter, and a reflex detrusor centre seated higher in the spinal cord. Both these centres are under the domination of a cerebral centre. According to Landois the inhibitory fibres concerned in the reflex inhibition of the sphincter urethræ probably arise from the optic thalamus. The experiments of Zeissl show that both the detrusor and the sphincter can act independently of each other; but the centre, I have discovered, is not an inhibitory centre, but an excitor of the detrusor. To decide through what nerves this centre acts, whether through the nervus erigens or the hypogastric nerves, will require further experimental work. A NEW YORK CITY. PHYSIOLOGIST of wide repute, not long ago, after conducting a series of experiments, consisting of intra-venous, intraperitoneal, and subcutaneous injections of strong solutions of hydrogen peroxide and commercial preparations of ozone upon dogs, drew the following conclusions: "Ozone is of no real value to the tissues, whether inhaled or drunk in fluid preparations, and it may be exceedingly harmful.” I have looked into the physiological properties of ozone during the past year, and, as the question regarding its value as a therapeutic agent is not uniformly recognized by the profession in general, I have collected the following extracts from the work of distinguished. observers all over the world, to which I beg leave to add a few words justified by my experience with ozone in the physiological laboratory. It required many years after the great Schönbein discovered what he called sour oxygen" to settle the question that ozone existed in the human economy. This was finally established by the careful research of Alexander Schmidt, and verified by Kuehne and Scholz. In order to avoid all possibility of confounding hydrogen peroxide with ozone, let me ask you to bear in mind that (1) hydrogen peroxide (H,O2) coagulates albumin ; * (2) ozone (O3) transforms albumin into fibrin and hæmoglobin into oxyhemoglobin, and When the act of micturition takes place the spinal detrusor centre is excited into activity by the pressure of the urine; the sphincter automatic centre is independently excited by introducing H2O, directly into the circulation. *And this in order to draw attention to the obvious effect of its prolonged action, in the nascent state, on this fibrin redissolves it and renders it incoagulable by acids and metallic salts. Physiological chemists accept these characteristics as proven beyond peradventure, and they form the groundwork upon which all subsequent physiological and therapeutic action is based. Considering ozone as existing per se, there is no doubt that it is capable of entering into fresh chemical combination with the gases in the blood, particularly the oxygen, and to transfer to them its peculiar characteristics. No work on chemistry gives any information on this point, but all show, with irrefutable certainty, that ozone in contact with other bodies is immediately disassociated. Baumann, however, asserts that when iron is oxidized by ozone no active oxygen is set free, but the ozone completely disappears; the ozonized oxygen entering into direct combination with the iron without forming or liberating active oxygen. The coloring matter of the red corpuscles, hæmatin, contains 7 per cent. of iron, which immediately absorbs with avidity liberated nascent ozonized oxygen. Ozone, as above indicated, combines directly with iron without decomposition, and the hæmatin, therefore, acts in the vascular system as a true ozone carrier. A solution of indigo added to highly-ozonized oil of turpentine is very gradually discolored; so soon, however, as a few drops of defibrinated blood are added, discoloration rapidly takes place. The red blood-corpuscles absorb the ozone from the oil of turpentine and transfer it to the indigo solution, which is rapidly discolored. Professor Liebreich, of Berlin, considered that ozone, as such, could not find its way into the body. He thought that when it came into contact with the organic fluids of the tissues it would immediately split up into ordinary oxygen (OO). All theoretical speculation on this point was overthrown by the able investigation of Professor Binz, of Bonn, who not only maintained the contrary, but proved that ozone slowly passed through a solution of albumin 1.85 centimetres in depth unchanged. This experiment established that ozone may not only exist in the fluid constitu. ents of the tissues, but is capable of acting in the most distant parts of the animal system. Some investigators assume that, owing to the high atomic weight of ozone (48), the elimination of carbonic acid from the blood is retarded, the atomic weight of CO, being so much less. Gad and Wuerster held that considerable quantities of active oxygen-ie., ozone-are formed in the body, and perform therein an active part; and Professor Wolfberg, of Strassburg, proved that ozone had a remarkable influence on the elimination of CO, from the blood. In a series of experiments on animals made by me last summer with the object of determining the physiological effects of galvanic electricity, after carefully testing the blood for both oxygen and ozone, Dr. Bleyer and myself advanced the deduction : "That oxygen in the blood enters into combination with the hæmoglobin of the corpus. cles with a partial transformation into ozone; and that, in loosing its combining bonds, it undergoes a further partial transformation into ozone." * At the time we had no knowledge of the fact that similar experiments had been made in the plant-world by Jannieson, who assumed that oxygen is taken up by plants as well as animals, and, entering into loose combination, is ozonized, and thus becomes active; also, that plants contain a substance differing from chlorophyll, which has an action analogous to the animal hæmoglobin, serving as an ozone carrier.† As an illustration of the nutrition carrying-power of ozone, let me briefly refer to a little experiment which we recently made in our laboratory. An ordinary barn-yard hen, which for a long time had been laying smallsized eggs with unusually pale yelks, was shut up in a coop that was kept supplied with ozonized air. There was no noticeable change in the character of the first egg laid after this treatment was begun. At the end of the second day, however, we observed that the egg laid was a trifle larger, the shell harder, and the yelk of a deeper-yellow hue. The fifth day the hen produced an egg weighing 6 grammes more than the one laid on the first day, with a rich, dark-red yelk. This rich color of the yelk continued to manifest itself, though the egg did not gain any further in weight, up to the twelfth day, when the hen "The Primary Effect of the Galvanic Current," Transactions American Electro-Therapeutical Association, 1893. J. Jannieson, Pharm. Journ. and Transact., 1879. |