little speculum in several instances, but am not prepared to state that it has been of value in any given case.

Abnormal Secretions of the Genital Tract.—I have no idea but that the condition of the secretions in the vagina frequently makes for or unmakes a conception. I can imagine how the excessive acidity, the excessive change in the normal mucous membrane, might cause the death of the spermatozoa. An unnatural reaction of the secretions of the vagina undoubtedly creates a difference in the susceptibility of women. For a cure the reaction of the secretions should

be regulated.

This delicate but interesting subject has been touched only upon the mountain peaks, as it were, and there are a number of foothills which we might dwell upon, but I have said enough, I think, to call your attention to this subject, and to make you appreciate that I at least consider it of importance enough to talk about. There is not enough in the books upon this matter. It is a topic which should command the very best chapter in the very best gynæcology, and I hope that the vigorous attitude that has been taken by President Roosevelt on a subject allied to this will dignify it and make it one not to be talked about lightly.

PATHOGENESIS OF LOCOMOTOR ATAXIA.— By G. B. HASSIN, M. D., Chicago.

If the clinical picture of locomotor ataxia is well established, thanks to the works of Todd, Romberg, Duchenne, Westphal, etc., we cannot say the same of the pathology or pathogenesis of this disease. The authors who wrote about this disease before Duchenne (1858), as, for instance, Romberg, Türk, Froriep, located the morbid process in the spinal cord, while Duchenne himself believed the essence of tabes dorsalis to be a cerebellar lesion; namely starting from the oculomotor nerves and corpora quadrigemina the tabetic affection spreads to the superior or inferior cerebellar peduncles and from there on to the cerebellum.* Such conclusions Duchenne made on the ground of Flourens' and Bouillaud's physiological researches of the function of the cerebellum in which lesions they observed disorders of co-ordination similar to those of tabes. In addition to this, Duchenne had mainly polyclinic material and private patients and he could not therefore verify his views by post-mortem examinations.

Some authors thought the essence of tabes to be in the affection of the sympathetic nervous system. Such an opinion was abandoned very soon, because changes of the sympathetic ganglia are very seldom met with in tabes and in such cases they must be explained as mere continuations of the morbid process from the spinal cord (Axenfeld). †

*"Le travail morbide central qui produit les phenomènes symptomatiques de cette maladie commence en général, par les nerfs moteurs de l'eil et par les tubercles quadrijumeaux, et de la s'étend aux pedoncules cérébelleux supérieurs ou inferieurs et eufin au cervelet." Duchenne (de Boulogne): A taxie locomotrice progressive (Arch. gen. de medicine, p. 443; 1859).

Axenfeld: Ataxie locomotrice progressive.-Dict. encyclopédique des sciences medic. Tome VII, p. 69.

The majority of authors located the tabetic process not outside of the spinal cord, i. e. neither in the cerebellum, nor in the sympathetic system, but in the spinal cord itself. Some of them believed the starting point of the affection to be in Clark's columns, others in the gray matter of the spinal cord, while others again located it in the white matter of the posterior spinal columns.

Clark's columns are indeed found to be affected in almost all cases of locomotor ataxia, even in the incipient stage of the latter, and this led Lothar Clark to think that the anatomical substratum of tabes dorsalis was an affection of these columns*; but the latest investigations, especially those of Redlicht showed that the affection of these columns is the sequel of the lesion of the posterior roots, of which they are a mere intramedullar continuation.

That the affection of the gray matter plays the chief part in the pathology of tabes dorsalis was taught in France by Bourdon, but this opinion prevailed in medical science but a short time, as there was soon finally established a view that in tabes dorsalis the white matter becomes affected, namely, that of the posterior columns.

If such a view on the localization of the tabetic process became general, the question about the nature of this lesion of the posterior columns produced a great difference of opinion and even now there is no unity of thought.

The prevailing view on tabes in the sixties and seventies of the past century is formulated by Prof. Erb§ in his well

*Erb: Handb. der Krankh. des Nervensystems. B. I, 2te Hälfte p. 545.-XI Bnd. Ziemssen's Hndb. der spec. Path. 1878.

†E. Redlich: Die h. Wurzeln des Rückenmarks und die Path. Anatcmie der Tab. dors.-Jahrb. f. Psych. Bud. XI.

Hip. Bourdon: Etudes cliniques et histologiques sur l' ataxie locomo. trice progressive.-Arch. general de med. 1861. Novemb. p. 513. Same author Gazette hebdomaire 1862, pp. 77-78.

Same author, Arch. general de medicine, Avril, 1862.

Erb: Handb. der Nervenkrankheiten.-Ziemssen's Pathol. Bnd. XI.

known text-book on nervous diseases, where on page 532 of the 1878 edition he says: "Under tabes we understand a spinal cord disease of a slow course that very probably must be referred to the group of chronic myelitis," and "Undoubtedly this disease starts in the posterior roots." This quotation shows (a) that tabes was looked upon as an inflammation of the spinal cord, as a myelitis, and (b) that an opinion existed that it began in the posterior roots, consequently occurring in the spinal cord only secondarily.

The latter view was sustained only by Prof. Leyden, the first, however, was a common one and the question was only where this inflammation started.

According to Charcot* the inflammation in tabes affects chiefly the nervous fibres themselves, being a parenchymatous process, the proliferation of the interstitial tissue is a secondary process; according to Waldmannt vice versa-tabes is chiefly an interstitial process, i. e., it starts in the connective tissue of the spinal cord or of its membranes and only secondarily, by the way of compression, produces degeneration and atrophy of the nervous elements. The third group of authors, as Rindfleisch, thought that tabes started in the capillary vessels of the spinal cord and this produced malnutrition of the nervous tissue and its consequent atrophy, the latter producing the secondary proliferation of the connective tissue,"In short, everything," says Rindfleisch, "makes us look for the origin of the disease in the changes of vessels and their smallest branches, which conclusion is verified by the results of microscopical researches."+

*Charcot: Oeuvres compl. t. II. 1894, p. 7.

"Nach Waldmann wird es primär in dem interstitiellen Gewebe der Hinterstränge ein entzündlicher Process hervorgerufen, welcher erst secundär die Atrophie und Degeneration der nervösen Elemente herbeiführt." -Quoted after Erb's Handb. der Nervenkr. 1878, p. 539.

"Alles führt uns darauf hin, den ersten Grund der Erkrankung in einer Veränderung einzelner Gefässe und ihrer Verzweigungen zu suchen, eine Vermuthung, welche von der microscopischen Untersuchung vollständig bestätigt ist.”—Rindfleisch: Histolog. Detail zu der grauen Degeneration von Gehirn und Rückenmark.-Virch. Arch. 1863. Bd. 26, P. 475.

Some authors, as Remak, Cyon,* kept themselves in a middle class; they held that the origin of tabes may be a parenchymatous process, as thought by Charcot, as well as an interstitial, as thought by Waldmann.

Opposing the opinion that tabes is an inflammation— primary or secondary-of the posterior columns of the spinal cord, was Prof. Leyden, one of the earliest investigators of this disease. As far back as 1863 he taught that tabes dorsalis is not an inflammation, but a peculiar degeneration, which especially affects the nervous elements of the spinal cord and starts in the posterior roots of the latter. Leyden's teaching was different from the accepted one in two respects: (a) That tabes is not an inflammation, but a peculiar degeneration of fibers of the posterior columns; (b) this disease or degeneration of the posterior columns is not a primary process, but a secondary one and not in Waldmann's or Cyon's sense, but as starting from the posterior roots. †

Such views seemed for that time very peculiar and gave rise to such a strong opposition, that Prof. Leyden, as he says in one of his papers on tabes dorsalis, § had to give up further researches in regard to his theory and the medical scientific world almost completely accepted the views on tabes as introduced by Charcot and his pupils (Pierret).

According to this teaching, formulated by Pierret in the beginning of the seventies of the past century, tabes dorsalis is a primary disease of the posterior spinal columns, consisting in parenchymatous irritation "irritation parenchyma

*E. Cyon: Zur Lehre von der Tabes dorsalis. Berlin, 1866.

+E. Leyden: Die graue Degeneration der Hinterrückenmarksstränge, klin. bearb. Berlin, 1863.

E. Leyden: Ueb. graue Degeneration des Rückenmarks.- Deut. Klin., 1863. No. 13.

E. Leyden: Zur gr. Degener. der hinteren Rückenmarksstr.-Virch. Arch. Bd. 40. 1867.

E. Cyon: Zur Lehre von der Tabes dors. Berlin, 1866.

See also-Virch. Arch. Bd. 41. 1867.

Leyden: Tab. dors. in Eulenburg's Real Encyclop., 1899, 2te Aufl.