duction of a steel sound, genito-uninary disorders of after the operation was his best for many a week. various kinds, operations upon the uterus, etc., have On the second day a faint pinkish rash made its been known to cause an attack. While these facts have appearance over the greater portion of the body, atbeen noted in connection with the disease, other and tended with itching, burning, and some fever. At the widely varying causes have been given. Violent same time fine papules were noticed covering the ex emotional paroxysms have been known to precede an tensor surface of the arms and legs. This erup outbreak. Others have noticed it in epidemic form, tion was unlike the ordinary flattened papules seen in and it has been seen as a complication of icterus, erythema at this location, but resembled more a cutis cirrhosis of the liver, and catarrh of the stomach. It anserina or lichen pilaris. About three days after the has been noticed as a forerunner of an attack of operation spots of a brownish-red color, slightly raised cholera.

The etiology is obscure. Lewyn concluded that the cause was a reflex action by irritation of the genito urinary apparatus, but Van Harlingen, in his very ex cellent article on this subject in the "Reference Handbook of the Medical Sciences," thinks this view too narrow to cover all cases. Luzzato has found insolated and grouped cocci in the blood of erythematous patients.

and varying in size from a split pea to a silver dollar, made their appearance in the region of buttock, thighs, and small of back The temperature varied at differ. ent times of the day,the highest point 104° F. Some irri tation and pain were complained of; in fact, the patient was generally miserable. The youth of my subject was a drawback in the way of gaining information regarding subjective symytoms The swelling of the penis increased considerably, and upon the mucous surface of The disease seems to be closely identified with urti- the glans a grayish looking superficial ulceration caria in that it is of nervous origin. The irritation formed, with considerable secretion. This secretion whether coming in the form of shock or violent emo caused any dressing that could be placed over the glans tional paroxysms through the central nervous system, to adhere with tenacity. After the eruption had lasted or acting from the peripheral surfaces, the same effect several days a crop of large vesicles or bullæ made is produced; viz, a dilation of the capillaries of the their appearance, seated upon the larger erythecorium, and an exudation therefrom. The irritation is matous lesions, situated upon the buttocks and transmitted in a reflex manner by a sensory nerve small of back. The eruption took no other through the sympathetic ganglia, in fact, both the shape than the one given: i. e., a general erythema, cerebro spinal and sympathetic systems take part in covering nearly the entire surface, disappearing and rethe process. It is reasonable to believe the impression turning at irregular intervals. This redness was fol. is conveyed through the sympathetic system, on ac- lowed by fine papules covering the extensor surfaces, count of the tardiness of the eruption in making its principally the feet and legs, hands and forearms. This appearance after the original irritation has been pro was in turn followed by inflammatory spots of various duced. When the eruption appears upon the skin sizes, the larger of these spots subsequently developing after an operation on the genitalia, or from other causes, a number of large vesicles. The eruption upon the the interval between the two may be from twenty-four body and penis with its high temperature, complicated to thirty-six hours. The treatment is empirical, and an otherwise simple operation, and was more annoying called for only as the general symptoms of the patient in a child than it would have been in an adult. The would indicate. eruption lasted about ten days, leaving no pigmentation, and only slight desquamation. From this time the child made an uneventful recovery, and was entirely relieved of its former nervousness, and general health was much better than before the operation.

It may be well to state that my patient was the subject of occasional attacks of urticaria before the operation, but none has been noticed since, although but three months have elapsed since the latter was per

The following case has several points of interest: B. C., a bright boy of five years, who presented a good family history, and had never had any serious illiness, was brought to me for treatment. The trouble was a nervous one; appetite poor, color pale, and occasionally a little fever. At night was restless and would cry out and groan in his sleep, and often remain awake for several hours. Occasionally there was some complaint of pains in the legs and lower part of the abdomen. formed. This case would seem to add weight to the During the day he would play as usual without complaint. On examining the penis I found a tight foreskin, closely adherent to the glans. The operation of circumcision was proposed and readily agreed to by the parents. Chloroform anesthesia used, and the opera tion begun after the corneal reflex had disappeared. mucous surfaces were rather tightly adherent, and their separation was attended with considerable reflex mus- Suicide in Europe. - From recent statistics it cular action, notwithstanding a liberal quantity of appears that 25,000 people commit suicide in Europe chloroform had been administered; in fact, quite as each year. In Paris alone the number last year was much as was considered safe. The patient's first night | 8,226.

fact generally admitted that uticaria and erythema multiforme are closely related, both being of a reflex nature and occurring in patients of a neurotic tendency.-R. W. Knox, M.D., in Journal of Cutaneous and Genito-Urinary Diseases.

NOTES: AND ITEMS

Dr. William G. Stearns has been appointed Superintendent of the Eastern Insane Hospital at Kan

kakee, Ill.

Anti-Cigarette Crusade.-A meeting was held recently at the Lindell Hotel by the Woman's Christian Temperance Union in which the Society indorsed a bill now pending in Congress to amend the interstate comin this direction. Two States have passed bills promerce law in such a way as to allow States to legislate in this direction. Two States have passed bills prohibiting the manufacture of cigarettes, but the laws had been declared unconstitutional on interstate grounds. Unveiling of the Statue of the Late Prof. It was decided to formulate a bill to be presented to the Samuel D. Gross, M.D.-The American Surgical new Municipal Assembly to forbid the selling or giving Association and the Alumni Association of the Jeffer- away of cigarette tobacco and cigarette paper. The son Medical College of Philadelphia request the honor School Board will be asked to establish anti cigarette of your presence at the unveiling of the statue of the leagues in the public schools of the city, and the teach. late Prof. Samuel D. Gross, M.D., near the Army Meders will be requested to lecture about once a week on the evils of cigarette smoking. ical Museum, Washington, D. C., Wednesday, May 5, 1897, at 5 o'clock in the afternoon.

posed professor only six sevenths of it, retaining oneseventh for himself.

A Professor Wanted.-The Vienna correspon. dent of The Lancet sends a bit of gossip under the cap. A Dispensary Patient.-The dispensary abuse tion "Dishonorable Conduct of a Medical Man." We has reached the stage of newspaper investigation. The agree with him that it was quite wrong to collect sev. Mail and Express, says the Medical Record, has been enty dollars as the "professor's fee," and give the sup conducting a quiet investigation of the worthiness of the applicants for dispensary relief, and says that discoveries of unique, almost grotesque, interest have been unearthed. The president of one of the largest munici pal railroad corporations has been identified as a regu lar attendant of one of the dispensaries. A free patient at an uptown hospital is the owner of three houses on Third Avenue. Other patients have turned out to be people of excellent financial standing in towns and cities remote from New York.

The fact of introducing to the patient as "professor" the consultant who held no professorship will not, however, appeal seriously to New York physicians as an unpardonable sin. The terms consultant and professor are synonymous in many quarters of the town. Then, too, professors are so numerous here that such a mis take would be hardly possible. Indeed, should a patient here insist upon having a real professor called, as seems to have been the case in the Vienna incident, the gen. Births and Deaths in St. Louis.-The total tleman chosen by the attending physician would in all number of deaths in St. Louis during the week ending probability have himself appointed to one of the colMarch 27, from all causes was 213, compared with 198 leges before the consultation rather than lose the case. during the preceding week and 180 in the corres--Medical Record. ponding period of last year. Based on an estimated population of 600,000 the death rate last week was 18 51 per 1,000 per annum. On hundred and ninety five births were registered during the week.

The contagious disease report for the past week is as follows: Diphtheria, 24 cases, no deaths; scarlatina, 11, no deaths; typhoid fever, 3 cases, 2 deaths; measles, 6 cases, no deaths; cerebro-spinal fever, 2 cases, 1 death; whooping cough, 2 cases, no deaths.

St. Louis Medical Society.-The following is the programme of the St. Louis Medical Society for the meeting of Saturday evening, April 3, 1897:

SYMPOSIUM:

"THE INDICATIONS AND LIMITATIONS OF CELIOTOMY."

Discussion opened by Dr. T. F. Prewitt, followed by Drs. W. B. Dorsett, N. W. Sharpe, G. W. Cale, C. M. Nicholson, W. H. Mayfield, J. H. McIntyre, J. T. Jelks, P. Y. Tupper, A. R. Kieffer, Spencer Graves, and E. H. Gregory.

The Bacteriological Findings in Scarlatinal Diphtheria.-Ranke (Versamml. der Gesellsch. Deutsch-Oaturforscher und Aerzte, '96; Medicine, March, 1897) in a clinical and bacteriological study of 142 cases of scarlatina reached the following conclusions:

(1) In 65 per cent of all fresh cases of scarlatina, diphtheritic deposits were recognized in the throat. (2) In 53 per cent of these cases the Klebs-Loeffler bacillus could be cultivated.

(3) In 38 per cent streptococci only were found. (4) It is characteristic of scarlatina that streptococci are found in the disease with greater frequency than they are in diphtheria, and occur not only in the lacu nar forms but in the severest types as well.

(5) In streptococcus diphtheria complicating scarla tina, the diphtheria process may reach the larynx and even deeper parts.

(6) When true diphtheria complicates scarlatina, the bacillus of Klebs and Loeffler replaces the streptococci primarily found in the throat.

(7) Because of the frequent coincidence of scarlaExecutive Committee. tina and diphtheria, Ranke recommends using diphthe ria antitoxin in scarlatina.

MEDICAL REVIEW,

VOL. XXXV.

A WEEKLY JOURNAL OF MEDICINE AND SURGERY.

ST. LOUIS, MO., APRIL 10, 1897.

The neuron is a nerve unit, and consists in its most elaborate and typical form of the following parts: (1) the nerve cell (neurocyte); (2) the dendrites, with their numerous branches and gemmulæ; (3) the neuraxon (axon), with its collaterals (paraxons), and the terminal end-brush.

The dendrites were formerly known as the protoplas mic or dendritic processes. The neuraxon was called the axis-cylinder process.

The term neuron was first used by Waldeyer to de signate the cell and all of its processes as a whole. But inasmuch as the same word has been used by others to designate certain parts only of the neuron, e.g., the cell body and the axon respectively, objections have been made to its employment. Other terms have been pro posed: by Kölliker, neurodenáron, or neurodendridion; by Baker, neure, and so on. Recently the French, Spanish and Italian writers have employed the word, neurone, from French le neurone. A recent writer, L. F. Barker, M.B., of Johns Hopkins University, suggests that the objections to Waldeyer's term, der neuron, may be overcome by bringing it into English through the French, and therefore that it be spelled "neurone." The slight etymological objection he shows is not greater than in the instance of the words "anode" and "cathode." And inasmuch as possible bibliographic confusion would be avoided by the prompt adoption of a term which shall be uniformly used by all nationalities, he advocates the general adoption of "neurone."

NO. 15.

The dendrites vary much in size. They extend in all directions, branching frequently and dichotomously. They always end in free extremities, either pointed or knob-like. They often present an irregular contour, a varicose appearance. Many of them are fringed or feathered by minute processes, the gemmulæ (lateral buds). The neuraxon is, throughout its course, of uniform size, and even contour, and is surrounded by an insulating sheath, which is lost towards its distal extremity. The end brush, in which the axon terminates, is free from covering. It is composed of free fibres, and not a net work, as formerly figured. Only in rare instances (at least in the higher mammalia) does the axon divide in its course into two branches; the only branches being the minute collaterals, which are given off at comparatively long intervals, at right angles, and divide at their extremities into small branches.

This very brief résumé will, I hope, be sufficient to convey an idea of the lines along which a renewed investigation of the minute anatomy of the nervous sys. tem have been conducted since the introduction of the improved staining methods of Golgi and Ramón y Cajal, whose discoveries have made their names justly famous in the scientific world. By the use of these methods, and certain modifications of them, a vast amount of detail histological information has been ac cumulated in the last few years, or months, as it were. The result of this has been to establish the fact that the whole nervous system is made up of certain aggrega. tions or systems of neurons. Hence, the neuron-conception of the nervous system.

With this anatomical knowledge comes logically the conclusion that the functions of the various parts of the nervous system are the results of the physiological processes which take place between the various systems of neurons. In fact, enough is already known about some of the anatomical relations to make certain physiological deductions quite secure, and others very probable. For example, we see the dendrites of certain systems freely mingling in a common territory and their axons similarly related to the dendrites of a neighboring group, combinations which suggests the same constancy in function that there is in anatomical arrangement. To quote a recent writer: "It is the manifold and diverse relations produced by the nerve cells and their dendrites on the one hand, and the end tufts of the axons and upon the nervous Read before the St. Louis Medical Society, Saturday Evening, collaterals on the other, that bestow February 20, 1897. system its structural and functional complexity. Without

regard to its topographic situation, there is no one part of the neuron. Is the cell body the efficient agent, or

of the nervous system that is not in relation with every other part. There is no one part that functionates ab solutely independently of every other part."

do the dendrites possess a differentiated activity of their own? Certain writers have supported the proposition that nerve impulses do not originate in or eminate from An interesting question arises as to how the nervous the cell, but that all such special function is the result impulse is transmitted from one set of branches to an- of an interaction among the various systems of other, i.e., from one neuron to another. The effort to branches, the only function of the cell body proper besolve this problem has been prolific in theories. Golgi ing a trophic one. According to this theory the cell is at one time believed that there was an anastomosis or simply a magazine where there is stored a supply of fusion between many of the branches of neighboring protoplasmic material, of nerve force, for the use of the neurons, and, therefore, that there was a direct protoplasmic channel by which the impulse was conveyed. Cajal and others proved that no such anastomoses ever exist, but that there is frequent contact among the branches, sufficient, in his opinion, to explain the interaction of the neurons. Cajal further elaborated his theory to explain the varying activity of function between the neurons by calling attention to the insulating effect of the neuroglia cells with their numerous, long and delicate processes. These have been observed to change their shapes and positions, and he claims that in so doing they vary the degree of insulation between the branches of the neurons and thus regulate their functional activity.

branches, by whose subtle activities it is turned to best. account in the performance of their special functions. Dr. Aloysius O. J. Kelly, of Philadelphia, thus expresses an opposite opinion: "That, structurally alike, the nerve cells and the dendrites are also functionally allied, being nutritive organs and organs for the recep tion and further propagation of impulses." Dr. Dercum argues at length for this latter view, opposing the opin ion of his fellow townsman, Dr. C. K. Mills.

Casually viewed, these questions may seem to be recondite matter simply suitable for theoretic disputation. However, they are just now receiving much attention from many eminent and practical minds. This is be cause of their practical bearings, the full force of which In this connection Dr. F. X. Dercum, of Philadelphia, can not be revealed within the scope of this modest has opened the question of the possibility of changes communication. I may simply state what now is an in the position of the neurons due to movements-slight accepted fact, namely, the necessity of reconstructing ameboid movements-on their part. He cites certain many of our physiological and pathological beliefs, for eminent writers who share his opinions that this kind the reason that, quoting a recent author: "The birth of of movements are probable in these bodies. He also the neuron theory of the architecture of the brain has criticises certain arguments of Cajal, claiming that after been accompanied by a flood of light in the interpreta all it is practically a matter of slight importance wheth tion, not only of the physiology of the brain, but of its er the relative position of the cell processes is due to a pathology as well." (Dr. Joseph Collins, "Twentieth movement inherent in the neuron itself or to a passive Century Practiee, Vol. X). movement effected by the interposition of the processes of the glia cells.

I shall content myself with citing some of the more familiar problems to the solution of which have been The newest theory of the transmission of impulses applied these recently acquired anatomical data. For from neuron to neuron is the discharge theory, enunci- example, to explain the phenomena of ordinary, or phy. ated by Prof. Bechterew, as follows: "The end ramifi siological sleep; it is assumed that when, as a result of cations of one nerve element do not come in direct con- physiological activity, certain cells of the cortex become tact with those of the other, but come only near each diminished in bulk there follows a retraction of their other at varying distances. The transmission of the processes, to the extent-very slight, of course—that nerve impulse from one element to the other takes place the neurons are not in active relation with one another, by a difference in the tension of the energy between hence a suspension of function pending the restful pe these two elements, which causes a discharge from one riod of the cell. In hypnotic sleep, by an inhibitory neuron to the other. This discharge may be compared effect, the processes of certain combinations of neurons to that taking place in a series of Leyden jars, which are made to retract, and others possibly are thrown into are discharged one after the other, and one into the closer relations, producing the peculiar perversions of other. The greater or less proximity of the nerve end-psychic activity which characterize the various phases of ings of one neuron to the processes or the body of the other will evidently cause a greater or less resistance to To the elucidation of the troublesome, phenomena of the transmission of the nerve stimulations from one hysteria, especially, have a number of writers attempted neuron to the other. The resistance to conduction will to apply these newer lights. To explain a hysterical farther depend upon the number of nerve elements re- paralysis or anesthesia it is only necessary to suppose quired to compose the corresponding conducting paths." the more or less sudden withdrawal of the branches of Closely related to this question of the manner of the one set of neurons from those of another, or perhaps transmission of impulses is that of the relative import- the interposition of an almost inconceivably slight inance or activity of the cell body (neurocyte) and the sulation, and the paralysis, the anesthesia is complete, dendrites in the accomplishment of the various functions total. By a mere suggestive or moral effect the pecu

hypnosis.

liar inhibition is removed, the neurons fall into line, in normal relations, and instantly function is restored. And if these simpler hysterical phenomena may be explained in this way, why not also the most complex ones.

be remembered that we are barely beginning to find our way in a vast field for exploration. It is evident, however, that by these new methods changes are being found which have eluded all former methods. Very The persistent and troublesome sensory symptoms of recent observations lead us to believe that not only much the neurasthenic are explained by an abnormally inti- will soon be accomplished in clearing up certain doubtmate relation between certain sets of neurons that per-ful problems of pathology, but that discoveries of still mits the constant passage of sensory impulses which a normal propinquity would never allow. It is only when some unusual stimulus is applied that the neurons as. sume their normal relation; and thus is explained why in moments of distraction the most grievous pains of the neurasthenic are lost-or, as we sometimes less charitably say, are forgotten.

DIAGRAM OF TYPICAL NEURON.

C. B. Cell body.

D. Dendrites.

D. G. Dendrites with gemmulæ.
A. Axon (neuraxon).

C.

Collaterals.

E. B. End-brush.

With conceptions of this kind before us there is no need of much ingenuity to frame in harmony therewith hypotheses to explain the numerous and various convul. sive and spasmodic conditions over which many generations have puzzled their brains. Of course, we must not forget that we are here dealing with undemonstrated, possibly with undemonstrable theories; yet, the contemplation of them reminds us that we have at least a new basis upon which to work.

greater import are near at hand. For example, we can now understand better than we have before why certain degenerative processes are confined to one set of neurons, in that there is lacking a continuity between the neurons which was formerly supposed to exist, and which, if it did exist, would permit the passage of the degenerative process.

It has been shown that the dendrites and cell body are more susceptible to most morbific agencies, the axon being much more resistant. The destruction of the neuron has been studied in acute infectious processes, showing that the degeneration begins in the gemmulæ and small branches of the dendrites, encroaching grad. ually to the cell and finally to the axon, until the neurons present an appearance which may be compared to the trees after a forest fire. Similar appearances have been witnessed in insanity. Berkley makes the following graphic application of them: "Once the gemmulæ lose their vitality, or in any way become diseased, conduction of nerve impulse is no longer possible, and the co-ordination of the cellular elements ceases. Confus. ion of thought is the first result, then the morbid process grows deeper and more wide-spread, co-ordinated thought almost entirely ceases, and a terminal dementia follows as a natural result."

NOTE.-Materials for a review as cursory as the foregoing are quite accessible and need hardly be cited, but I desire to mention especially a paper on "The Neuron," by Dr. Aloysius O. J. Kelly, of Philadelphia, read before the Philadelphia County Medical Society, Nov. 25, 1896, and published in the University Medical Magazine, Jan. 1897. It is comprehensive, and most admirably written. I have here drawn upon very it largely and am correspondingly obligated to its author.

Self-Inflicted Wound of Bladder in Childbed.-Kalnikoff (Monats. f. Geburt. u. Gynak; Brit. Med. Jour.) reports, in the "Proceedings of the Medical Society of the Don Province," that he was called in to a patient who, when micturating on the second day of childbed, found that something projected from the vulva, and took it for "after-birth." She deliberately cut into the projecting object, which happened to be a cystole. A vesico vaginal fistula had formed, and the edges were gangrenous. No plastic operation was perWhile it can not be said that by the silver-stain formed, but the fistula was healed after several months method there have thus far been discovered pathological by antiseptic irrigations and catheterism of the bladder changes characteristic of any particular disease, it must at regular hours.