CLINICAL NOTES ON NERVOUS 
DISEASES OF TVOMEN. 
BY 
WM. B. NEFTEL, M.D., 
NEW YORK. 
REPRINTED FROM 
Dr. Brown-Seqnard's Archives of Scientific and Practical Medicine. 
Nos. 3, 4, and 5, 1873. 
G. P. PUTNAM'S SONS, 
Twenty-third St. and Fourth Ave. 
NEW YORK: 
1873. CLINICAL NOTES ON NERVOUS DISEASES OF WOMEN. 
267 
VII. 
CLINICAL NOTES ON NERVOUS DISEASES OF 
WOMEN. 
BY 
WILLIAM B. NEFTEL, M.D., 
The division of medicine into different specialties has undoubtedly 
increased our knowledge. In this way identical or similar facts are 
accumulated within the sphere of the same observer, thus affording 
him sufficient material particularly adapted for researches by the in- 
ductive method, that must be the basis of medical investigation. But 
in order that the single observations should not degenerate into a 
routine registration of facts, without any organic connection, these ob- 
servations of the physician, like those of the natural philosopher, should 
be controlled, or rather guided, by the deductive method. For this 
reason it is justly required from the physician to be thoroughly ac- 
quainted with the whole domain of medicine and its collateral 
sciences, as well as with the modern methods of investigation, before 
devoting himself to some special branch. Thus every physician, 
even one with a limited field of observation, is enabled to contribute to 
the general stock of our knowledge. In the following notes I merely 
give some general conclusions drawn from observations of a number 
of cases presenting the same characteristic features. The detailed 
histories being important only to the writer, I omit giving them, 
knowing from my own experience how tedious and useless they often 
are to the reader. 
During the last seven or eight years I have often had the opportu- 
nity of observing cases of the peculiar kind of paralysis that is caused 
by lead-poisoning. The majority of the patients were ladies of good 
social standing, and as a rule, the primary cause of their disease was 
generally ascribed to some affection of the spinal cord. A careful 
examination, however, could always reveal the true nature of the 
malady, especially in those typical cases, where only the extensor 
muscles of the fore-arms were paralyzed and atrophied. The cor- 
rectness of the diagnosis could be established not only by the charac- 
NEW YORK. 268 
WILLIAM B. NEFTEL. 
ter of the electro-muscular contractility and other pathognomonic 
symptoms, but also by the experimentum crucis-the presence of 
lead in the urine. I could further ascertain that the poisoning was 
produced in almost all the cases by a continued and liberal use of 
cosmetics containing lead. 
Lastly, I found in a considerable number of the persons thus af- 
fected an intense degree of Vaginismus, in consequence of which the 
married ladies were sterile, as sexual intercourse was almost impossi- 
ble. I therefore concluded that vaginismus must be a symptom of 
lead-poisoning, analogous to the well-known Saturnine colic.* 
Indeed, by treating the general lead-poisoning (with iodide of 
potassium, sulphur, etc.), the vaginismus would disappear by itself, 
thus corroborating my supposition. 
The relation of the lead-poisoning to the vaginismus was not al- 
ways the same. In some cases the vaginismus has been already in- 
tensely developed many years before the paralysis appeared. These 
cases were generally treated as hysterical or reflex paralysis, and the 
affection of the genital organs, especially if there was a displacement 
or some other morbid condition of the womb, was considered as the 
primary cause of the paralysis, and attracted therefore the principal 
attention. In other cases the vaginismus was not accompanied by 
real paralysis, but only by a general weakness of the whole muscular 
system, or by a paretic condition and incipient atrophy of the ex- 
tensor muscles of the forearms, with diminished electro-muscular 
contractility. Again, there were cases of lead-palsy without vaginis- 
mus, though even in these a considerable amount of irritability of the 
introitus vaginae could be found. However plausible it seemed to 
me that vaginismus is a symptom of lead-poisoning, yet such an 
assertion would remain a mere hypothesis unless it could be ex- 
perimentally demonstrated. New clinical observations offered me 
the opportunity of testing its value, f 
Madame L., a distinguished French actress, aet. 28, married 5 years 
but sterile, has suffered of intense vaginismus for years before she 
came under my care, Feb. 16, 1869. I suspected lead-poisoning 
through the use of cosmetics, and the chemical analysis of the urine 
demonstrated the presence of lead. Feb. 17, I was sent for in great 
haste, as the patient was suffering from an attack of Saturnine colic, - 
with all its characteristic symptoms so well described by Tanquerel 
des Planches, in his classical work. J The vascular system espe- 
cially presented very remarkable, phenomena. The face and extremities 
* Neftel. Zur /Etiology des Vaginismus. Centi-alblatt fur die med. Wissensch. 1868, No. 5a. 
+ Etiology of Vaginismus, Med. Record, 1869, No. 3, p. 70. 
t Traitd des maladies de plomb ou saturnines. Paris, 1839. CLINICAL NOTES ON NERVOUS DISEASES'OF WOMEN. 
269 
of the young and vigorous patient were pale and cold, the contractions 
of the heart extremely feeble, and the pulse small, hard and slow, with 
only 44 beats. These phenomena are explained by Brown-Sequard's* 
discovery, made long before Goltz's f and Bernstein's J experiments, 
showing that irritation of sensitive abdominal nerves produces a reflex 
irritation of the vagus, viz. : retardation of the contractions of the heart. 
The case named was undoubtedly one of lead-poisoning (by means 
of cosmetics), with the symptoms of vaginismus and colic, though 
without paralysis of the extensor muscles of the forearms. The 
patient said, however, that she had felt for some time a weakness in 
the forearms, especially in the wrists, which were occasionally pain- 
ful, and the electro-muscular contractility was found diminished. I 
may add that the usual treatment for lead-poisoning removed the 
colic and also the vaginismus, from which latter she had suffered for 
so many years. 
Twice I treated married and sterile ladies who have been suffering 
from vaginismus, though they have not been using cosmetics con- 
taining lead. However, they have often had preparations of lead 
prescribed against a chronic diarrhoea, which for many years could be 
checked solely by this remedy. In these cases, too, the treatment 
of the lead-poisoning has also removed the vaginismus. 
When Dr. J. Marion Sims so graphically and correctly described this 
morbid condition, he was justly impressed with its purely nervous 
character and named it vaginismus, reminding, as it were, of analogous 
spasmodic affections-blepharismus, laryngismus. I cannot agree with 
the opinion of Scanzoni, Martin, and others, who consider this spas- 
modic condition as a consequence of local inflammatory irritation of 
the external genital organs ; though I admit that this latter may 
occur as an accidental complication. The cases of vaginismus I had 
the opportunity of observing, among which were several unmarried 
ladies, certainly manifested themselves as a pure neurosis, a spas- 
modic hyperresthesia, without inflammation of the vagina or other parts. 
Nor can I agree that the spasmodic contraction is due exclusively to 
the constrictor cunni muscle (Scanzoni) or to the levator ani,(Hilde- 
brandt). It seemed to me that not only both these muscles, but all the 
other ano-perineal muscles-ischio-cavernosus, transversi perinei, 
sphincter ani-participate in the production of the spasm in vaginismus. 
With reference to the treatment of vaginismus I shall mention 
the oldest surgical method of John Burns, consisting in the section 
of the pudic nerve. A relapse, however, usually follows this opera- 
* Rech, surla physiol, et la pathol. des capsules surrdnales. Paris, 1856, p. 30, and Cours« 
of Leet, on the Physiol, and Pathol, of the Central Nerv. Syst. Phila. i860, p. 159. 
+ Goltz. Vagus & Herz. Virchow's Archiv, Bd. XXVI. p. 1. 
$ Bernstein. Vagus & Sympathicus. Centralb. f. d. m. Wiss. 1864. . No. 16. 270 
WILLIAM B. NEFTEL. 
tion, as proved by Simpson, who considered it as a mere palliative 
measure. Even on mere theoretical grounds the operation is not to 
be recommended, because the modern improved methods of electro- 
therapeutics have taught us to substitute with great advantage in 
neuralgic affections the galvanic treatment for neurotomy. The well- 
known surgical method of Sims was the only one efficient in the treat 
ment of vaginismus. Scanzoni, basing himself on the inflammatory 
origin of vaginismus, rejects altogether the surgical treatment, as in 
alleviating the local irritation with bath, poultices, etc., he succeeded 
to remove the spasm. This may be the case where the vaginismus 
is complicated and aggravated by local irritation, but the pure 
neuralgic form will not always yield to such a treatment. 
That patients affected with vaginismus improve under different 
modes of treatment, medical as well as surgical, I chiefly ascribe to 
the circumstance that they generally discontinue the use of cosmetics 
during the treatment, especially during a more severe one, while at 
least a portion of the lead is eliminated from the system with the 
secretions. Considering vaginismus as a symptom of lead'-poisoning, 
the most rational indication seemed to me the treatment of the latter. 
For that purpose I prescribe iodide of potassium in larger doses, 
the iodine forming a soluble combination with lead, which is thus 
eliminated. The internal use of this remedy alone is sufficient to 
cure the vaginismus. In order to hasten this result, I sometimes use 
in married ladies, besides the iodide of potassium, a weak galvanic 
current, bringing the hyperaesthetic parts under the influence of the 
anode. The whole treatment is not painful, and does not interfere 
with the daily occupations of the patient. No relapse has ever 
occurred in these cases. 
There remains the following question to be answered, but it must 
be left to the gynecologists. Do all the cases of vaginismus originate 
from lead-poisoning, or does there exist besides this symptomatic 
affection an idiopathic one, perfectly independent of the lead- 
poisoning ? In the ten cases I had the opportunity of observing, the 
vaginismus has always been accompanied or followed by other symp- 
toms of lead-poisoning. 
With reference to the lead-palsy, which often is limited only to 
the extensor muscles of the forearms and hands, I will mention that 
besides the internal treatment with iodide of potassium, the use of 
electricity, and especially of the galvanic current, is quite indispen- 
sable to restore the functions of the atrophied muscles. The most 
efficient method is to pass a stabile ascending current through the 
nerve-trunks of the affected extremities. After the return of the 
electro-muscular contractility, faradization of the peripheric nerves CLINICAL NOTES ON NERVOUS DISEASES OF WOMEN. 
271 
and. of the atrophied muscles may also be resorted to with 
benefit. 
Besides cosmetics, which are the most frequent source of lead- 
poisoning in women, the water-pipes, especially the corroded ones, 
contribute to the development of symptoms of lead-poisoning in 
susceptible persons. It would, therefore, be a great benefit to the 
community if the lead pipes for drinking-water were altogether 
abolished and substituted by iron-pipes. 
(To be continued.) CLINICAL NOTES ON NERVOUS DISEASES OF WOMEN. 
365 
XI. 
CLINICAL NOTES ON NERVOUS DISEASES OF 
WOMEN. 
BY 
WM. B. NEFTEL, M.D., 
{Continued'fromf 271, March, 1873, No, 3.) 
NEW YORK. 
The affection to which I now desire to call the attention of 
gynecologists is dysmenorrhcea. In another place* I have spoken of 
its yielding to the galvanic treatment, but hesitated to give an account 
of this method until time and more numerous cases would have con- 
firmed my first observations. 
The majority of patients, before coming under my care, had been 
treated for a considerable time, some even for many years, by the 
most skilful gynecologists, who had exhausted all the remedies and 
tried the different surgical methods without avail. 
The following being my first case of dysmenorrhcea treated with 
the galvanic current, I give a more detailed history of it, though it 
is contrary to the plan adopted by me in this article. 
Mrs. P., aged 24, married six years, but sterile, suffered from dysmenorrhcea in 
its intensest form. She had regularly menstruated from her thirteenth year, and 
was always healthy until seven months before her marriage, when she had a fall, 
striking with great violence in the lumbar region against a solid wooden box. The 
accident was immediately followed by the untimely appearance of a very profuse 
menstrual flow. Since then she suffered a great deal of pain in the lumbar and 
the left part of the hypogastric regions, and also of profuse menstruation 
accompanied by the severest dysmenorrhcea. Several distinguished gynecologists 
treated her in succession with different internal remedies, especially narcotics, and 
using sponge-tents and other applications to the uterus. Her general health, how- 
ever, and the local affection of the genital organs, grew constantly worse. Even 
during the intervals of the painful menstruation she. complained of constant 
bearing-down pain, of dyspepsia, loss of appetite and sleep, and of general debility. 
An incision of the peck of the womb was performed, followed by applications 
of caustics, in combination with large doses of opiates, during the menstruation. 
Under this treatment, which lasted eighteen months, all the symptoms became very 
* Galvano-Therapeutics, p. log. 366 
WILLIAM B. NEFTEL. 
much aggravated. The menstruation assumed the character of menorrhagia, and 
the intense dysmenorrhoea necessitated the keeping in bed of the patient under the 
complete influence of opiates. 
I first saw the patient April 20, 1870, and found her well-built, but very pale 
and thin, the uterus increased in size, especially the neck, indurated, tender to the 
touch, and showing a cicatrix from the previous incision. She complained of a dull 
headache, a sensation of fulness and heaviness in the lower part of the abdomen, 
of a burning sensation in the internal genital organs, with bearing-down pains. She 
was scarcely able to walk, especially up the stairs, could not stand or sit straight, 
and was obliged to lie down most of the time. She had very little sleep or appe- 
tite, and ate no meat at all. The tongue was coated, and she complained of dif- 
ferent symptoms of dyspepsia. 
I commenced the galvanic treatment a few days before the expected menstruation, 
Aug. 22. A stabile current of 20 Siemen's elements was used, applying the anode 
to the dorsal and lumbar regions, and the cathode to the hypogastric region, over 
the ovaries and uterus. On the following three days the anode of a current of 12 
to 17 Siem, elements was applied to the nape of the neck, and to the lumbar re- 
gion ; the cathode as before. The effect of this treatment was extremely favorable. 
The headaches, the pain in the back and in the region of the left ovary disappeared. 
She felt stronger, and could walk a considerable-distance-had a good appetite, and 
slept better than she had for a long time. The menstruation appeared painless for 
the first time after so many years, and the loss of blood was perfectly normal, so 
that the patient, who, on former occasions, was obliged to keep her bed during the 
entire period, remained up, and suffered from none of the former symptoms. 
I repeated the galvanic treatment at different times, after long intervals. The 
general health of the patient became completely restored, the chronic metritis has 
disappeared, and the menstruation is still perfectly normal. 
This change had been so sudden and so complete that it aroused 
a doubt in my own mind. I knew not whether it had to be 
ascribed to the galvanic treatment, or simply to the discontinuance 
of the former, especially ofithe last severe, treatment. This supposi- 
tion seemed so much the more probable, as, judging from the earlier 
history of the case, the patient must have been entirely free from any 
structural uterine disease. The chronic metritis might have developed 
itself either in consequence of the accident, or perhaps from the fre- 
quent use of sponge-tents and other intra-uterine medications em- 
ployed against the dysmenorrhoea, and it might have disappeared 
spontaneously, thus removing the cause of the dysmenorrhoea. 
Other cases of dysmenorrhoea, in which I obtained the same result, 
would have confirmed the efficacy of the galvanic treatment, had not 
all these patients, like my first, previously undergone different heroic 
treatments. At last some cases of severe dysmenorrhoea came under 
my care, which had been treated only by the expectant method, 
though narcotics were necessarily administered during the menstrua- 
tion, and to correct displacements of the uterus simple pessaries 
were worn in the intervals. In these cases the womb Presented vari- CLINICAL NOTES ON NERVOUS DISEASES OF WOMEN. 
367 
ous conditions ; either there was no morbid alteration, or there was 
anteflexion, or an undeveloped state, conical neck, etc. 
One of the first cases belonging to this category was a patient of Dr. Steele, of 
this city. 
Mrs. H., aged 26, married several years, but sterile, always suffered from 
dysmenorrhoea that became more intense after a miscarriage in the seventh month 
of pregnancy. Her menstrual flow has always been very scanty, and for several 
days during her period she had to remain in bed under the influence of narcotics. 
For the last two years she was under the treatment of a distinguished gynecologist, 
who tried different mild methods with no improvement of the dysmenorrhoea. I 
commenced the galvanic treatment Dec. 13, 1871, and the second period came 
on quite painless. While, before the galvanic treatment, the unpleasant premoni- 
tory symptoms would keep her at home on the approach of the menstruation and in 
bed during several days, it now appears without any warning, allowing her to 
exercise every day in the open air. 
It would be too monotonous to give the histories of analogous cases, and I shall 
only mention the following case of dysmenorrhoea, particularly interesting on 
account of its complications. Miss T., about 35 years old, belongs to a very 
healthy family, and was formerly in comparatively good health. Whilst travelling in 
Europe, she exposed herself to a great deal of fatigue and atmospheric changes 
during her monthly period, which suddenly became very painful, and remained so 
during the last twelve years, notwithstanding the different modes of treatment she 
was subjected to by a number of experienced physicians. During three days of every 
month she suffered intense pains, besides being obliged the week preceding and 
following the menstruation to remain in bed, owing to the great prostration. The 
menstruation was very profuse and irregular, appearing sometimes at intervals of 
ten or fourteen days. She was chlorotic, extremely emaciated, and her hearing was 
very much impaired, the galvanic reaction of the auditory nerve exhibiting qualita- 
tive changes of Brenner's formula. My attempt to make a digital examination was 
frustrated by the intense vaginismus the patient was suffering from. Oct/24, 1872, 
I commenced the treatment of vaginismus and dysmenorrhoea with iodide of potas- 
sium and the galvanic current. Her next menstruation was very little painful; 
she was not in bed, and could even walk outside the house. The vaginismus hav- 
ing almost disappeared, I was able to make an examination, and found all the 
genital organs in a perfectly healthy condition. They were undoubtedly so before 
the beginning of the treatment, which could not have produced any material change 
in so short a time. 
Thus, a fact important for the theory of dysmenorrhoea has been 
demonstrated to me, namely, that the most intense dysmenorrhoea may 
exist without any organic affection of the uterus and its adnexa, and 
that dysmenorrhoea may last for many years without producing an or- 
ganic affection of these organs. 
In this case, as in the others, the dysmenorrhoea yielded to tl e 
galvanic treatment. 
The particulars of the method shall be described when speaking 
of other disturbances of menstruation. 368 
WILLIAM B. NEFTEL. 
It is evident that dysmenorrhoea is a symptom accompanying 
various morbid conditions of the uterus. The fact that dysmenor 
rhcea may occasionally exist without any structural alteration of tho 
uterus, proves that it belongs to the so-called functional diseases, 
and is analogous to other visceral neuralgias. Therefore the mechan- 
ism which produces the phenomena of dysmenorrhoea must be essen- 
tially the same, however different may be its primary cause; it 
depends upon some nervous, probably spasmodic, affection of the 
uterus. 
As an illustration of this, I shall briefly mention the following two 
cases :- 
Miss P., aged 38, well built, but exceedingly anaemic, has suffered, during the last 
ten years, of dysmenorrhoea, with very profuse menstruation, generally lasting eight 
or ten days. During the first four days of menstruation she suffered excruciating 
pains, nausea, and vomited constantly after each meal. For the last year 
she has entirely given up taking food through the stomach during the first four 
days of menstruation, and takes instead an enema of beef-tea, to which laudanum is 
added. The uterus is anteflected, and presents a tumor of the size of a child's 
head. The increased size of the uterus is owing to the existence of a fibro-myoma, 
which is partially intramural and partially protruding into the uterine cavity. A 
few years ago, to relieve the menstrual pain, an incision of the neck of the uterus 
was made, however without any result. I commenced treating the patient with 
very strong galvanic currents, Jan. 22, 1872. After twelve daily treatments the 
menstruation appeared with much less pain, though she took no laudanum; she 
could eat, having vomited but twice during the whole period, that lasted one week. 
The loss of blood was less than usual, and she soon recuperated and felt stronger 
than on all former occasions. I continued the treatment the following month, 
using, especially during the week before the period, voltaic alternatives of a power- 
ful current directed through the pelvis. Her general health has very much im- 
proved. The next menstruation came on during the night, with pains of a peculiar 
character, which she had never experienced before, and, according to her own de- 
scription, and those present, exactly resembling pains during labor. When they 
reached their climax, becoming perfectly unbearable, a large solid mass was expelled 
through the vagina, followed by a dangerous hemorrhage and syncope. Unfortu- 
nately the solid mass was thrown away, and only half a vessel of coagulated blood 
was left for my examination. A spontaneous expulsion of the intra-uterine portion 
of the tumor undoubtedly took place, called forth, as I presume, by the powerful 
voltaic alternatives. Indeed, an examination through the abdominal walls and the 
vagina showed the uterus greatly diminished in size. It took several weeks for the 
patient to recuperate from the consequences of the acute anaemia. Afterwards the 
menstruation became normal, and the general health of the patient restored. 
Besides the interest this case presents with regard to the expulsion 
o the tumor, it shows the possibility of abolishing the phenomena of 
dysmenorrhoea without removing the organic disease of the uterus by 
which they are caused. 
This was still more evident in the following case, where the dys- 369 
menorrhoea disappeared during many months, though the tumor, 
which caused it, remained almost in the same condition. 
CLINICAL NOTES ON NERVOUS DISEASES OF WOMEN. 
Mrs. Ch., aged 43, married 23 years, but sterile, has suffered from dysmenorrhcea, 
and has been treated by most distinguished gynecologists. A large fibro-myoma 
developed itself in the posterior wall of the uterus, which called forth various symp- 
toms, among which were constipation of the bowels, pain in the back, difficulty to 
walk, etc. To remove the tumor by a surgical operation was considered perfectly 
impossible. I commenced to treat her daily with the galvanic current, and the 
next menstruation appeared without any pain. 
Here the galvanic current removed the visceral neuralgia (dysmenorrhcea), though 
its primary cause-the tumor-could not have been much modified by it in so 
short a time. The continuation of the galvanic treatment, however, seemed to 
have subsequently diminished also the size of the tumor, in consequence of which 
the constipation of the bowels was removed, the patient could walk great distances 
without any inconvenience, and her general health was restored. 
The mechanism of dysmenorrhoea can be supposed to take place 
in the following way: An irritation originating in the uterus (or per- 
haps elsewhere) is propagated to a nervous centre, whence it is trans- 
mitted to motor nerves which produce the spasmodic contraction of 
the muscular fibres of the uterus. Usually the irritation is caused on 
the mucous membrane of the uterus by the pressure of the accumu- 
lated menstrual blood, the free escape of which is impeded. The 
nervous centre where the irritation is transmitted from the sensitive 
to the motor nerves remains undetermined. Supposing this hypothe- 
sis to be correct and able to stand the test of a direct experiment, it 
may be asked which are the sensitive nerves conducting the reflex 
irritation to the motor fibres, and which are these latter that contract 
the uterus ? This question has not yet been satisfactorily answered. 
It is known from the experiments of Kilian, that uterine contractions 
can be called forth by irritating the cerebellum, the medulla oblongata, 
and the spinal cord. The sympathetic is the way through which the 
excitation of these organs is propagated to the muscular fibres of the 
uterus, according to Longet, Valentin, Budge, Obernier, Franken- 
haeuser, and others. Frankenhaeuser * has proved by direct ex- 
periments that the plexus uterinus is the motor nerve of the uterus. 
This is corroborated by the fact that all the nerve-branches compos- 
ing this plexus contain motor fibres, such as the plexus mesentericus 
superior (the irritation of which produces contractions of the intesti- 
nal canal and of the uterus), the renal nerves, and those originating 
from the second and third lumbar ganglia of the sympathetic. These 
latter communicate with branches of the spinal cord, and Budge has 
produced most powerful uterine contractions by irritating this region 
* Die Nerven der Gebarmutter. Jena, 1867, p. 42. WILLIAM B.' NEFTEL. 
of the cord. The motor branches from the renal ganglia to the plexus 
uterinus bring the kidneys into close relation with the genital or- 
gans. This explains the frequent derangement of the urinary secre- 
tion during pregnancy, and in various uterine diseases. 
The sacral nerves are considered as the sensitive nerves of the 
uterus. The following case described by Scanzoni * is very instruc- 
tive with regard to these points. A woman with complete paralysis 
of the lower half of the body was delivered of a child without feeling 
any pain. The patient died ten days later, and at the post-mortem 
the spinal cord was found compressed by a hydatid tumor at the 
level of the first thoracic vertebra. The symptoms can be explained 
by admitting that the sympathetic produces the uterine contractions, 
and that the sacral nerves are the sensitive nerves of the uterus. 
In dysmenorrhoea, as in other visceral neuralgias, we meet with 
abnormal activity of the vascular system, which must be considered 
as a reflex phenomenon from irritation of the sensitive abdominal 
nerves upon the vagus. The splanchnic nerves, the most powerful 
vaso-motor nerves which exercise so great an influence upon the 
circulation in the abdominal viscera, very probably also participate 
in the production of the phenomena of dysmenorrhoea. 
It is likewise probable that in dysmenorrhoea the galvanic treat- 
ment not only affects directly the uterus and its nerves, but also in- 
fluences them indirectly through the splanchnic nerves, by modifying 
the circulation in the pelvic organs. 
370 
* Scanzoni. Lehrbuch der Geburtshiilfe. 
(To be continued.) 416 
WILLIAM B. NEFTEL. 
III. 
CLINICAL NOTES ON NERVOUS DISEASES OF WOMEN. 
BY 
WILLIAM B. NEFTEL, M.D., 
NEW YORK. 
{Continuedfront No. 4, />. 370.) 
In female patients suffering from various affections, backache is 
very frequently met with. I prefer this simple name, designating but 
a mere symptom, to the more learned term of spinal irritation that 
may lead to a false interpretation. The doctrine of spinal irritation 
has already done much harm and greatly arrested the progress of 
neuro-pathology. Promulgated at first by some obscure physicians 
in England, it rapidly found enthusiastic adherents all over the world. 
Indeed, for superficial observers, it seemed an easy means to diagnosti- 
cate and treat almost every disease. The method of examining was 
very simple, requiring only to find over the spinal processes some 
places that were painful, either spontaneously or by pressure, and this 
was deemed sufficient to explain an affection of the corresponding 
organs. The treatment then had to be directed to those painful parts,, 
and was not difficult, although varying according to the different mean- 
ing given to spinal irritation by different authors. Fortunately this fal- 
lacious doctrine met with a strong opposition on 'the part of such 
excellent physicians like Romberg,* Hasse,f Stilling and others, 
and called forth a salutary reaction. At present the affection hitherto 
described under the name of spinal irritation is entirely excluded 
from the nosological system, and is not even mentioned in the more 
recent works on nervous diseases by Eulenburg, J Rosenthal,§ and 
others. 
An analysis of the phenomena constituting the so-called spinal 
irritation, shows that this latter is a symptom or a complex of symp- 
toms accompanying the most different morbid conditions, in the 
* Lehrbuch der Nervenkrankheiten des Menschen. Dritte Auflage. Berlin, 1853, p. 179. 
+ Krankheiten des Nervensystems. Zweite Auflage. Erlangen, 1869, p. 43. 
t Lehrbuch der functionellen Nervenkrankheiten. Berlin, 1871. 
$ Handbuch der Diagnostik and Therapie der Nervenkrankheiten. Erlangen, 1870. CLINICAL NOTES ON NERVOUS DISEASES OF WOMEN. 
417 
same way as do the symptoms headache or cough accompany vari- 
ous affections of different organs. Thus we find spinal irritation, or, 
to be more plain, backache, as a symptom of neuralgia of the spinal 
nerves; in the cervico-occipital neuralgia, in cervico-brachial neu- 
ralgia, in intercostal neuralgia, in lumbo-abdominal neuralgia. These 
neuralgias appearing spontaneously and culminating in paroxysms, are 
often met with in anaemic persons, and we generally find this kind of 
backache, like other neuralgic pains, in patients whose blood has un- 
dergone some qualitative or quantitative alteration, for instance in 
miasmatic (malarious) and contagious diseases, in chlorosis, etc. 
Sometimes the backache may have its seat in the muscles, in which 
case the pain is not so acute as in the neuralgic form; it is more su- 
perficial, increases by certain movements, and is diminished or abol- 
ished during rest (in a quiet recumbent position). 
Again, a deeply-seated pain, which is very much increased by pres- 
sure, and impedes the movements of the vertebral column, may be a 
sign of an affection of the vertebrae or of their articulations. 
In spinal meningitis, the backache is greatly increased by every 
passive and active movement of the trunk and of the extremities, but 
not by external pressure on the spine. This backache, therefore, 
causes immobility by impeding the action of the muscles, which 
appear rigid. 
In myelitis the backache is circumscribed, corresponding to the 
seat of the affection, and is not aggravated by movements of the 
extremities. According to the seat of myelitis, pain is felt also either 
in the extremities or on the external surface of the trunk, and in its 
internal organs. Moreover, the backache in myelitis is accompanied 
with a paralytic condition of the tipper, and still oftener of the lower, 
extremities, 'and of the sphincter muscles. If myelitis is complicated 
with an affection of the vertebrae, the backache will be provoked and 
aggravated not only by pressure, but even by the least external 
touch, for instance, with a warm sponge, etc. 
I have observed the most severe backache in patients suffering 
from carcinoma, after this latter has become generalized, and deposits 
formed in the vertebrae or in the cord and its membranes. By this 
peculiar kind of backache, resisting every medication, I have 
been enabled to make the diagnosis of cancerous diathesis in 
patients in whom a cancer had been previously extirpated.' The 
excruciating pains in the back can be explained by the presence 
of extremely numerous sensitive nerves, discovered by Luschka,* 
in the walls of the veins of the vertebral canal and in the vertebrae. 
* Die Nerven des menschlichen Wirbelkanals. Tubingen, 1850. 418 
WILLIAM B. NEFTEL. 
It is obvious that the engorged and dilated veins may produce pain 
by their pressure upon the cord, or upon the sensitive nerves of its 
membranes, or upon the sensitive nerve-trunks ; in the same way, pain 
may be produced by an increase of the cerebro-spinal fluid. 
It is well known that backache frequently accompanies hysteria. 
In such patients the disposition to morbid sensations and to reflex 
movements is so great that irritation of the skin, not only of the 
spine, but also of the anterior surface of the trunk, especially pressure 
on the region of the ovaries, will call forth numerous neuralgic and 
reflex phenomena. The backache in hysterical persons is so intense 
that pressure will make them faint. 
Lastly, backache may accompany affections of the organs of res- 
piration, of circulation, and of digestion ; also of the kidneys, uterus, 
etc. I have reason to believe that the backache of this last category 
depends on a peculiar morbid alteration of the spinal cord, that 
has recently been the subject of most exhaustive and exact clinical 
as well as histological researches made by L. Meyer.* I shall 
give an account of this morbid condition of the spinal cord in a separate 
paper on the recent researches in neuro-pathology. Here I shall 
briefly mention that accumulations of fat-granules and granule-cells 
are found in the cord under different circumstances. They were 
first noticed by Tuerck f at the autopsy of persons with inveterate 
organic lesions of the brain. He found this secondary degeneration 
of the spinal cord on the opposite side of the primary cerebral lesion. 
Westphal J found such collections of granule-cells in the posterior 
and lateral columns, in the progressive paralysis of the insane, and in 
the gray degeneration of the cord.- He assumes that the granule- 
cells originate from proliferation of the connective-tissue corpuscles, 
and considers the whole process as chronic myelitis. T. Simon § 
found collections of granule-cells in the spinal cord of persons who 
died of tuberculosis, and of other diseases accompanied with deep 
nutritive alterations. 
L. Meyer's researches have shown that the accumulations of 
granule-cells are not produced by the proliferation of connective- 
tissue cells, and do not designate myelitis, but originate from the fatty 
degeneration of the walls of blood-vessels, especially of the small 
veins. They are found in various diseases accompanied with pro- 
* Ueber die Bedeutung der Fettkornchen und Fettkornchenzellen im Ruckenmarke und Gehirne. 
Archiv fur Psychiatric und Nervenkrankheiten. Bd. III. Heft i and 2. 
+ Tuerck. Zeitschrift der Gesellsch. der Acrztc in Wien, 1849. Quoted by Meyer, Simon, West- 
phal. • 
t Ueber Erkrankungen des Ruckenmarks bei der allgemeinen Paralyse der Irren. Virchow's 
Archiv, Bd. XXXIX. p. 105. 
§ T. Simon Uber den Zustand des Ruckenmarkes in der Dementia paralytica, etc. Griesinger's 
Archiv, Bd. I. p. 583. found nutritive changes of the system, and are seated in different 
parts of the cord, corresponding to the different diseased organs. 
Thus the upper and middle portions of the spinal cord are the seat 
of granule-cells in diseases of the respiratory organs, of the jieart, and 
especially in tuberculosis. In epilepsy, the cervical portion of the 
cord is especially affected, whilst in diseases of the sexual and uri- 
nary organs the lumbar portion is the principal seat of the affection. 
Meyer assumes that in the diseases of these organs the granule- 
cells present a secondary affection of the spinal cord, analogous to 
its secondary degeneration in organic affections of the brain. In 
both cases the secondary affection is developed in certain portions of 
the cord, through the nerves coming from the paralyzed limbs and 
diseased organs. 
From the foregoing it follows that it is not sufficient, either practi- 
cally or theoretically, to have found in a patient the existence of spinal 
irritation, but that we have besides to diagnosticate in each separate 
case the real affection of which the backache is merely a symptom. 
For that purpose we have to proceed according to the general rules 
and methods described in the treatises on special pathology and thera- 
peutics. To these well-known diagnostic methods must be added the 
examination with the different electric currents, a valuable method, 
though still often neglected by clinicists. 
This method of examination is indispensable for the diagnosis of 
affections of the nervous centres of the motor-nerves and muscles by 
calling forth the characteristic electro-muscular contractility and sen- 
sibility. It is also very valuable for testing the condition of the 
cutaneous sensibility and of the reflex irritability. Moreover, I found 
the electrical examination useful for discovering the so-called "points- 
douloureux" in neuralgias. On passing a button-shaped electrode 
of a very mild induced current over the region where the affected 
nerve is distributed, these points are at once noticed by the intense 
pain felt in them. Valleix * was the first to call the attention of the 
profession to the existence of painful spots or points in neuralgias. 
He asserted that they are always present in, and therefore pathog- 
nomonic for, real neuralgias. Although Hasse f and others have 
met with some exceptions to-this rule, still the frequent presence and 
the importance of Valleix's points-douloureux in neuralgias has been 
admitted by Romberg | and others. I have found that these painful 
spots have a high therapeutic significance, as by acting on them with 
the anode of a weak galvanic current, the treatment of neuralgias is 
CLINICAL NOTES ON NERVOUS DISEASES OF WOMEN. 
419 
* Trait6 des Nevralgies. Paris, 1841, p. 666. t S. citat. p. 47. 
t Zur Kritik der Valleix'schen Schmerzenspunkte in Neuralgien. Archiv fiir Psychiatric und 
Nervenkrankheiteu, Bd. I. p. 1. 420 
WILLIAM B. NEFTEL. 
made considerably easier and shorter. In using the current in the 
same manner as for ascertaining the painful points in neuralgias, we 
may sometimes discover affections of abdominal organs-liver, 
spleen-by the tenderness or pain that is provoked by moving the 
electrode over the regions of these organs. 
By means of the galvanic current I once discovered the presence 
of malarial poison in the following case :- 
Mrs. K., setat. 45, of a robust constitution, suffered for several months from ob- 
scure symptoms of a nervous character, with general prostration, loss of sleep and 
of appetite, backache, and especially acute rheumatic pain in the right shoulder, 
impeding the movements of the whole arm. I employed a galvanic current of 20 
to 30 Siem, elements, applying the broad anode in a stable manner to the affected 
shoulder. After the current had been flowing for about four minutes the patient 
became pale, was seized by an intense rigor, followed by a feeling of excessive heat, 
and by profuse perspiration. Another paroxysm appeared on the third day, and 
this time spontaneously, thus proving the disease to be a masked intermittent fever, 
the real nature of which could not be previously revealed, and which now rapidly 
yielded to the use of quinine. 
The treatment of backache must necessarily vary according to 
the nature of the disease which causes it. It is hardly requisite to 
mention that a constitutional treatment is almost always indispensa- 
ble. Thus in anaemic and chlorotic persons we have to resort 
to tonics-iron, quinine, wine, country-air, sponge-baths, nourishing 
food, etc. If, at the examination with the induced current, no pain- 
ful points can be discovered, but on the contrary the patient after it 
feels considerably relieved from the backache, I generally continue 
to apply the same current to the spine, every other day or even 
every day, until the pain entirely disappears. To insure success the 
current must be exceedingly weak, so as not to be painful at all, and 
not to produce muscular contractions. 
Miss A. C., about 35 years old, principal of a school, extremely anaemic, 
though her appetite good and all the functions apparently normal. She con- 
sulted me, Oct. 29, 1870, in regard to her backache, being alarmed by the,recent 
death of her mother and sister from spinal meningitis. I applied to the spine 
every other day, and with considerable benefit, a weak, perfectly painless induced 
current. I occasionally tried the electric brush, but it invariably increased the 
backache. Even a less painful current, just sufficient, however, to produce mus- 
cular contractions, would also aggravate the backache. Having thus satisfied my- 
self that the backache could be favorably influenced only by very weak and scarcely 
perceptible currents, I continued this treatment at first every other day, after- 
wards, twice and once a week, and then only occasionally during eight months, 
until the backache had entirely disappeared. 
As a general rule, however, the induced currents are seldom bene- 
ficial in backache of women; they sometimes even aggravate it, and CLINICAL NOTES ON NERVOUS DISEASES OF WOMEN. 
421 
where their employment is useful, the treatment is always very pro- 
tracted. 
In this respect there seems to be a marked difference in both 
sexes. A strong induced current, in some cases of lumbago in men, 
is followed by great relief and often by a complete disappearance of 
the pain. 
In the majority of cases of backache in women, especially in the 
form which accompanies intercostal neuralgia, the most efficient 
remedy is the constant current. I generally use a weak current, or 
of moderate strength, bringing the painful parts (especially the points- 
douloureux) under the influence of the anode, and gradually diminish- 
ing the intensity of the current before breaking it. 
As an illustration, I select a few cases from a large number treated 
by me in a similar way :- 
Mrs. L., aged 38, of a good constitution, married, and mother of four children, 
suffered for years from a pain in the upper part of the spine, extending to the occi- 
put and sometimes all over the head, that generally felt dull and heavy. She was 
never entirely free from these pains, which disturbed her sleep, diminished her 
appetite, and prostrated her general health. She at last became melancholic to 
such an extent that her husband was obliged to place her in a lunatic asylum. 
He soon, however, withdrew her from the institution, in the same condition of 
mind, and consulted me Dec. 31, 1868. I commenced at once the treatment with 
the galvanic current, applying the anode to the nape of the neck, the cathode to 
the palm of the hand, using a current of 12 to 15 elements of Siemens. Subse- 
quently I alternated this method with the following, using only 6 or 8 elements, 
and sending the current through the head, and imperceptibly graduating the current- 
intensity by means of a rheostate. I occasionally resorted to the galvanization of 
the sympathetic. The effect of the treatment was extremely beneficial. After the 
first application of the current she felt her head relieved and slept soundly. Her 
disposition soon became natural, the appetite and digestion good, and at the end 
of a fortnight she considered herself perfectly restored to health, though I con- 
tinued to treat her occasionally for several months. 
I saw her a few days ago (May 5, 1873) > her health continues in an excellent 
condition. 
Mrs. C., wife of a clergyman, and mother of two children, complained of back- 
ache, especially of a pain in the back of the neck ; also of a heavy feeling in the 
head, of want of sleep, and of dyspepsia. She at last became melancholic, with 
occasional attacks of acute mania. She was treated by most distinguished special- 
ists for nervous diseases, but her condition, nevertheless, became more and more 
alarming. The prognosis was very unfavorable, the development of an incurable 
form of insanity being expected. I saw the patient March 16, 1871, and com- 
menced to treat her exactly in the same way as the preceding patient, except that 
the galvanic current I used was still weaker, and I did not galvanize the sympa- 
thetic. The effect of this treatment was as surprising as in the former case, and 
she soon regained her health, which still continues very good. 
If the seat of the backache is in the,middle or lower portion of, 
the spine, I apply the anode of a much stronger current than above 
VOL. I.-23 422 
WILLIAM B. NEFTEL. 
mentioned to the painful part, carefully avoiding large fluctuations 
of the current-density by means of a rheostate used as an accessory 
current. The cathode I generally place into the palm of the hand, 
unless there is a special indication to apply it to another remote part 
of the body. 
Though the cases of this kind under my observation were numerous, 
yet their treatment and its favorable result are so uniform that it will 
be sufficient to mention one of them as an illustration :- 
Miss G.,'23 years old, suffered for years from pain in the middle portion of the 
back. Her general health was very good, and no affection of any organ could 
be found. I applied the elongated anode to the painful part of the spine, the 
broad cathode being placed in the palm of the hand. The intensity of the current 
was gradually increased to 20 Siem, elements, and then slowly diminished, care- 
fully avoiding large fluctuations of the current-density by means of a rheostate. 
Duration of each treatment, 6 to 10 minutes. At the end of five weeks the back- 
ache had entirely disappeared. 
There are, however, cases of backache apparently belonging to this 
category which will not yield to this method of treatment. I pre- 
sume that here the backache depends on a secondary affection of the 
cord (collections of granule-cells), in consequence of a disease (not 
always recognizable) of some viscus. 
Mrs. M., wife of a physician, was sent to me Jan. 26th, 1871, by Dr. J. Marion 
Sims, who treated her for endometritis and dysmenorrhoea. In this case the method 
described above would not produce the desired effect, but a strong galvanic current 
passing through the spine, in the form of Voltaic alternatives, would make the pain 
disappear instantaneously, though only to reappear the next day, or a few days 
after. 
Though this result is merely temporary, still it is of great import- 
ance, allowing the sufferers to have a night's rest and regain their 
strength. In these cases, a permanent benefit can be attained only 
by a prolonged galvanic treatment with currents of moderate inten- 
sity sent through the spinal cord, either in an ascending or descend- 
ing direction. 
MissH., 32 years old, consulted me Jan. 27th, 1870. She repeatedly had attacks 
of dysentery and of congestions to the liver, which left a chronic derangement of 
the digestion with torpid action of the bowels. I found the liver considerably in- 
creased in size, and tender to pressure. Her appetite was not good, the bowels 
constipated; she complained of general debility, and especially of pain in the mid- 
dle and lower portions of the spine, from which she was suffering for years. Hav- 
ing regulated her diet, and recommended the use of Kissengen water, I applied to 
the spine a descending galvanic current, and at times an ascending one of 10, 12, or 
15 elements of Siemens, during five minutes, every other day. She felt at first but 
a slight relief, which, however, became more decided as the treatment progressed, 
until, at the end of three months, not a trace of the backache remained, and she 
left for her home (California) in perfect health. CLINICAL NOTES ON NERVOUS DISEASES OF WOMEN. 
423 
Neither in this nor in other analogous cases of backache could I 
observe any marked difference in the action of the ascending or 
descending currents; either, therefore, may be used. 
This kind of backache, which is very distressing, I have often 
observed in women who had previously suffered from pelvic cellulitis, 
chronic metritis, parametritis, or oophoritis. As already mentioned, I 
ascribe this kind of backache, and generally the backache accom- 
panying affections of some organ, to the presence of collections of 
granule-cells in the spinal cord (its secondary degeneration). 
I have observed one of the most obstinate kinds of backache in 
women exhibiting symptoms of fatty degeneration of the heart. In 
these patients the whole complex of morbid phenomena is very char- 
acteristic, and can be easily recognized. The patients are generally 
very anaemic (though not always emaciated), in consequence of some 
preceding severe illness, or from loss of blood. Their face is pale, 
and flushes at the slightest emotion. They complain of pain in 
the upper portion of the spine, of loss of sleep, and of a sensation of 
extreme fear. They seem continually in dread of some imaginary 
danger, and are frightened at everything without any reason. The 
action of the heart is weak, the pulse sometimes irregular, with inter- 
missions. Some have no appetite ; others, on the contrary, have a 
very good one, but suffer from dyspepsia. 
I will mention here a peculiar kind of backache which I have 
observed in a number of women suffering from dyspepsia. This 
backache is situated between the shoulder-blades, more on the left 
side, and accompanies only the attacks of dyspepsia, disappearing 
during the intervals. These latter may last for weeks or months until 
the dyspeptic symptoms reappear, and with them the distressing 
backache. The pain is relieved by pressure, and often such patients 
ask to be struck on the painful part with a solid body, and knocked 
in rapid succession with both fists of an assistant. 
Mrs. C., an elderly lady, and mother of a large family, often suffered from dys- 
pepsia associated with backache of the kind just described. In the intervals she 
would feel very well and have an increased appetite, which she would satisfy, and 
thus accelerate the return of dyspepsia, with the most painful backache. She had 
been treated for many years by different physicians, who had exhausted all reme- 
dies and methods of treatment, without any benefit, scarcely being able to relieve 
her during the attacks. 
Having examined, Feb. 16, 1871, the contents (which she threw up) of her 
stomach, I found butyric and lactic acid, and also sarcina ventriculi and other 
fungi, which proved conclusively that fermentation was going on in the stomach, 
and interfering with its normal functions. As the patient had been treated by 
very able practitioners, I could therefore commence quite a different mode of 
treatment, and dispense with all the remedies they had already employed, among 424 
WILLIAM B. NEFTEL. 
others bismuth and pepsin. Considering how minute a dose of this ferment is 
sufficient to digest enormously large quantities of food, provided there be present 
free hydrochloric acid and plenty of water, it is surprising that large doses of pepsin 
should be unnecessarily prescribed, and that the drinking of water should be pro- 
hibited to dyspeptic patients. I recommended, on the contrary, to the patient to 
drink as much water as she wished, and prescribed, internally, freshly-prepared 
chlorinated water, in doses of 15 to 20 drops, four times a day. My object in 
giving this remedy was to arrest the fermentation in the stomach,* and by the 
chlorine being transformed into hydrochloric acid to promote the digestion. The 
result of this treatment was quite in accordance with my expectations. The patient 
felt a great relief from the first doses, and the dyspeptic attack and the backache 
yielded sooner than on all former occasions. As an after-treatment, I prescribed 
one-grain doses of rhubarb, four times a day, it being very useful for exciting the 
secretion of the deficient gastric juice. 
I have applied this treatment to a number of similar cases, and it 
has been generally followed by the same beneficial result. 
It does not enter into the plan of this paper to consider the 
backache accompanying myelitis, meningitis, and diseases of the 
vertebrae. 
In concluding this first article on nervous diseases of women, I 
wish to allude to some aetiological and therapeutical peculiarities as 
regards diseases of wotnen generally. Much has been said already 
with reference to the irrational mode of woman's clothing impeding 
the functions of the organs of the thoracic and abdominal cavities, 
and predisposing to different diseases. It is to be regretted, however, 
that this subject should have been discussed mostly by social reform- 
ers, moralists, or by advocates of a special cure of female diseases. 
The only competent judges in this matter are the physicians, and the 
most decisive arguments for the discussion must be derived from 
post-mortem examinations and from experiments. In this respect 
we possess some facts that may serve as a basis for further investiga- 
tion. I have seen at the autopsies of women in Virchow's Patholo- 
gical Institute some specimens of livers presenting remarkable de- 
formities in consequence of tight lacing. Such a liver bears the 
name of corset-liver (Schniirleber), and illustrations of such deformi- 
ties can be seen in Frerich's classical work on diseases of the liver.f 
This malformation must necessarily interfere with the normal func- 
tions of this important organ, and must be followed by chronic and 
incurable derangements of the digestion and of the circulation in the 
system of the portal vein, with all their consequences. 
In 1863 I made a considerable number of experiments on animals 
in the laboratory of Prof. Harley, in the University College, London, 
♦ Botkin, Berlin, klin, Wochenschrift, 1870, No. 38, and 1873, No. 5. 
t Frerich's Klinik der Leberkrankheiten. Zweite Aufl. Bd. I. p. 47, figs. 7, 8, 9, 10, xx. CLINICAL NOTES ON NERVOUS DISEASES OF WOMEN. 
425 
which I continued, in 1867, in the Pathological Institute of Prof. Vir- 
chow. Though the object of these experiments was to study the 
effect of a slight but continuous impediment of the respiratory move- 
ments upon the development of affections of the lungs and heart, I 
found that the effect of the pressure was still more pronounced in 
the abdominal organs, especially the liver and kidneys. I have not 
yet published the result of these experiments, and give here the 
following extract from my note-book :- 
Rabbits cannot bear even a very slight compression of the trunk 
by a bandage. Their respiration becomes accelerated, the conjunc- 
tiva congested, and they invariably die, sometimes after 24 hours. 
May 22d, 1867, 1 applied loosely a bandage around the thorax and 
abdomen of a rabbit. The animal died May 26th. I found the 
liver and kidneys very much congested. In the liver, especially on 
its convex surface, numerous white spots from the size of a pin's 
head to that of a pea, very resistant and retracted. There were, 
besides, psorospermia. 
May 29th, 1867, a similar bandage, but still looser than the former, 
was applied to a well-nourished and vigorous rabbit, which neverthe- 
less died June nth, being much emaciated, and the liver and kidneys 
ve\' much congested. 
May 30th, 1867,1 applied a very loose bandage around the thorax 
and partly around the abdomen of a female dog. During the first 
fortnight no perceptible change could be noticedin the animal; after- 
ward it grew thinner, and coughed, which I ascribed to the irritating in- 
fluence of the air of the chemical laboratory where the dog was kept. 
It died July 4th. At the post-mortem the blood was found very thin 
and dark, the heart dilated, the lungs emphysematous, a haemorrhagic 
infarction in the spleen, and the small intestines contracted, the liver 
and kidneys congested, the epithelium of the latter fatty degenerated, 
etc. In cases where the compression by the bandages was minimal, 
and the animal survived a longer time, the kidneys presented the ap- 
pearance of Bright's disease in its first stages. 
Perhaps it is worth mentioning that high-heeled shoes are very in- 
jurious, by excluding certain groups of muscles from participating in 
walking, and over-exerting other sets. Backache in the lumbar re- 
gion is apt to follow after wearing such shoes for a considerable 
length of time. 
That irregularities in the sexual functions play an important part 
in the aetiology of diseases of women is well known to physicians. 
I was told that not unfrequently ice-water is injected into the va- 
gina immediately after sexual intercourse, with the object of prevent- 
ing conception. Two ladies who were in the habit of so doing are 426 
WILLIAM B. NEFTEL. 
suffering from large fibroid tumors of the uterus ; others are affected 
with chronic metritis and extreme nervousness. 
The injurious effect of the intense and sudden cold upon the sex- 
ual organs during their increased activity may easily account for their 
disorders. Moreover, admitting the development of tumors from 
local irritative processes, we can also explain the origin of the fibro- 
myomata in the above cases. 
In treating chronic diseases of women, especially nervous disorders, 
we have to bear in mind the important influence of muscular exercise 
upon the healthy condition of the whole economy. The accumulated 
products of tissue-metamorphosis act in a deleterious manner upon 
all the vital processes, especially producing a depressing effect upon 
the muscular and nervous system, and a feeling of exhaustion. 
Ranke * has shown that these so-called exhausting substances (ermii- 
dende Stofife), as lactic acid, carbonic acid, etc., abolish the irritability 
and electro-motor properties of the muscles. Their effect can be 
neutralized by injecting blood through the blood-vessels into the ex- 
hausted muscles. In the living organism it is the alkaline blood and 
lymph that act in the same beneficial way. The circulation of blood 
and lymph facilitate the removal from the muscles, and nervous ap- 
paratus, of these effete substances, and their final elimination from 
the system, after which, these organs regain their irritability and other 
electro-motor properties. Thus we see persons tired and prostrated 
without any muscular activity, feel refreshed and vigorous in walking, 
and the more so, the more they continue to take exercise. 
Furthermore, the neglect of exercising and developing the muscles, 
which constitute the largest part of the body, is followed by other in- 
jurious consequences for the whole organism. During muscular ac- 
tivity a large amount of blood circulates in the muscles, thus relieving 
and facilitating the circulation in the internal organs. On the con- 
trary, when the muscular system is inactive, the circulation is im- 
peded in the viscera, which become congested and their veins dilated. 
This is frequently the case with the system of the portal vein; hence 
the passive congestions in the abdominal organs, especially in the 
sexual organs of women. 
Again, the development of the muscular system increases also the 
energy of the heart's action, thus facilitating the circulation gener- 
ally ; whereas want of muscular exercise weakens the heart and re- 
tards the circulation. 
It is therefore obvious that those methods are irrational which in 
the treatment of chronic diseases of women require prolonged rest 
and muscular inactivity, and that much may be gained by any mode 
of treatment that admits of muscular exercise. 
* Physiologie, 2 Auflage, 1872, p. 634.