PATROLOGY OF THE NERVOUS SYSTEM. 
JAMES J. PUTN1M, M. D. 
SEOOKDIBEPORT. 
[Reprinted from The Boston Medical and Surgical RECENT PROGRESS IN PATHOLOGY OF THE NERVOUS 
SYSTEM. 
JAMES J. PUTNAM, M. D. 
Cerebral Concussion. - In the last report,1 certain reasons were given 
for believing that in so-called cerebral concussion a vascular paralysis 
occurs inside the cranium, the blood collecting in the larger veins and 
sinuses as it does in those of the abdomen in cases of shock, leaving 
the brain-substance essentially in a condition of anaemia ; and that it is 
to this that the symptoms are due. More recently some experiments 
have been reported by Koch and Filehne 2 in which this condition of 
concussion was produced experimentally in animals by rapping the head 
with a light hammer, care being taken to entirely avoid causing haem- 
orrhages. Under these circumstances they found reason to think 
that not alone the vaso-motor, but all the other cerebral centres as 
well, suffered direct mechanical injury. 
Post-Paralytic Chorea? - It has long been known that chorea in chil- 
dren is often associated with, or followed by, a more or less well marked 
hemiplegia, and Hughlings Jackson has used the fact as an argument 
in favor of his view that, as a rule, the usual form of chorea is depend- 
ent upon a lesion (minute emboli) in the anterior part of the hemi- 
sphere of the brain. According to Dr. Mitchell, it happens also that 
a one-sided awkwardness of movement, even so marked as to suggest 
incipient chorea, " is sometimes the precursor in children of a hemi- 
spasm." The reverse sequence, the choreal disorders following on 
hemiplegia, has hitherto not been distinctly acknowledged as something 
of frequent occurrence, although, their attention being once called to the 
point, many physicians can no doubt recall cases like those described 
by Mitchell. He claims " that on adults who have had hemiplegia 
and have entirely recovered power, there is often to be found a choreal 
disorder, sometimes of the leg and arm, usually of the hand alone ; 
that it may exist in all degrees, with partial loss of power, and with full 
1 Boston Medical and Surgical Journal, xci. 114, July 30, 1874. 
2 Archiv fur klinische Chirurgie, 1874, xvii. 
3 S. Weir Mitchell, M. D., American Journal of the Medical Sciences, October, 1874. 4 
Progress in Pathology of the Nervous System. 
normal strength ; that it may consist in mere awkwardness, or exist to 
the degree of causing involuntary choreoid motions of the part;" 
further, " that the younger the person when paralyzed, the more prob- 
able is the occurrence of choreal developments, so that in many cases 
of infantile deformity the choreal troubles remain as the chief difficulty 
long after there has been a restoration to full muscular power; " and 
moreover, that there is " reason to believe that some of the general and 
prolonged choreoid disturbances which we see now and then from birth 
are due to, or rather are in some fashion related to, intra-uterine 
palsies which have either wholly or in part passed away." 
It is plain that these facts, if they are such, lend further support to 
the theory proposed by Hughlings Jackson, mainly on theoretical 
grounds, that the involuntary, localized, movements of chorea and the 
unilateral convulsions associated with it are produced by the irrita- 
tion of the central portion of nerve-tracts corresponding to definite 
groups of muscles, and are analogous to the contractions and convul- 
sions observed in the well-known experiments of Fritsch and Hitzig. 
As Mitchell says, the above propositions, if true, indicate " that choreoid 
affections may be owing to gross organic lesions, and that, under certain 
favoring circumstances, the same lesion which occasions a palsy may in 
itself, or in the disturbances it causes, also bring about chorea." 
It is also interesting to remark in this connection, as further evidence 
of their cerebral origin, that the choreal movements observed in these 
cases were sometimes of a truly coordinated order, and thus again analo- 
gous to the movements in some of the experiments of Hitzig and others. 
Thus one patient used to " rub continually the right leg with the right 
hand, so as even to wear out the pantaloons." In another case the arm 
was alternately flexed and supinated, and in another it would swing 
across the body, but only while the patient walked, the fingers being 
firmly flexed at each step. Hughlings Jackson has reported recently 
the case of an epileptic who went regularly through the motions of twirl- 
ing his mustache, in complete unconsciousness. 
As regards their clinical history, these cases of post-paralytic chorea 
are very obstinate, but improvement is not out of the question, especially 
under persistent and careful gymnastic training of the muscles affected, 
by a competent teacher. 
It is now several years since Dr. W. A. Hammond first described a 
disease, called by him athetosis, which though not identical with chorea 
is certainly analogous to it, consisting in perpetual, slow, powerful, 
totally uncoordinated movements of the fingers and toes, their muscles 
becoming hard and large under the constant exercise, and this also 
there is some reason to regard as an affection of cerebral origin ; at 
least in both the cases given in the author's Diseases of the Nervous Sys- 
tem, there was other evidence of cerebral disease, epilepsy in one, Progress in Pathology of the Nervous System. 
5 
aphasia in the other, associated in both with failure of the memory and 
intelligence. 
Circulation in the Encephalon.1 - We would simply refer by title to 
this work, which does not admit of a brief summing up, on account of 
its great practical value. It consists of a description of the exact distri- 
bution of the cerebral vessels, and promises, in the light of a more ad- 
vanced knowledge of the functions of the different parts of the brain 
itself, to aid us greatly in the exact localization of embolic inflammations, 
and help to further physiological results. 
Localized Inflammation of the Anterior Cornua of the Spinal Cord. - 
No doubt can now be entertained of the propriety of recognizing the 
occurrence among adults of a disease closely resembling, in its pathol- 
ogy and clinical history, the so-called essential or spinal paralysis of 
children, although in certain details the two are different. The follow- 
ing group of symptoms is given by Seguin 2 as characteristic : - 
" Dysaesthesia and slight temporary anaesthesia, paresis and akinesis, 
both these symptoms affecting the extremities, and in rare cases the 
face, eyes, tongue, and throat ; not affecting the respiratory muscles 
nor those of the back and abdomen, nor the bladder, nor the sphincter 
ani. Muscular atrophy in the paralyzed parts. Loss of electro-mus- 
cular contractility (to faradic current) in the atrophied muscles. A 
strong tendency to spontaneous retrocession of the palsy and to spon- 
taneous cure. 
" The important negative characters of this affection are : Absence 
of palsy of bladder, or of sphincter ani, or of respiratory muscles. No 
bed-sores. No great and extensive anaesthesia. No spinal epilepsy " 
(all signs of acute diffused myelitis). 
The pathology of the disease is essentially " granular degeneration 
of the ganglion-cells of the anterior horns." The treatment resembles 
that of infantile paralysis. 
A case of muscular wasting from localized inflammation of the ante- 
rior cornua, though perhaps not belonging fairly to the class of dis- 
eases just discussed, is reported by Prevost and David,3 where the sole 
symptom was atrophy of the muscles of the thenar eminence on the 
right hand, and the nervous lesion atrophy of the eighth spinal nerves 
on the right side, atrophy and sclerosis of the right anterior cornu, in- 
volving the large, motor nerve-cells of the lateral group alone, through 
a space of about one inch in length, the maximum of disease lying 
opposite the eighth nerve. The patient was sixty years old and had 
1 By II. Duret, Archives de Physiologic, vi., 1874. 
2 For excellent summaries of our knowledge on this subject, with original cases, see Con- 
siderations sur 1'atrophie aigue des cellules motrices, par Petitfils, Paris, 1873 ; Spinal 
Paralysis, by E. C. Seguin, Transactions of the New York Academy of Medicine, 1874. 
See also this journal for March 25, 1875, a paper by Dr. D. F. Lincoln, of Boston, and Bern- 
hardt, Archiv fur Phsychiatrie und Nervenkrankheiten, iv. 2. 
3 Archives de Physiologic, vi. 595, 1874. 6 
Progress in Pathology of the Nervous System. 
died from some surgical injury, the muscular atrophy having existed, 
apparently unchanged, since his childhood. 
Two remarkable cases, one of elevation, the other of depression, of 
the general bodily temperature in conyiection with spinal injury have 
been reported in England. The first,1 observed by Mr. Teale, of Scar- 
borough, apparently under every precaution, was that of a young lady 
who was thrown from her horse while hunting, sustaining a fracture of 
two ribs and an injury of some sort to the spine at the level of the 
sixth dorsal vertebra. During the attack of meningitis which followed, 
the temperature, measured both in axilla and in the rectum, rose re- 
peatedly to 122° Fahrenheit, and perhaps higher, no thermometer 
being at hand which would record above that point. During nearly 
two months it remained above 110° Fahrenheit. The case ended in 
recovery. 
The other case 2 was that of a man who through a severe fall sus- 
tained a dislocation of the first dorsal vertebra, followed by red softening 
of the cord at that level, with complete paraplegia. When first, ad- 
mitted into the hospital he had a temperature of 95.2° Fahrenheit, and 
from then until his death, which took place on the eleventh day, it con- 
tinued to sink gradually, reaching 80.8° Fahrenheit, its lowest point. 
Phosphorus in Nervous Affections. - It is well known that Thompson,3 
as well as Broadbent4 and others, have been praising highly the efficacy * 
of phosphorus in neuralgia, and a number of other diseases, mainly of 
the nervous system. Although the number of their cases is not yet 
great enough, and their observations have not yet been sufficiently con- 
trolled, to justify us in definitely accepting their conclusions, yet those 
who wish to test them will do well to observe certain precautions which 
they recommend, especially Thompson, as the incautious use of the drug 
is attended with great danger. Phosphorus has generally been adminis- 
tered either in pillular form, where it exists either diesolved in suet, 
wax, resin, bisulphide of carbon, or a menstruum similar to these, or as 
reduced phosphorus, or in the shape of phosphide of zinc ; or else in 
solution in alcohol, ether, or one of the vegetable or animal oils. 
According to Thompson, the solutions in the vegetable (almond and 
olive) oils should be strictly avoided, since annoying and serious results 
have occasionally followed their use in the hands of several observers, prob- 
ably because a portion of the phosphorus is converted (by the limited quan- 
tity of oxygen dissolved in the oil) into hypophosphorous acid, which 
is irritating to the stomach and very poisonous when absorbed. Theoret- 
ically this change would not take place if the oil had been superheated, 
1 Lancet of March 6, 1875. See also this journal for April 8, 1875. 
2 British Medical Journal, February 8, 1873. 
3 Free Phosphorus in Medicine, J. Ashburton Thompson, London, 1874. See also a re- 
view of the work in this journal for January 21, 1875. 
4 Practitioner for April, 1873, and January, 1875. Progress in Pathology of the Nervous System. 
7 
and the contained air driven off ; careful clinical experiments upon 
tin's point have, however, it is said, not yet been made. The author 
thinks it is the results of the use of this preparation that have served 
largely to give phosphorus its bad reputation among the profession. 
The pills containing phosphorus dissolved in bisulphide of carbon 
are also objectionable on account of the poisonous character of the men- 
struum, as well as because there is reason to think that the latter tends 
to counteract the effect of free phosphorus. The pills made with wax 
and resin are objectionable on theoretical grounds on account of their 
insolubility, but the latter, so far as they have been tried, have proved 
sufficiently efficacious. 
Pills of undissolved free phosphorus are dangerous unless special 
precautions be taken, in their manufacture, to subdivide the element 
thoroughly, and at the same time to prevent it from becoming coated, by 
oxidation, with the inert phosphoric acid, and this is not usually done. 
Even then each pill should be carefully protected, and given on a full 
stomach, in order that the oil in the food may help dissolve the drug, 
which otherwise is in danger either of being partially converted into 
hypophosphorous acid, or of remaining undissolved, to be absorbed sud- 
denly at some future time in accumulated amounts, when a quantity 
of oily food happens to come into contact with it. 
The pills made with suet are theoretically unobjectionable, but have 
not practically proved so good as some other preparations, of which the 
best are the solutions in cod-liver oil,1 alcohol,2 or ether, and the pills of 
phosphide of zinc. Of these the second can be made the most palatable, 
but the former is, on the whole, the best. Phosphide of zinc, in sugar- 
coated pills, is/a good preparation, especially for children, but as it 
decomposes only with the aid of a weak acid each dose should be fol- 
lowed by a draught of an acidulated tonic or of lemonade, lest the drug 
should accumulate in the intestine. 
A full dose of phosphorus for short periods is one twelfth of a grain 
of the solution in alcohol or*cod-liver oil every four hours, or one third 
of a grain of the phosphide of zinc every two hours ; but for prolonged 
use one fiftieth of a grain of the former is enough. There is no abso- 
lute reason to believe that the effects of the drug are cumulative, but 
under the slight uncertainty it is well to make a pause every two or three 
weeks. It is said that with these precautions phosphorus may be given 
with perfect safety, but in view of some of the cases of poisoning that 
are reported, and of the fact that our knowledge of its chemical and 
1 
Phosphorus 
gr. j. 
Cod-liver oil 
3iss. 
Oil of peppermint 
mj. 
2IV 
Tincture of phosphorus (a saturated solution in absolute alcohol dis- 
solved with heat and agitation) 3 
iij. TH X. 
Glycerine to 
3 iss. 
Spirits of peppermint 
m v. 8 
Progress in Pathology of the Nervous System. 
physiological relations is confessedly a little insecure, the physician conld 
hardly be too watchful while using it, especially since according to 
Thompson no antidote is known which will neutralize the effects of the 
drug after it has entered the circulation. " The slightest symptom of 
dyspepsia should lead to its instant intermission," and the patient should 
be examined for tenderness at the epigastrium or right hypochondrium, 
and for enlargement of the liver, as signs premonitory of danger. 
Monobromide of Camphor. - The use of this drug, warmly recom- 
mended by Bourneville 1 as a hypnotic and sedative, on the ground of 
physiological and therapeutic experiments, is not favored by Lawson,2 
who on fair trial found it less efficient than some other drugs of the 
■same kind, and difficult to take in efficient doses without causing 
gastric irritation. 
1 Practitioner, August, 1874. 2 Ibid., November, 1874; April, 1875.