characteristic, is the dorsal extension of the great toe which occurs in the club-foot, differing in this respect from the condition in ordinary tabes, where the toe is extended. Ataxia, the progressive course, the gait, the absence of remissions, slow speech, nystagmus, abolition of knee reflexes, scoliosis, and the peculiar deformity of the foot are the characteristic symptoms in diagnosis, together with certain negative symptoms,-the absence of lightning pains and anæsthesia, the normal reaction of the pupils, the integrity of vision, the absence of any genito-urinary trouble, and of syphilitic antecedents. Pathologically, Friedreich's ataxia is a combined sclerosis of the spinal cord, in which several systems of fibres have been affected from birth or during infancy. There is an arrest of development in the cord, and the fibres of these systems degenerate before attaining their full growth. Friedreich's ataxia is distinguished, pathologically, from tabes by the combined primary systemic sclerosis of the spinal cord, by the degeneration of the direct cerebellar and of the crossed pyramidal tracts, by the pronounced atrophy of the cells and the fine fibres of the columns of Clarke, whilst the marginal zone of Lissauer always remains intact. In tabes the peripheral nerves are often degenerated and the marginal zone is constantly degenerated. In the other combined scleroses we meet with the most varied lesions, whereas, in Friedreich's disease, the scat of the systemic localization is regular. Ladame considers the prognosis as regards life as not materially bad, but the affection is incurable. Careful prophylaxis Careful prophylaxis may do something to prevent the development of the disease. Electricity and suspension afford some relief.

61

Inglis reports a case of the disease in a boy of 6, and, from a review of the autopsies, considers that the disease affects tracts which degenerate upward, and are usually looked upon as centripetal and as conveying sensory impulses. He says that the symptoms of the disease demonstrate that these tracts do not convey sensory impulses, for sensation is not impaired, but that they are the main tracts for conveyance of co-ordinated motor impulses downward,—a theory which is strengthened by a study of the development of these tracts, for the posterior columns and the cerebellar tracts are complete before the pyramidal tracts are developed.

4

Nov. 24,90

Mendel enumerates the symptoms of the disease as ataxic motor disturbances of the hands and feet; ataxic disturbances of

speech; nystagmus; deformity of the feet, with the great toes permanently extended dorsally; failure of the knee-jerks; no disturbance of sensibility; no disturbance of the visceral reflexes.

Jan.14

Friedenreich 373 reports a case which seemed to him to have been congenital, but which grew rapidly worse after an acute disease. In this case there was atrophy of the optic nerves.

787

Oct.

Caisson Disease.-C. P. Knapp reviews our knowledge of the disease and reports 22 cases, giving rules for prevention, which are substantially those given some years ago by Smith, with whom he agrees in commending the use of ergot.

Jan.15

Landry's Paralysis.-Klebs reports a reports a case of Landry's paralysis in which the autopsy showed pericardial tuberculosis and widely distributed hyaline thrombi in the branches of the central artery of the spinal cord, which were most numerous in the lumbar region. As secondary phenomena there were found minute hæmorrhages and exudations, especially in the ganglion-cells, which the author considers as necessary results from the circulatory changes. The peripheral nerves were intact. The changes in the ganglion-cells he considers can be explained by the morbid process occurring in the central artery of the cord. The cause of the thrombosis is to be found, probably, in the action of some poison.

68 Nov.,"90

Kirilzew and Mamurowsky report a case with autopsy, in which there was a well-marked acute primary parenchymatous neuritis, affecting especially the nerves of the feet, legs, and forearms, and to a slight extent the roots of the cervical and lumbar enlargements of the spinal cord. The cord itself showed hyperæmia of the gray substance, cloudiness, and a slight atrophy of the anterior ganglion-cells and an accumulation of cortical cells in and about the central canal. They hold that in almost all cases Landry's paralysis is a variety of acute multiple neuritis.

May 30

Hun reports a case, with autopsy, which was practically negative. He found a slight cerebral and spinal meningitis, an infiltration of the walls of some of the veins of the spinal pia mater, and a degeneration or neuritis of some of the fibres of the anterior roots of the cauda equina, the central nervous system in every respect being normal. The symptoms in his case were a steadily progressive loss of power, beginning in the ankles and extending upward, finally involving the face and the muscles of

Peripheral

respiration. There were no sensory symptoms, nor any atrophy, or tremor, or muscular tenderness. The muscles responded normally to electricity. electricity. The reflexes were absent. Cultures were made from the various parts of the nervous system, but no bacteria were found. Brown reports a probable case which recovered. In last year's ANNUAL (vol. ii, C-28) the various theories as to

Jan.

FIG. 1.-SHOWING THE INFILTRATION AND THICKENING OF THE WALLS OF THE SPINAL VEIN. In the section A the walls have collapsed so that the lumen is artificially closed. The lumen is nearly normal.

(New York Medical Journal.)

brane of the eye or the nose has an

the nature of this affection were discussed. The further work of this year seems to indicate that there is an affection marked by a rapidly-ascending paralysis and by an absence of sensory symptoms and of muscular atrophy, in which there are no discoverable changes in the nervous system, which some cases of acute neuritis and of acute poliomyelitis may very closely resemble. This may account for the various views as to the pathology of the affection, and may, perhaps, explain the contradictory autopsies.

inhibitory effect upon spasm

of the glottis, and concludes that mechanical irritation of the fifth nerve may exert a reflex action upon the laryngeal nerve. He has employed this in the treatment of one or two cases of spasm of the glottis.

Abducens Nerve.-Dufour, has studied 3 cases of bilateral paralysis of the sixth nerve which were attended by some diplopia

Peripheral Nerves.

PERIPHERAL NERVOUS DISEASES.

C-5

and by a convergent strabismus. In these cases there was a probable chronic cerebro-spinal

disease,

such as tabes,

FIG. 2.-SECTIONS SHOWING THE NORMAL

showed that the pathologi- STRUCTURE AND THICKNESS OF THE ANTERIOR

cal change in the nucleus

of the sixth nerve gave rise

SPINAL VEIN.

to a paralysis of the corresponding external rectus, with a conjugate

FIG. 3.

A, thickened and infiltrated vein accompanying one of the anterior dorsal spinal nerve-roots; B, thickened

and infiltrated anterior spinal vein.

(New York Medical Journal.)

inaction of the opposite internal rectus. This paralysis was not

Peripheral

always absolute; it was present in distant but not in near vision. The presence of this symptom showed the disease to be central.

FIG. 4.-SHOWING THE AVERAGE NUMBER OF DEGENERATED FIBRES IN THE
ANTERIOR ROOTS OF THE CAUDA EQUINA.
(New York Medical Journal.)

In

In peripheral paralysis of the sixth nerve it was never seen. central paralysis of the sixth nerve the secondary deviation con

O

DEGENERATED FIBRES.

(New York Medical Journal.)

sisted of an external strabismus, in peripheral paralysis of an internal strabismus, and this combination was explained by a

FIG. 6.-SECTION SHOWING THE NUMBER AND DISTRIBUTION OF THE CELLS

IN THE CAUDA EQUINA.

(New York Medical Journal.)

fasciculus passing from the nucleus of the sixth nerve to the internal rectus of the opposite side,