diseases of the nervous system - forgotten books · m ethod of testing: (i) anosmia and (2)...

D i s e as e s o f th e N e rv ou s Sy s tem

DES IGNED AS A NOTE BOOK FORTHEUSEOF STUDENTS

H E N R Y H U N

Professor of D iseases of th e N ervous S ystem in th e Al bany Med i cal Col l eg e

I N T WO VO LUM E S

VO L . 1 1

DIS EAS ES OF T HE BRHIN

I L LU S T RA T E D

ALBAN Y . N . V.

T HE ARG US COM PAN Y

1902

TH I S SYLLABUS contains al l the didacti c lectu res on the di seases of the n ervous

sy stem del ivered in the Albany Medical Col l ege on Monday morn ings throughout

a col lege year . I n the appendix i s included several lectures on the examinat ion of

the b lood and excret ions , del ivered , or rather demonstrated , in the course on cl in i ca l

medicine on Wednesday morn ings , which lectures , with those pub l i shed.

in volume I ,

complete the physical examination of patients . I n the appendix is al so a syllabus o f

the essent ial s of insanity , which was prepared by Dr . Mosher,and i s based upon his

course of cl in i cal l ectures on insan ity . The sections on the examinat ion of the gastric

contents and of the faeces were revi sed by Dr . MacFarlane .

I t i s intended that the b lank spaces l eft in the book shal l be fi l led by the studen t

with notes taken at the lectures and in hi s s ubsequent reading .

I am indebted to Dr . George L . Street er for the i l lustrations in th i s book .

EXAMINATION OF PAT IENTSI n t ro du c t o ry

The method oi l eamiflg the hi story of a case and the phys ica l examinat ion necessary

to di scover di sturbances of motion , sen sat ion and reflex act ivity have been described in

volume I of th i s note - book

M e th o d o f te s t ing d i st u rb an ce s o f : ( I ) con sciousness ( coma , semi - coma , somnolence ) , ( 2 )intel l igence ( amentia , dement ia , hal lucination s , delus ions , del i rium ) , (3 ) feel ings ( sad ,

j oy ous , con fused , apathet ic ) , (4 ) memory ( amnesia )

M e th o d o f t e s t ing d i s t u rb an c e s of v i s i on : ( I ) b l indnes s , ( 2 ) field o f vis ion for white and

colors , ( 3 ) hemianops ia , (4 ) psychic b l indness

M e th od of t es t ing d is tu rb an c e s of s pe e ch ( 1 ) motor aphasia ( 2 ) sen sory aphas ia ,transcort ical aphasia

Me th o d of te s t ing : ( I ) agraphia and ( 2 ) alex ia

M e t h o d o f t e s t ing : ( I ) anosmia and ( 2 ) ag eus ia

O th e r t e s t s not g i v en in vo l um e on e

“

ab n orm a l i t i e s

(a) Developmenta l : ( I ) acrany , ( 2 ) anen cephal y , ( 3 ) hemicrany , (4 ) encephalocele , ( 5 )microcephaly , ( 6 ) brachy cephal y . ( 7 ) do l icocephaly

( b ) Acqu ired from Disease : ( 1 ) hydrocephalus ( general , anterior , posterior ) , ( 2 ) rickets ,2 ) asymetry

MENINGITIS

(a ) Pach ym en ingit i s

( b) Leptom en ingi t is

PACHYMENINGIT I S EXTERNA , S IMPLE AND PURULENT

I nt ro du c t ory

Et io l ogy : ( 1 ) age , ( 2 ) traumati sm , ( 3 ) exten s ion of inflammation ( caries , otit i s , erysipelas )

P ath o l og ica l an a tomy : ( I ) congest ion , ( 2 ) ab scess , ( 3 ) th icken ing w i th adhes ions

10

Sfymptom atology : ( I )_ ( 2 ) masked , ( 3 ) headache , (4 ) convuls ions , ( 5 ) del i rium , (6 )coma , ( 7 ) fever

D iagn os i s

P rogn o s i s

T re a tm en t

P a ch ym en ingi t i s In t e rn a P u ru l en t a

PACHYMENINGIT IS INTERNA HAEMORRHAGI CA

(Haematoma of Dura Mater . )I n t ro du c t ory

E t i o l ogy : ( 1 ) age , ( 2 ) sex , (3 ) in fection ( tubercu los i s syph i l i s 1m, puerperal sepsi s

(4 ) cerebral disease ( 5 ) cardiac disease 1875, (6 ) chron ic alcohol i sm 555, (7 ) b looddi seases

, (8 ) t raumati sm

12

P ath o l ogi c al an atom y

(a) Macroscopic : ( I ) appearance of membrane , ( 2 ) pos it ion , (3 ) haematoma

( b ) M icroscopic : ( 1 ) structure , ( 2 ) inflammatory or hemorrhagic origin

Sym ptom a to logy

(a) Previous to hemorrhage : ( I ) ( 2 ) masked , ( 3 ) un certain

At the t ime of and a fter hemorrhag e : ( I ) headache , vert igo and vomiting , ( 2 ) coma ,

3 ) hemiplegia ( complete or part ia l ) , (4 ) convuls ions and contractures , ( 5 ) reflexes

( pupi l , cutaneous and tendon ) , (6) mental symptoms , ( 7 ) relapses

P ath o l ogy : ( I ) origin , ( 2 ) symptoms caused by inflammation, ( 3 ) symptoms due to

orrhag e (4 ) tran s itory nature of symptoms

16

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Var i e t ie s ( I ) cerebro—spinal ( epidemic form ) , ( 2 ) tubercular, ( 3 ) purulent

CEREBRO SP INAL MEN INGITIS

I n t ro du ct ory

E t i o l ogy : ( I ) ( 2 ) sex , ( 3 ) epidemics , (4 ) season , ( 5 ) c l imate , (6 ) t raumati sm ( 7 )cold and dampness , (8) in fect ion (Wech selbaum

’

s diplococcus intracel lulari s men ingit idi s

and Fraenkel’s pneumococcus )

P ath o l ogi c a l an a tom y : An acute exudati ve inflammation of the pia mater of the b rain and

spinal cord and of the nerve sheaths : ( I ) hyperaemia , ( 2 ) hemorrhages, 3 ) exudation

( serum ,fibrin , pus ) , (4 ) dilated ventricles , ( 5 ) neurit i s

S ym pt om at o l ogy

(a) Incubat ion

( b ) Prodromal

20

( c ) Men ingea l i rri tat ion : ( I ) sensory , ( 2 ) motor , ( 3 ) psych ic

( d ) Paralyt ic symptoms : ( I ) sensory , ( 2 ) motor , (3 ) psych ic

( e ) Cutaneous les ions : ( 1 ) herpes , ( 2 ) petechiae , ( 3 ) taches cé ré brales , (4 ) corneal andcon j unct iva] inflammations

pupi l, ( 2 ) tendon , 3 ) cutaneous , (4 ) organ i c , 5 ) respiratory

, (6 )

( g ) Constitutional‘

symptoms ; ( I ) temperature , ( 2 ) pul se , ( 3 ) emaciation , (4 ) const ipat ion

5 ) album inur ia , (6) glycosuria

( h ) Lumbar puncture : ( I ) ten s ion of cerebro—spinal fluid , ( 2 ) character of flu id , (3 ) bacte

rial content

( z'

) Sequelae : ( I ) headache , ( 2 ) b l indness , ( 3 ) deafness , (4 ) aphasia , 5 ) paralys i s , (6)convulsion s , (7 ) menta l weakness

D i ff e r en t i a l d i agn o s i s

( 0 ) From typhoid

(Z") From tetanus

( c ) From uraemia and diabetes

( d ) From sinus thrombos is

( e ) From alcoholi c and other del i riums

( f ) From pachymen ingiti s

(g ) From cereb ral abscess

( h ) From septicaemia

P rogn o s i s and c o u r s e ( 1 ) great variat ions , ( 2 ) abort ive form , ( 3 ) fu lminat ing form,

(4 ) average mortal ity

T re atm en t : ( 1 ) prophylact ic , ( 2 ) rest in dark , ( 3 ) cold to head and warmth to extremit i es,

(3) b l i sters , drugs (morphine , mercury , ( 5) l umbar puncture 7

LECTURE IV .

D i s e as e s o f th e Bra in

D I SEASES OF THE MEMBRANES ( Cont inued )

TUBERCULAR MENINGITISIn t ro du c t o ry

Et i o l ogy : ( 1 ) age , ( 2 ) traumatism , ( 3 ) baci ll us tubercu los i s

P a th o l ogi c a l an a t omy : ( I ) exudat ion , ( 2 ) th icken ing of pia mater , ( 3 ) milia ry tub ercles ,

(4 ) di lated vent ri cles , 5 ) hydrocephalu s é

S ymptom ato l og y : ( I ) absent , ( 2 ) masked

(a ) Those of original disease

( b ) Prodomata : ( I ) peevishness , ( 2 ) anorexia , ( 3 ) emaciatio-n, (4 ) mental dulness

( c ) Men ingeal i rritat ion : ( I ) sensory , motor, ( 3 ) psychic , (4 ) hydrocephal ic cry

30

d ) Hydrocephalus

( e ) Ophtalmoscop ic changes : ( I ) choked tubercles in choroid

( f ) Lumbar puncture

g ) O ther symptoms are in the main quite s imi lar to those of epidemic cerebro - spinal men in

git i s,but are usual ly less intense

3 ]

P rogn os is an cours e

Tre atm en t

P a th o l ogi c a l an a t om y : ( I ) congest ion , ( 2 ) exudation ( pus ) , ( 3 ) ab scess exten t , ( 5 )bacteri a

Sym ptom a to l ogy : ( I ) absent , ( 2 ) masked

(a) Those of original disease

(b ) Prodromal

( 6 ) Same as in epidemic form with minor exceptions

34

Differen t i a l d i agn o s i s

Cerebro - spinal men ingi t i s : ( I ) epidemic , ( 2 ) primary disease , 3 ) l umbar puncture

( b ) Tubercular men ingit i s : ( 1 ) primary disease , ( 2 ) lumbar puncture

Puru lent meningit i s : ( 1 ) primary di sease , ( 2 ) lumbar punctu re

P rogn o s i s an d cou rs e

Tre atm en t

SEROUS D OTHER FORMS OF ACUTE MEN INGIT I S

36

LECTURE V .

D i s e a s e s o f t h e B ra in

D I SEASES OF THE MEMBRANES (Concluded )

CHRON IC LEPTOMENINGIT I SInt rodu c t ory

Et i o l ogy : (Excluding syphi l i s and tuberculosi s ) : ( 1 ) alcohol , ( 2 ) in san i ty , ( 3 )

Path OI Og i cali

anatom y ; ( I ) COIOY , ( 2 ) th icken ing, (3 ) structure , (4 ) vascular occlus ion ,

5 ) hydrocephalus

S ym ptom at o l ogy ( I ) absent , ( 2 ) headache , vert igo , vomit ing, ( 3 ) tenderness , (4) del i ri umand mental du lness , 5 ) insan i ty , (6) local ized spasms , (7 ) local ized paralyses , (8 ) rigidity

of. extremit ies, (9 ) strab i smus , nystagmus and Optic neurit i s

38

D i agn o s i s : ( 1 ) difficu lt and uncertain , ( 2 ) primary disease or in j ury

P rogn o s i s and cou r s e

Tre atm en t : ( 1 ) b l i sters , ( 2 ) drugs (mercury , iodides ) (3

CHRONIC INTERNAL HYDROCEPHALUS

I n t ro du c t ory

Et i o l ogy

(a ) Congen ital : ( I ) heredity , ( 2 ) syph i l i s in parent s , alcoholi sm in parents

(b ) Acquired : ( I ) rarer than congen i tal , 2 ) men ing itisB)

‘42

Path ol ogica l an at om y

(a ) Congen ital : ( I ) bones and sutures , ( 2 ) membranes of b rain and choroid plexuses, ( 3 )

ventricles , (4) b rain t i s sue, 5 ) miscrosc0p ic appearance , (6 ) character of effusion

( b ) Acqui red

43

S ym ptom at o l ogy : ( I ) en largement of head , ( 2 ) sutures and fontanel les , ( 3 ) smal l face

idiocy,imbeci l ity or feeb le - minded , 5 ) headache and vomit ing

, (6) convulsions , (7 ) par

alyses, ( 8 ) rigidity , (9 ) reflexes , ( I o) opti c neurit i s , ( I I ) lumbar puncture

44

Di agn os is : ( I ) en l arged head , ( 2 ) de fect ive inte l l igence

D i ffe ren t i a l d i agnos i s

ri ckets

( b ) From cereb ra l tumor

P rognos is and c ou rs e

Treatm en t

CONC‘

USSION OF THE BRAIN

E t iol ogy : ( I ) b low over large area’

of sku l l , ( 2 ) individual ity , 3 ) drunkard

P ath o l ogi c a l an a t om y

(0 ) Many sources of error

( b ) I n mild cases

( 6 ) I n fatal cases : ( I ) microscopic changes in nerve element s, ( 2 ) vascular changes , (3 )

contus ions , (4 ) hemorrhag es

( d ) Secondary or remote changes : ( I ) men ingit i s , ( 2 ) tumor , ( 3 ) sclerosi s

48

Remote symptoms of : ( I ) men ingit i s , ( 2 ) insan i ty , (3 ) tumor , (4 )

Patho l ogy : ( I ) shak ing of brain , ( 2 ) shock , ( 3 ) inh ib it ion , (4 ) movement o f cereb ro - spina l

fluid , ( 5 ) pressure 7

5 ]

D i agn os i s

P rogn os i s and cou r s e ( I ) guarded , ( 2 ) depends on severity and duration of symptoms

T re atm en t ( 1 ) cold to head , ( 2 ) warmth to extremiti es , ( 3 ) purgat ives , (4 ) st imulants

52

( 1 ) inj ury , ( 2 ) bone , ( 3 ) hemorrhage H "U

P a th o l ogi c a l an a tom y : ( I ) that of primary disease , ( 2 ) compress ion of brain , ( 3 ) cerebra l

vein s empty,arteri es congested

S ympt om a to l ogy

(a) May not occu r immediately

( b ) Those of concuss ion may precede and accompany those of compress ion

( c ) General not local

(d ) Symptoms of i rritat ion : ( I ) congested face , ( 2 ) contracted pupi l , ( 3 ) headache , (4 )vomit ing

, 5 ) s low pulse

( 6 ) Symptom s of depress ion : ( I ) coma , ( 2 ) pupi l s di lated , ( 3 ) pul se and respi rat ion , (4 )paralyses

54

D iagn os is : ( 1 ) natu re o f in j u ry , ( 2 ) escape of bl ood or fluid from ears, ( 3 ) delayed symp

toms , (4 ) severity and durat ion of symptoms

P rogn os i s and c ou r s e ( I ) intens ity and prog ress ive nature of symptoms , ( 2 ) possib i l i ty

of Operat ion

T re a tm en t ( I ) remove cause by t reph in ing , ( 2 ) pu rgation

LECTURE VI I .

INJURY (Concluded )

CONTUSION OF THE BRA IN

I n t ro du cto ry

Et i ol ogy

P a th o l ogi c a l an at om y

(a) Hemorrhage and lacerat ion of cerebra l cortex at point of in j ury or at point of b rain

direct ly Oppos ite ( con t re coup ) , or at both

( b ) C lustered o'

r widely disseminated minute extravasat ions of b lood

56

b ) Local symptoms depend on cortical centers in j ured

D iagn o s is

P rogn o s is and cou rs e

Tre a tm en t

Pa th ol ogi c a l an a t om y : ( I ) divi s ion of t issue , ( 2 ) hemorrhage , ( 3 ) laceration and in fect ion,

(4 ) sloughing , ( 5 ) suppurat ion

S ym pt om at o l ogy

(a ) General : ( I ) shock or coma

( b ) Loca l : ( 1 ) i rritat i ve , ( 2 ) dest ructive

( d ) Foreign bodies remain ing in brain often after years lead to suppurat ion

Path ol ogy

D iagnos i s

Progn os is and cou rs e

T re a tm en t : ( 1 ) treph ine , ( 2 ) dis in fect , (3 ) close wound , (4 ) remove foreign

s ib le , ( 5 ) danger o f prob ing

MEN INGEAL HEMORRHAGE

I n t ro du c t o ry

E t i o l ogy : ( I ) in j u ry , ( 2 ) aneurism , ( 3 ) pacchymening itis

P a th o l ogi c a l an a t om y : ( 1 ) pos it ion , ( 2 ) extent , ( 3 ) appearance , (4 ) changes , ( 5 ) cyst ,

(6 ) b rain compress ion and anaemia

61

S ym ptom ato l ogy

(a) Absent or latent

( b ) General : ( I ) coma , ( 2 ) pul se and respirat ion , ( 3 ) pupi l s , (4 ) remi ss ion

( 6 ) Local : ( 1 ) vary ing with seat of les ion , ( 2 ) i rr itat ion , ( 3 ) paralyti c , (4 ) temporary

P a th ol ogy

D i agn os i s

P rogn os i s an d c ou rs e

T re atm en t

62

LECTURE VI I I .

D i s e as e s o f t h e B ra in

CIRCULATORY D I SEASES OF THE BRAIN

In t ro du c t o ry

CEREBRAL ANAEMIA

E t i o l ogy : ( 1 ) general anaemia , ( 2 ) cardiac inadequacy , ( 3 ) emotions and vaso - motor spasm ,

(4 ) atheromatous arteri es

63

P a th ol ogi c a l an at om y

(a ) Condit ions after death may differ from those during l i fe and may vary with the manner

of making the autopsy

(b ) M i croscopic changes : ( 1 ) color , (2 ) punctae’vasculosaefi ( 3 ) atheromatous arteries

,

(4 ) soften ing

( c ) M i croscopic changes

Symp t omat o l ogy

(a) Funct ional anaemias : ( I ) fainting, ( 2 ) vert igo , t inn itus aurium , (4 ) dimness of

vis ion , 5 ) nausea , (6 ) feeb leness , (7 ) convul s ion s a

64

P ath o l ogy

D i agno s i s

( a ) Al l other condit ions must be excluded

( b'

) General anaemia , cardiac inadequacy , atheromatous arteries or emot ional d isturbances

must be present

P rognos i s an d c ou rs e

T re a tm en t : ( 1 ) remove the cause , ( 2 ) posture , ( 3 ) b lood ton i cs , (4 ) cardiac ton ics , ( 5 )cu lar di lators , (6 ) n ervines

66

CEREBRAL H

( a ) Act ive : ( I ) worry and emotion s, ( 2 ) vaso—motor paraly si s , ( 3 ) excessive cardiac action

Passive : ( I ) venous obst ruct ion

Pat h o l ogi c a l an a t om y

( 0 ) Condit i on of b l ood vesse l s may change a fter death and depend on manner o f making

autopsy

( b ) Macroscopic appearances : ( 1 ) color , ( 2 ) engorged vessel s , ( 3 ) punctae vasculosae ,

(4 ) oedema

67

S ymptom at o l ogy (fanci ful ) : ( I ) headache , fu lness , ( 3 ) man ia and del i rium , (4 ) apo

p lecti form attacks

P a th o l ogy ( 1 ) pressure , 2 ) hyperact ivity from excessive b l ood supply

D i agn os is

(a) Al l other condit ions must be excluded

( b ) Poss ib le etiological factors must be present

P rogn os is and cou rs e

T re a tm en t : ( 1 ) remove the cause , ( 2 ) posture , ( 3 ) purgatives , (4 ) diuret ics , 5 ) d iaphoreti cs

,drugs ( ergot , bel ladonna , b romide , morphin e )

CEREBRAL OEDEMA

Et iolOgy : ( always a secondary disease )

(a) General : ( I ) nephrit i s , ( 2 ) general venous ob st ruct ion

( b ) Local ( 1 ) local venous obstruct ion , ( 2 ) inflammat ion , 3 ) tumors

P a th o l ogi c a l an a t om y ( 1 ) color , ( 2 ) moistu re , ( 3 ) punctae vascu losae

S ym ptom at o l ogy : ( I ) coma , ( 2 ) convuls ions ( loca l or general ) , (3 ) paralyses ( local orgeneral )

69

Path o l ogy : ( 1 ) pressure , ( 2 ) loss of funct ion from interference with b lood supply

D i agn os is

P rogno s i s an d c ou rs e

Tre atm en t : ( I ) posture , ( 2 ) purgatives , ( 3 ) diureti cs (4 ) diaphoret ics , ( 5 ) drugs (g lonom,

digital i s )

D i s e a s e s o f th e Bra in

CIRCULATORY CEREBRAL D I SEASES ( Cont inued )

APOPLEXY

CEREBRAL HEMORRHAGE

Predi sposit ion : ( I ) heredity , ( 2 ) age , ( 3 ) sex

(b ) Traumati sm : ( I ) b lows , ( 2 ) b i rth

( 0 ) Haemic diseases : ( 1 ) scurvy , ( 2 ) purpura , 3 ) pern i cious anaemia , (4 ) leucocythaemia

(d ) Arterial degenerat i on : ( I ) mi l iary aneuri sm , ( 2 ) pecu l iar to brain , (3 ) pecu l iar

character of cerebral arterioles , (4 ) re lat ion ship to atheroma , 5 ) di ssecting aneuri sms

72

(t) I ncreas ed b l ood tens ion : ( I ) doubt fu l cause , ( 2 ) posture

P a th o l og ic a l an a t om y

(a) Locat ion in the order of re lat ive frequency : ( 1 ) corpus striatum , Optic thalamus and

internal capsule , ( 2 ) centrum ovale , 3 ) cortex , (4 ) peduncle , ( 5 ) pons , (6 ) cerebel lum

(b ) Arteries aff ected : ( 1 ) l ent icu lo- st riate , ( 2 ) lent i cu l o- Op t ic , (3 ) anter ior corpus st ri ate ,

(4 ) choroid

(c ) Appearance : ( 1 ) s iz e and shape , ( 2 ) coagu lum , ( 3 ) red so ft en ing , (4 ) compress ion of

ne rve t i ssue , ( 5 ) des t ruct ion o f nerve t i ssue , (6 ) effusion into vent ricles

( d ) Al te rat ion in appearance w ith t ime : ( 1 ) color , ( 2 ) degen eration , (3 ) l iquefact ion , (4 )absorpt ion , 5 ) cyst , (6) scar , (7 ) secondary degenerat ion

76

S ymptom at o l ogy

(a ) Prodromal : ( I ) uncertain an d uncommon , ( 2 ) headache , (3 ) vertigo , (4 ) t inn itusaurium , 5 ) i rritabi l ity , (6 ) disordered mental act ion , (7 ) drows iness , (8 ) l ocal

alyses , (9 ) paraesthesiae, ( I o ) epi stax i s

(b ) Cardinal symptoms : ( I ) sudden onset , ( 2 ) general shock , (3 ) l ocal paralys i s

78

( c ) Onset : ( I ) from one s econd to 24 hou rs , ( 2 ) death , ( 3 ) coma , (4 ) headache ,con fusion and vomit ing , 5 ) paralysi s , (6 ) convuls ions

( 03) G eneral sh ock or acute stage : ( I ) coma or semi—coma , ( 2 ) t emperature , 3 ) pulse , (4 )respi rat ion

, 5 ) pupi ls , (6) eye- ball s (8 ) sensation , (9 )

80

( e ) Local paralys i s or chron i c stage : ( I ) abs ent , (2 ) distribution ( hemiplegia , hem ianops ia ,aphas ia , ( 3 ) temporary and permanent , (4 ) order of recovery ( face , l eg , arm ) ,

5 ) reflexes , (6) automatic movements , (7 ) menta l weakness , (8 ) res idual motor

turbances ( contractures , t remor , cho-rea , athetos is , spasms , atrophy ) , (9) bed sores

82

( b ) Coma due to the hemorrhage : ( I ) sudden ly increased pressure , ( 2 ) local and genera l

anaemia, ( 3 ) oedema of brain , (4 ) tearing of nerve t i ssue

( 6 ) Temperatu re , pulse and resp irat ion disturbed by i rritat ion or paralys i s o f correspond

ing centers in brain

( d ) Reflexes abol i shed on account of i rritat ion of descending tracts

( e ) Local paralys is varies w i th locat ion of hemorrhage and i s temporary (pressure ) or per

manent ( dest ruct ive )

( f ) Order of recovery

(g ) Contractu re and other motor di sturbances

86

Di fferen t i a l d i agn o s i s o f c om a

Faint ing

Uraemia

( c ) Diabetes

( f ) I l luminat ing and coal gas poi son ing

( g ) Internal hemorrhage

h A o lecti form attacks in b ra in disease a resis , tumor , cereb ral alsP P P P Y

(a) Prophylax i s : ( I ) exces ses ( alcohol and venery ) , ( 2 ) worry , 3 ) rheumatism and syph

i l i s, (4 ) ( iodides and glonoin )

( b ) The attack : ( I ) rest and posture , ( 2 ) cold to head , warmth to extremit ies , ( 3 ) b leed ing,

(4 ) purgation, ( 5 ) drugs (glonoin ,ergot , morph in e , bromides )

91

( c ) The paralysi s : ( I ) exerci se , ( 2 ) electri c ity , ( 3 ) massage , (4 ) Sweed ish movements ,

5 ) strychn ine , (6 ) hydrotherapeutics

92

LECTURE XI .

D i s e a s e s of th e B ra in

CIRCULATORY CEREBRAL D I SEASES ( Conc luded )

ACUTE SOFTEN ING

CEREBRAL EMBOLISM AND THROMBOS IS

E t i o l ogy

(a ) Embol i sm : ( 1 ) age , ( 2 ) s ex , ( 3 ) origin of embolus ( endocardit i s , endarterit i s , aneur

i sm,th romb i in heart or lungs )

93

( b ) Thrombos is : ( 1 ) age , ( 2 ) sex , (3 ) arterial degenerat ion , (4) haemic changes, 5 )

cardiac weakness

94

( I ) s imi lari ty o f les ion s in embol i sm and thrombosi s, ( 2 ) occluded

vessel , 3 ) red , yel low and 5 ) cyst formation , (6)

95

D iffe ren t i a l i agnos i s

(a ) embol ism

(b ) thrombosi s

( c ) hemorrhage

( b ) O f the attack and paralysi s

S INUS THROMBOSIS

In t rodu c to ry

E t i o l ogy : ( 1 ) in fect ion ( caries and ot it i s ) , ( 2 ) in fect ious diseases ( especia lly of head and

n eck ) , ( 3 ) terminal in fect ion (marant i c ) , (4 ) s luggish ci rculat ion , ( 5 ) chloros i s , (6 ) age

100

(b ) Special : ( 1 ) Super i or longitudinal s inus ( epi staxis , oedema of forehead ) , ( 2 ) tran s

verse s inus ( oedema behind ear , j ugular veins ) , (3 ) cavernous sinus ( oedema

junctiva,prominen ce of eyebal l , oedema of temple )

102

P a th o l ogy : ( 1 ) local oedema , ( 2 ) ab scess

D i agn o s i s : ( 1 ) cause for thrombos i s , ( 2 ) symptoms of men ing it i s of mild intens ity and w ithout

retract ion of head , 3 ) external oedema , (4 ) tendern ess over j ugu lar

P rogn o s i s and c ou rs e

T re a tm en t

103

LECTURE XI I .

D i s e a s e s of th e B ra in

CEREBRAL PALSY OF CH ILDHOOD ( PORENCEPHALY )I n t ro du c t o ry

E t i o l ogy ( 1 ) age , ( 2 ) sex, ( 3 ) heredity , prenatal influences and inj ury at b i rth , (4 ) in jury

in infancy, ( 5 ) in fect ion , (6 ) syphi l i s

104

Sympt om at o l ogy

(a) Hemiplegia : ( I ) paralys is , ( 2 ) convul s ions , ( 3 ) coma , (4 ) fever , etc ., 5 ) contracture ,

rigidity and increased reflexes , (6 ) atrophy , arrest of development and deformit i es , (7 )posthemiplegic motor di sorders , (8 ) epi lepsy , (9 ) psych ic

106

( b ) Diplegia : ( I ) doub le hemiplegia , complete or part ial , ( 2 ) same as in hemiplegic form

but b i lateral

P a th o l ogy“

: ( I ) in genera l s imi lar to that of men ingea l hemorrhage , ( 2 ) paralyt ic symptoms ,

( 3 ) i rritat ive symptoms , (4 ) psychic symptoms , 5 ) atrophy and de formit ies

108

( c ) From Friedrich’s Ataxia : ( I ) tendon reflexes , ( 2 ) spast ic symptoms , ( 3 ) ataxia")

P rognos is and c ou r s e

Tre atm en t : ( 1 ) electri city , ( 2 ) massage , (3 ) tenotomy, (4 ) orthopaedi c apparatus , ( 5 )

drugs

1 10

LECTURE X I I I .


INFLAMMATION

ENCEPHALITIS


Var i e t i e s : ( I ) pol ioencephal it i s acuta hemorrhagica superior (Wern i cke ) , ( 2 ) acute encepha

l i t i s o f ch i ldren and adults ( Struempel l ) , ( 3 ) men ingo - encephal it i s, (4 ) react ive inflam

mations, 5 ) abscess

l l l

CEREBRAL ABSCESS

I n t ro du ct ory

E t i o l ogy : ( 1 ) age , ( 2 ) sex , ( 3 ) in fect ion ( in j u ry 2 0 - 2474, caries 5075, in fected thrombos is ) ,

(4 ) in fectious di seases (men ingit i s , typhoid , scarletina,influenza

,erys ipelas

,pyaemia ,

tuberculosi s , actinomycosis) )h

1 12

Symptom at o l ogy

(a) O f primary disease

( b ) General : ( I ) fever , ( 2 ) headache , vertigo and vomit ing, (3 ) convu ls ions , (4) psych ic ,

5 ) optic neuri t is , (6 ) pulse and resp iration , (7 ) latent stage

114

(d ) Compl icat ions : ( I ) ruptu re , ( 2 ) men ing i t i s

Pat h o l ogy : ( 1 ) increased pressure , ( 2 ) i rritat ion , ( 3 ) inhib it ion , (4 ) destruction

D i agn o s i s : ( 1 ) et iology , ( 2 ) l atent stage

116

Progn os is and c ou rs e

T reatm en t : ( I ) prophylacti c , (2 ) evacuat ion and drainage , 3 ) same as men ingit i s

1 18

LECTURE XIV.

D is e a s e s of th e Bra in

INTRACRAN IAL TUMOR .

I n t ro du c to ry

E t i o l ogy : ( I ) age , ( 2 ) sex , ( 3 ) heredity , (4 ) congen i tal defect , 5 ) in fect ion and paras ites

( syph il i s , tubercle , (6 ) metastat i c , ( 7 ) in j u ry

119

P ath o l ogi c a l an at om y : ( 1 ) location , ( 2 ) variet ies (gl ioma , psamoma,sarcoma

,carcinoma

,

tubercles , gumma , l ipoma , myxoma , ch loesteatoma,aneur i sm

,cyst ) , ( 3 ) relat ive frequency ,

excluding gummata,which are most frequent

, ( tubercl e gl ioma 1 5y2, sarcoma 1 575 , others

(4 ) different iat ion from b ra in t issue , ( 5 ) changes in b rain

120

S ym ptom ato l ogy

(a ) Absent

( b ) General : ( 1 ) headache , ( 2 ) vertigo and vomit ing , 3 ) choked di sc and opt ic neurit i s ,

(4 ) psych ic symptoms , 5 ) convuls ions , (6 ) pulse and respirat ion

P ath o l ogy : ( 1 ) increased pressure , ( 2 ) i rritat ion , ( 3 ) inh ib it ion , (4 ) dest ruct ion

D i agn o s i s ( I ) steady increase of severe psych ic , motor and sensory symptoms , ( 2 ) headache ,

3 ) choked disc , (4 ) local symptoms

( c ) From general paresi s : ( 1 ) speech and tremor , ( 2 ) exaltation , ( 3 ) choked di sc

( d ) From epi lepsy : ( 1 ) convul s ion on ly symptom , ( 2 ) no choked disc

( 6 ) From hysteria : ( I ) hysterica l st igmata

( f ) Atheromatous arteri es wi th local soften ings : ( I ) mult ip l i city of symptoms , ( 2 ) no

choked disc

(g ) From internal hydrocephalus : ( 1 ) s low course, ( 2 ) multipl icity of symptoms , ( 3 )

deformity of skul l

126

Tre atm en t ( 1 ) pal l iat ive , ( 2 ) medicinal , (3 ) surgica l

LECTURE XV .


SYPH ILIS OF THE NERVOUS SYSTEM

In t ro du c to ry : ( 1 ) in general , ( 2 ) post syphi l it ic n ervous di seases, (3 ) tertiary nervous syph

i l i s, (4 ) secondary nervous syphi l i s

128

P a th o l ogi c a l an a tom y

(a ) O f gumma : ( 1 ) appearance , ( 2 ) structure

( b ) O f men ingit i s gummosa

( 6 ) O f art erit i s syph il it i ca : ( 1 ) periarteriti s ( 2 ) endarteri t i s syphi l it ica ,softening

( d ) O f perineurit i s syphi l i t i ca

( e ) A comb inat ion of the above described les ions

( f ) Syphi l it i c inflammations are rare and un sc rtain

13 1

S ymptom at o l ogy

( a ) I n general : ( 1 ) multiple , mult i form and variab le , ( 2 ) pareti c rather than paralyt ic ,

( 3 ) nocturnal headache

( b ) O f men ingit i s gummosa cereb ra l i s : ( 1 ) headache (nocturnal ) , ( 2 ) vertigo and vomit

ing ( 3 ) insomn ia , (4 ) psych ic , ( 5 ) convuls ion s , (6 ) polyuria , ( 7 ) impl i cat ion of cra

n ial nerves (men ingit i s basi lari s ) , (8 ) cort ica l symptoms (men ingit i s cort ical i s )

LECTURE XVI .

D i s e a s e s Of t h e B ra in

SYPH ILI S OF THE NERVOUS SYSTEM (Concluded )

S ymptom at o l ogy ( concl uded )( 6 ) O f cerebro - spinal syphi l i s ( cerebro- spinal syph il it i c men ingit i s ) : ( 1 ) same symptoms

as described under b,

"but l ess intense , 2 ) sensory spinal symptoms , 3 ) motor spina l

symptoms

134

( d ) Of arterit i s syph i l iti ca : ( 1 ) cereb ral or spinal anaemia , general or loca l , ( 2 ) cereb ral

thrombos i s , bulbar symptoms

( e ) O f perineurit i s syph i li t ica : ( 1 ) usually associated w ith men ingiti s , ( 2 ) opt ic nerve,

3 ) oculo—motor nerve,

other crani al ne rves , ( 5 ) spinal nerves , (6 ) mult ipl e neur itis

136

D i agn o s i s : ( 1 ) history of infection‘

or previous syphi l it ic symptoms, ( 2 ) nocturnal headache,

3 ) Optic neurit i s , ptos is , Argyl le - Robe rtson pupi l , (4 ) multipl icity , variab i l ity , incomplete

ness and trans itory nature of symptoms

138

D i fferent i a l d i agn o s is o f t h e d i ffe ren t form s

P rogn os i s an d c ou r s e : ( 1 ) bad un less treated , ( 2 ) curab i l ity , ( 3 ) hereditary form , (4)arterit i s

, ( 5 ) men ingi t i s , (6 ) neuri t i s, ( 7 ) effect of tuberculos i s and alcohol i sm

, (8 ) course

139

Tre atm en t ( 1 ) prophylact ic , ( 2 ) drugs , 3 ) durat ion o f t reatment

(a ) Locali sat ion with in the motor area : ( 1 ) extent of motor area , ( 2 ) arm, (4 )

face, 5 ) minute representat ion , (6) multiple representat ion , (7 ) centers of innervat ion

feel ings, (8 ) sensory di sturbances , (9) involvment by l es ion of proj ect ion and associa

t ionfib res , ( I O) i rritat ive symptoms , ( 1 1 ) inhib itory symptoms , ( 1 2 ) paralyt ic symp

toms, ( 1 3 ) diagn osti c points , ( 14 ) rest itution

142

( b ) Local igation w ith in Elie pari etal lObe 5\ ( 1 ) no local symptoms , ( 2 ) mayi

involve motor

centers, (3 ) muscle sense , (4 ) conj ugate deviat ion of eyebal ls, 5 ) hemianops ia , (6 )alex i a

146

( c ) Local isat ion within the occipital lobe : ( 1 ) no local symptoms, ( 2 hemianopsia

,

hemiamb lyopia and hemichromatops ia . (4 ) psych ic b l indness , ( 5) optic aphas ia , (6 )alexia

, ( 7 ) visual hal lucination s

148

1 ion w i th in the tw poral l obe : ( 1 ) ‘

no local symptoms , ( 2 ) sensory aphas ia , 3 )anos a , (4 ) auditory and odori ferous hal luc inat ions

153

( 71 ) Local on with in the nucleus caudatus and nucleus l en t icu lari s : ( 1 ) no local sympindi rect hemiplegi a , 3 ) elevat ion of temperature , (4 ) motor disturbances

( i ) Loca l i t ion with in the opt ic tha lamus : ( 1 ) no loca l symptoms , ( 2 ) indi rect hemiplegi a

or h sthes ia, ( 3 ) hemianops ia , (4 ) motor di sturbances , ( 5 ) mimic di sturbances ,

(6 ) vaso - motor d isturbances

15 7

the cerebe l lum and it s p eduneles : ( I ) no local symptoms, ( 2 )cere ataxia , 3 ) vert igo , (4 ) vomit ing , tremor d nystagmus

,indirect

hemiplegia , ( 7 ) retraction of neck

160

( l ) Local isat ion with in the bra in stem cons ide red in volume one

(m ) Local i ion at the base of the brain ( tumors )

(a ) of the pitu i tary body : ( 1 ) aerom y, ( 2 ) amb lyopia , ( 3 ) b itemporal

hemianops ia, (4 ) o almOp leg ia and exo almos

, ( 5 ) diabetes ins ipidus and

mel l itus

161

( b ) Tumors of the sel la turcica : ( 1 ) same as in a,

" except no acromegaly

( c ) Tumors in anterior fossa of the sku l l : ( 1 ) anosmia , ( 2 ) amb lyopia , (3 ) oph

thalmop leg ia (4 ) sensory disturbances in forehead , 5 ) motor aphas ia

162

LECTURE XIX .


FUNCT IONAL D I SEASES

NEURASTHENIA

In t ro du c t ory

E t i o l ogy ( 1 ) race ( Semet ic ) , ( 2 ) sex , ( 3 ) age , (4 ) heredity , ( 5 ) occupation , (6 ) excesses

( alcohol ic , narcot ics,venery

,overwork ) , ( 7 ) emot ion s ( fright , j ealousy , mis fortune ) , (8 )

mental stra in (worry ) , (9 ) toxines , ( I O) chron i c local di sease ( ocu lar , nasal , pelvic ) , ( 1 1 )anaemia

164

P ath o logi c a l an at om y ( 1 ) negat ive

( 6 ) Sexual : ( 1 ) mastu rbat ion , ( 2 ) em i ss ion s , ( 3 ) ob scene thoughts , (4 ) fear of impotency

f ) Comb ined forms

( 2 of 3 weakn es s,

i rritab i l i ty

Progn o s i s and c o u r s e

173

Tre atmen t : ( I ) rest , ( 2 ) food , (3 ) cond it ioi’fs , massage an el ectric ity ,systemati c exercise

, (6 ) ton ics

174

D i s e a s e s Of th e B ra in

FUNCT IONAL D I SEASES (Cont inued )

HYSTERIA


E t i o l ogy : ( 1 ) race ( Semetic and Latin ) , ( 2 ) cl imate , ( 3 ) civi l izat ion and cult ivat ion, (4 )

age , 5 ) sex , (6 ) heredity , (7 ) education , ( 8 ) example , psychic traumata,acute ( emo

t ions ) or chron i c (worry ) , or sexual ( rape , j ea lousy , masturbat ion , ( 1 0 ) exhaust ion

and anaemia , ( 1 1 ) local disease , ( 1 2 ) men struation , ( 1 3 ) excesses ( alcoholi c , narcot ic,

venery )

1 78

P a th o l ogi c a l an at om y ( 1 ) negative

on of other“

diseases , (3 ) fraud and

Or chroni c local or

18 1

( b ) Psych ic : ( 1 ) normal , ( 2 ) energet ic and capab le , ( 3 ) bright and attractive , (4 ) rii'

e-ur

"

=

asthen ic , ( 5 ) sel f - centered , (6 ) emot ional , theatrica l and des irous of admirat ion, (7 )

ch i ldi sh l iars, (8 ) suggest ib l e , (9 ) i rr itab le and lacking in sel f - control

, but obst inate ,

( 1 0 ) insan ity , ( 1 1 ) doub le consciousness

1 82

ercep

phob ia ( 5 )neuralgia ( clavus , (6 ) anaesthesia (n l imited to d istribution o f any nerve , hemi

anaesthesia ) , ( 7 ) tran s ference , ( 8 ) concen tri c l imitat ion of field of vi s ion, (9 ) b l indn ess ,

( I O) deafness , ( 1 1 ) anosmia and ageus ia

185

( d ) Motor d isturbances in hysteria : ( 1 ) tremor, ( 2 ) l ively reflexes

, ( 3 ) paralysi s ,astas ia and abas ia

, ( 5 ) contracture , (6 ) convuls ion

188

V y 0 VasO—motOr and secretor d i sturbance S . Pi l l 8 1n'

i nLb " ( 9 Sweat ing er tl1 ema

1mi

(g ) Greater or general hysteri ca l attacks : ( 1 ) convul s ion , ( 2 ) catalepsy , ( 3 ) tran ce (buriala l ive ) , (4 ) ecstasy , ( 5 ) somnambul i sm

, (6 ) coma (narco - lethargy ) , ( 7 ) insanity“

107

HYSTERIA (Cont inued )

(h ) Hypnot ism and suggest ion : ( 1 ) method of product ion ( fascination and suggestion ) ,

( 2 ) result obtained (pervers ion of con sciousness,

abe-yance of vol it ion , imperat ive

obedience,analges ia

, ( 3 ) cataleptic state ( eyes open ,emot ion s excited by gesture ) ,

(4 ) l ethargi c state ( eyes closed , neuro—myotat ic i rri tab i l ity ) , 5 ) somnambul i st i c state

( execut ion of commands ) , (6 ) tel epathy , ( 7 ) suggest ion therapeutics

C li n i ca l subdivi s ion of hy steri a

( 1 ) Convul s ive t ic and loca l spasm

( 2 ) Paramyoclonus multiplex

3 ) Hab it chorea

P a th o l ogy : ( I ) perverted amb i t ion , ( 2 ) psychos i s with imperat ive ideas , ( 3 ) exaggeration of

sl ight symptoms 1

208

LECTURE XXI I I .

D is e as e s o f th e Bra in

FUNCT IONAL DI SEASES (Cont inued )

HYSTERIA (Concluded )

D i agn o s is : ( 1 ) mult ipl icity and variab i l i ty of symptoms , ( 2 ) symptoms inexpli cab l e by any

organ i c disease , (3 ) age and sex , (4 ) su rroundings ( stage sett ing ) , 5 ) globus li vstericus ,

(6 ) emotional nature , (7 ) ovarian pressure , (8 ) decept ion . (9) Important to remember

that hysteria may accompany and mask an organ i c d i sease .

( d ) From epi lepsy : ( 1 ) no true loss o f consciousness , ( 2 ) effect of suggest ion , ( 3 ) b it ingof tongue and in j u ries

,durat ion of attack, (4) ovarian pressure

( 0 ) From j oin t d i sease : ( 1 ) etherization

( f ) From organ ic paralys i s and cont ractures

212

Progno s i s cou r s e

Tre a tm en t

(0 ) PrOphylactic : ( 1 ) healthy envi ronment . ( 2 ) separation from hysterical and nervous

people, ( 3 ) wi se tra in ing , (4 ) out - of- door athl et ics

, ( 5 ) avoidance o f excitement and

conte st s, (6 ) avoidance of al l excesses

218

( b ) O f chron i c hysterica l state : ( 1 ) phys ician should exercis e mental influence and sugges

t ion, ( 2 ) e ncouragement and assurance of cure, 3 ) no j oking ,

fami l iarity nor scolding ,

and i solat ion , 5 ) massage and e lectri city, (6 ) systemati c work and divers ion ,

(7) avoidance of worry and anxiety , ( 8 ) travel , (9 ) drugs ( valeri an ,assa foeti da

,phos

phates , malt , i ron ,arsen i c

, b romides , etc . )

214

( 6 ) O f hysterical attack : ( 1 ) mental suggest ion and encouragement . ( 2 ) el ect ri c ity ( Far

ad ic ,stat ic and el ectri c brush ) , ( 3 ) b l i sters , ( 4 ) actual cautery , ( 5 ) etherization . (6 )

ovarian or supra—orb ital pressure, ( 7 ) cocaine . ( 8 ) quin ine in large doses , ( 9 ) valerian

and assa foet ida , ( I O ) b romides

217

LECTURE XXIV .

D i s e a s e s o f t h e B ra in

FUNCT IONAL D ISEASES (Cont inued )

CONVULSIVE D ISORDERS

EPILEPSY

In t ro du c t o ry ( I ) symptomati c and i diopath ic

E t i o l ogy ( 1 ) age , ( 2 ) sex , ( 3 ) heredity . 4 ) consang uin ity in parents , ( 5 ) hab i tat ion (6 )

( 7 ) in fect ion , (8 ) poi son , sun stroke, ( I O) masturbation , ( 1 1 ) fright

, ( 1 2 )reflex

220

Path ol ogical an a t omy : ( 1 ) negative or not characteri st ic , ( 2 ) deformities o f skul l , 3 ) sec

ondary changes in brain

222

( b ) O f minor epi leptic attack ( le peti t mal ) : ( I ) au ra ( 2 ) sudden on set , ( 3 ) unconscious

ness, (4 ) pallor , ( 5 ) tendency to act ion , (6 ) amnesia

( c ) O f the psychi c equivalent : ( 1 ) dream - li ke state ( somnambul i sm ) , ( 2 ) insane (man i

acal )

226

O f the epi lept ic state

( f ) O f the epi lept ic interval : ( 1 ) normal , ( 2 ) menta l weakness , ( 3 ) dement ia

228

theory,

2 ) cort ical.

D iagn o s i s ( 1 ) unconsciousness , ( 2 ) amnes ia

D i ffe ren t i al d i agn os is

(a) From sy ncope : ( I ) no convuls ions , ( 2 ) cardiac inadequacy

(b ) From J ackson ian epi lepsy : ( 1 ) local i sed spasm

( c) From uraemia : ( 1 ) long durat ion , ( 2 ) albumen and casts

(d ) From hysteria : ( 1 ) unconsciousness on ly apparent , ( 2 ) durat ion , ( 3 ) suggest ib i l ity

(4 ) stage setting , 5 ) ovarian pressure"

230

P rogn os i s and c ou r s e

Tre atm en t : ( 1 ) remove al l causes of i rritation , ( 2 ) avoid alcohol and tobacco , ( 3 ) t reph in ing ,

(4 ) drugs (bromides , n it rite o f amyl , hyoscy amine , ch loral hydrate )

N"

Os N

a

LECTURE XXV .

D is e a s e s of th e Bra in

FUNCT IONAL DISEASES (Cont inued )“

LL-L

CONVULS IVE D I SORDERS (Cont inued )

INFECT IVE OR SYDENHAM ’S CHOREA

In t ro du ct ory

E t i o l ogy ( 1 ) age , ( 2 ) sex , (3 ) heredity , (4 ) season , 5 ) anaemia , (6) nerve strain and

school work , (7 ) i rr itation ( ocular , gen ita l , (8 ) fright , (9 ) in fect ion , ( 1 0 ) rheumat ism

and endocardit i s , ( 1 1 ) pregnancy

234

P at h o l ogi c a l an at om y ( 1 ) negative in nervous system, ( 2 ) endocardit i s

S ymptom at o l ogy ( I ) sub —acute onset . ( 2 ) characteri st ic movements, ( 3 ) extent (hemi

chorea) , (4 ) effect on voluntary movement s ( speech ,deglut it ion

,walking , ( 5 ) motor

weakness, (6 ) psych ic symptoms , ( 7 ) cardiac sounds , ( 8 ) duration

236

P ath ol ogy : ( I ) embol ic theory , ( 2 ) infection , 3 ) secondary symptoms

D i agnos is

DEGENERAT I VE , OR HUNT INGTON ’S CHOREA

In t rodu ct o ry

E t i ology : ( 1 ) age , ( 2 ) sex ( 3 ) heredity

P a th o l ogi cal an at om y : ( 1 ) many les ions , but none characteri st i c

movement s, ( 2 ) chron i c course , ( 3 ) steady mental deteriora

241

Progn os i s and c ours e

T reatm en t

Pa th o l ogi c a l an a t om y ( 1 ) no characteri st ic les ion, ( 2 ) changes in central spinal gray matter

‘

in ch i ldren

Sym pt om at o logy ( 1 ) characteri sti c muscu lar spasm , ( 2 ) musc les attacked . ( 3 ) duration o f

spasm, (4 ) Trousseau ’s phenomenon , ( 5 ) increased i rritab i l ity of nerves , (6 ) insan i ty

246

LECTURE XXVI .

D i s e a s e s o f th e B ra in

FUNCT IONAL D ISEASES (Cont inued )

CONVULSIVE D ISORDERS (Concluded )

TETANUS

In t ro du c t ory

E t i o l ogy : ( 1 ) age , ( 2 ) sex , ( 3 ) baci l lus o f tetanus . ( 4 ) tetan in , ( 5 ) wound , (6) puerperal ,

(7 ) neonatorum, (8 ) local ity , (9 ) i d iopath i c

248

S ym ptom at o l ogy : ( I ) incubat ion , ( 2 ) premon i tory . ( 3 ) ri g id ity . (4 ) cony uls ion . ( 5 ) pa in ,

(6 ) pul se and temperature

P ath ol ogy

E t i o l ogy ( I ) b ite of an an imal , especial ly a dog , su ffering from rab i es

P a th o l ogi c a l an a tom y

Symp tomatOI Ogy : ( 1 ) incubat ion , ( 2 ) prodromata , spasm , espec ial ly

253

D iffe ren t i al di agn os i s

(a) From tetanus

( b ) From hysteria

P rognos i s and c ou rs e

Tre atm en t : ( 1 ) cauteriz at ion , ( 2 ) Pasteur’

s

Diagn o s i s

P rogn o s i s

Tre a tm en t

OCCUPATION NEUROSES

In t ro du c t ory

Va ri e t ie s : ( I ) writers’ cramp

,te legraphists ’ cramp

, 3 ) pian i st s’ cramp . (4 ) viol in i sts

’ cramp ,

5 ) seamstress’ cramp

E t i o l ogy ( I ) neuropathi c predi spos it ion, ( 2 ) exhaust ion

258

P rogn o s is an c ou r s e

Tre atm en t

TRAUMAT IC NEUROSES

Var ie t i e s ( 1 ) neurasthen ia, ( 2 ) hysteria , ( 3 ) tremor , ( 4 ) chorea . ( 5 ) epi lepsy

E t i o l ogy : ( i ) psych ic trauma acute ( inj ury and fright ) , ( 2 ) neuropath ic pred ispos it ion , ( 3 )exhaust ion

26 1

S ymptomatology ( I ) depress ion , ( 2 ) neurasthen i a, (3 ) neuros is , (4 ) t remor

LECTURE XXVI I .

D i s eas e s o f th e Bra in

AUTO — I NF ECT I ON

In t ro du c t ory

MYXOEDEMA (CACHEXIA STRUM IPRIVA) AN D CRET I NISM

In t ro du c t o ry

E t i o l ogy ( 1 ) loss o f funct ion of thyroid , ( 2 ) age , ( 3 ) sex , (4 ) heredity

264

P at h o l ogi c al an a t om y

S ym ptom atol ogy

P a th o l ogy

D iagnos is

P rognos is and c ou rs e

T re a tm en t : ( 1 ) thyroi d

S ymptom ato l ogy : ( I ) ( 2 ) goitre, ( 3 ) rapid pulse , (4 ) t remor , ( 5 ) Graefe’

s

symptom, (6 ) vaso—motor disturbances , (7 ) nervousness

, (8 ) weakness , (9 ) emaciat ion

2638

P rogn o s i s and c ou r s e

Tre atm en t : ( 1 ) rest , ( 2 ) d rugs ( quin ine and i ron"

ACROMEGALY

In t ro du c t ory

E t i o logy ( I ) hypertrophy o f pitu itary , ( 2 ) age , ( 3 ) sex

P ath o logi ca l an atomy : ( 1 ) disease o f pituitary body ( tumor )

Symptom a t ol ogy : ( 1 ) en largement o f hands , feet , lower j aw ,ste rnum

,etc .

, ( 2 ) kyphosi s ,

(3 ) vi sual symptoms , (4 ) glycosuria

270

URAEMIA

In t ro du c t ory

E t i o l ogy : ( I ) nephrit i s

P a th o l ogi c a l an at om y : ( I ) anaemia of bra in , ( 2 ) oedema of brain

S ymptom at o l ogy : ( I ) c oma, ( 2 ) convul s ion s , ( 3 ) restlessness , (4 ) headache , ( 5 ) vert igo ,

(6 ) amauros is , (7 ) hemipleg ia tu n a ( I a ) 7u t u‘

v'u o

272

P a th o l ogy : ( I ) u rea , ( 2 ) tox ic , ( 3 ) oedema and anaemia, (4 ) atheromatous a rteries and

irregular b lood supply

273

D i agn os is ( 1 ) albumen and casts i n urine , ( 2 ) other cerebra l d iseases excluded

P rogn os is and c ou rs e

T reatm en t : ( 1 ) posture , ( 2 ) diaphoret i cs , ( 3 ) diureti cs , (4 ) etheriz at ion

PTOMAINE AND LEUCOMAINE PO ISON ING

276

LECTURE XXVI I I .


TOX ICI n t rod u c t ory

ALCOHOLIC PO ISON I NG

Acute alcohol i sm : ( I ) exaltat ion , ( 2 ) coma or semi - coma , (3 ) man ia

( b ) Sub acute alcohol i sm : ( I ) del iri um t remens , ( 2 ) insan ity (man iaca l and con fu s iona l )

( c ) Chron i c alcohol i sm : ( 1 ) dement ia , ( 2 ) insan ity ( con fu sional and amnes ic )

278

NARCOT IC PO ISON I NG

Var i e t i e s : ( 1 ) opium , ( 2 ) chloral , ( 3 ) cocaine , (4 ) chloroform , ( 5 ) cannab i s indica

(a) Acute narcot ism : ( I ) coma“

(b ) Chron i c narcoti sm : ( 1 ) nervousness , ( 2 ) neuralgia, ( 3 ) mental weakness , (4 ) los s of

moral sen se, 5 ) insomn i a , (6 ) tremor

280

NICOT INE PO I SON ING

(a) Acute : (2 ) vomit ing , (3 ) coma and convuls ions

( b ) Chron i c : ( 1 ) t remor , ( 2 ) intermittent and i rregular pu lse , (3 ) palpitation and dysp

noea

c) Treatment

282

LEAD POISON ING

Symptoms : ( I ) neuralgia ( col ic and arthralgia ) , ( 2 ) paralys is ( extensor ) , 3 ) cereb ral“

symptoms ( convuls ions , coma , del i r ium ,headache )

( b ) Treatment : ( 1 ) morphine, ( 2 ) heat

, ( 3 ) iodide of potass ium

284

VERT IGOIn t ro du c t ory

Exp e r im en t al v e rt igo ( I ) galvan i sm , ( 2 ) rapid whi rl ing or turn ing of body , 3 ) men ingeal

i rritat ion, (4 ) in j ury to semi - ci rcu lar canals , ( 5 ) in j ury to cerebel lum or its peduncles , (6)

in j u ry to sensory n erves , (7 ) poi son

MEN INGEAL I RRITAT ION

AURA OF EPI LEPSY

290

S ymptom at o l ogy : ( 1 ) verti go , ( 2 ) t inn itu s aurium , ( 3 ) deafness , (4 ) vomit ing , ( 5 ) fal l s , (6)unconsciousness

, (7 ) eye symptoms , (8 ) headache , (9 ) ataxia , ( I O) duration

202

D iagn o s i s

P rogn o s i s and c our s e

Tre atm en t

I NJURY TO SEMI - CIRCULAR CANALS

CEREBELLAR INJURIES . OR D I SEASES (D IRECT OR I NDIRECT )

(a) Les ions : ( 1 ) tumors , ( 2 ) hemorrhages and soften ings, ( 3 ) multiple scleros is

(b ) Symptoms

294

TOX IC VERTIGO

296

of headache indicative of i ts orig in

Var i e t i e s

(a ) Neuralgic : ( I ) supra - orb ital, ( 2 ) occipita l

( b ) Muscu lar rheumat i sm : ( I ) scalp musc les ( occi pito - frontal i s )

( c ) Symptomatic of visceral d isease : ( 1 ) pelvic , ( 2 ) gastric

( d ) Symptomatic o f organ i c b rain disease : ( I ) men ingit i s , ( 2 ) syphi l is , (3 ) tumor and

abscess

( e ) Tox i c : ( I ) fever ( infect ion ) ( 2 ) uraemic , ( 3 ) con st ipation , (4 ) alcohol ic and narcot ic ,

( 5 ) l ead , etc .

298

(g ) Vascular : ( I ) anaemic , ( 2 ) congestive (n i troglycerine , n it rite of amyl ) , ( 3 ) migraine

M IGRAINE

E t i o l ogy ( 1 ) age , ( 2 ) sex , ( 3 ) heredity , (4 ) in fect ion ( 5 ) excit ing cause ( excesses , alco

hol ic or sexual,menst ruation , worry , emotion s , indigest ion )

Pathol ogi c a l an a t om y

“

S ym ptom at o l ogy : ( I ) parox smal atta ks 2 remon itory symptoms , ( 3 ) aura , (4 ) headache (hemicran ia ) , ( 5 ) pera ges vaso motor and secretory disturbances

, ( 7 ) nauseavomit ing

, (8 ) durat ion , (9 ) imperfect attacks , ( 10 ) th e hemicran ial equ ivalent

30 1

P rogn os is and c ou rs e

Tre a tm en t

LECTURE XXX1 .

D i s e a s e s o f th e B ra i n

GENERAL REVIEWAND SUMMARY

I ntro duc t o ry

D i s e a s e s t o b e con s i d e re d

G en e ra l e t i o l ogy

(A) PRIMARY FACTORS

(a ) Direct hered ity and congen ita l de fect s : ( I ) main ly organ i c di seases , ( 2 ) cran ia l

abnormal it i es and encephalocele , ( 3 ) men ingiti s , tubercu lar and syphi l it ic , ( 4 )cereb ral pal sy of ch i ldhood

, ( 5 ) cereb ra l hemorrhage , (6 ) tumor , ( 7 ) convuls ive

di sorders ( epi lepsy ,chorea

,in fect ive and degenerative ) , ( 8 ) neu rasthen i a and

hysteria

305

( b ) Indi rect hered ity ( neuropathi c predi sposi tion ) : ( 1 ) al l the functional di seases , ( 2 )no organ i c d iseases except degenerat ive chorea

( c ) In fect ions : ( 1 ) acute meningit i s , ( 2 ) syph i l i s , ( 3 ) tetanus and hydrophob ia , (4)in fect ive chorea

, 5 ) ab scess

306

( 12) Other di seases : ( 1 ) diseases of b lood vessel s , ( 2 ) diseases of thy roid , ( 3 ) tuber

culos is, (4 ) tumors , exten s ion or metastasi s

, ( 5 ) nephrit i s, (6 ) diabetes

(B) SECON DARY FACTORS

Ag e : ( 1 ) chi ldhood (hydrocephalus , cereb ra l pal sy of ch i ldhood , men ingit i s ,chorea

,tetany ) , ( 2 ) adult age ( syph il i s , neurasthen ia , hysteri a

, ( 3 ) old

( amplexy )

( b ) ( 1 ) female (hy steri a ) , ( 2 ) male ( in j uries , syphi l i s )

308

Psych ic t raumata acute ( emotions ) or ch ron i c (worry )

( g ) Exces ses

( l l ) Comb inat ion o f et iologica l factors

G en e ra l p a th o l ogi c a l an a tom y

(A) ORGAN IC D I SEASES

(a) Nervous t i ssue not primari ly involved in most cerebral di seases

(b ) Diseases of the membranes : ( 1 ) congen i tal abnormal it ies , ( 2 ) men ingit i s

( c ) Diseases of the b lood vessel s : ( 1 ) fatty degenerat ion ,endarteriti s , mil iary aneu

risms, ( 2 ) rupture , ( 3 ) occlus ion , (4 ) s inus thrombosis , 5 ) ab scess

3 10

(B) FUNCTIONAL D I SEASES

(a ) Congen ital ly weak

( b ) I rritat ive ( reflex )

( c ) Blood supply

( d ) Chemical or toxic.

(A) GENERAL D IM INUTION OF CEREBRAL ACTIVITY ( due to destruct ive lesion )

(a ) Loss o f consciousness : ( 1 ) coma , ( 2 ) semi - coma or stupor , ( 3 ) sopor , (4 ) somno

lence, ( 5 ) con fus ion or giddiness , (6 ) drowsiness ( traumat ic compress ion ,

etc . ,

apoplexy,epi lepsy

,s inus thrombosi s

,men ingit i s

,tumor , general pares is , mult iple

scleros i s , alcohol i sm , narcot i sm , uraemia . diabetes , fever )

‘3 13

( b ) Loss of in tel l igence : ( 1 ) ament ia ( i d iocy ,imbeci l ity , feeb l e minded ) , ( 2 ) dement ia

( resu lt o f insan ity and of the diseases noted above under “

a

( 6 ) Loss of feel ing ( emotions ) : ( I ) apathy (neurasthen ia and in san ity )

(d ) Loss of memory in general : ( I ) amnes ia ( diffuse atroph ic or degenerative cor

t ica l changes usual ly of vascular origin )

314

( b ) Loss of speech : ( 1 ) motor aphas ia , ( 2 ) sensory aphas ia , ( 3 ) tran scort ical a

( tumor , apoplexy ,men ingit i s )

316

( 0 ) Loss o f reading and writ ing : ( 1 ) alexia , ( 2 ) agraph ia ( tumor , apoplexy , menin

git i s )

Loss Of smel l and taste : ( 1 ) anosm ia , ( 2 ) ageus ia ( tumor , apoplexy men ingit is)

( 0 ) Loss of cutaneous and muscular sens ibi l ity : ( I ) astereognosi s , ( 2 ) hemianaesthesia ,

( 3 ) l i emianalg es ia , (4 ) thermic hemianaesthesia . ( 5 ) los s o f musc le sense ( apo

plexy,tumor

,meningit i s , hysteri a )

( f ) Monoplegia ( apoplexy , tumor , men ingit is , hysteria )

(g ) Hemiplegi a , total or part ial ( apoplexy , tumor , men ingit i s , hysteria , uraemia )

3 18

(C ) EXAGGERATION OF CEREBRAL ACT IVI T i

(a ) Psych i c : ( I ) insomn i a (neurasthen ia )

( b ) S ensory : ( I ) hyperaesthesi a , ( 2 ) hyperalgesia , (3 ) thermic hyperaesthesia, (4 )hyperosmia

, 5 ) hypergeus ia , (6 ) photophob ia , ( 7 ) intolerance to sound ( al l may

occu r in hysteria )

320

Motor : ( 1 ) contracture , act ive or pass ive (men ingiti s , apoplexy , cerebral pa l sy of

chi ldhood,tetany

,hy steri a ) , ( 2 ) restlessness ( neurasthen ia and hy steria ) . ( 3 ) con

vuls ion ,general , un i latera l or monospasm ; ton i c , C lon i c . tetan i c , chorei form ( epi l

epsy,tetanus

,hydrophob ia

,hysteria

,chorea . men ingit i s , apoplexy , cereb ra l pal sy of

ch i ldhood,tumor )

321

(D ) PERVERSION OF CEREBRAL ACTIVITY

(a ) Psych ic : ( I ) depressed and apprehens ive ( insan i ty , traumati c neuroses , neuras

then ia,hysteria

,chron i c narcot i sm ) , ( 2 ) j oyous and exalted ( insan ity , hysteria) ,

( 3 ) changeab le ( insan i ty , hysteria chron i c narcot ism ) , (4 ) hal lucinat ion s , 5 )delusions , (6 ) del i rium ( last three may occur in fever

,insan ity , chron i c nar

cotism,men ingit i s )

322

( C ) Motor : ( 1 ) cort ical ataxia ( tumor , apoplexy , or men ingiti s of cereb ral cortex,

causing astereognos is ) , ( 2 ) cerebel lar ataxia ( l es ion s of cerebel lum or its pe

duncles, 3 ) tremor (neurasthen ia , hysteri a , exophthalmic goitre , multipl e scleros is ,

post - hemiplegic ) , (4 ) athetosi s ( post—hemiplegic ) , ( 5 ) inert ia (hysteria or

alepsy )

324

Genera l p ath o l ogy

Resul t of increased pressure : ( 1 ) general , ( 2 ) loca l

( b ) Resu lt o f anaemia : ( 1 ) general , ( 2 ) loca l

( c ) Result of i rregula r b lood supply

( d ) Result o f cort ical i rritat ion : ( 1 ) general , ( 2 ) local

Result of poisons

( f ) Resu lt of lack of nerve force

P rognos i s and c ou rs e

Tre a tm en t

(a ) General prophylaxis : ( 1 ) direct inheritance , ( 2 ) neuropath ic predisposit ion , (3 ) con

sanguinious marriages , (4 ) educat ion , ( 5 ) manner of l i fe , (6 ) food and st imulant s

03

N)

U)

(b ) The actual dis ease : ( I ) rest , ( 2 ) systemat ic exerci se , 3 ) massage , (4 ) elect ri city , 5 )hydrotherapeutics

, 6) heat and cold , (7 ) drugs (hypnotics , s edat ives , nerve

ci rculatory )

330

INSAN ITY

I n t roductory

M e t h o d Of exam in a t i on

(a) A complete hi story and phys ica l examinat ion made according to the scheme given in

volume one i s necessary in every case

( b ) Point s to be especia l ly observed : ( 1 ) sub j ect ive symptoms ( hi story ) are much more

important than the ob j ect ive ( phys ical examinat ion ) , ( 2 ) obtain al l the in formation

poss ib le be fore seeing the pat ient , ( 3 ) ascerta in the degree of culture , pecu l iari t ies and

temperament of the pat ient previous to the attack , (4 ) do not deceive the pat ient , ( 5 )note t ime of mental react ion

33 7

G ene ral e t i o l ogy

(a) Predispos ing causes : ( 1 ) age , ( 2 ) sex , 3 ) heredity ( direct inheritance , neurasthen ic

predispos it ion,consanguineous marriages )

338

P atholog ical an a t omy : ( I ) th e brain , ( 2 ) the b lood vessel s , ( 3 ) the lympath ics , (4 ) pia

dura mater, (6 ) the skul l

341

(B) STAGE OF ACTIVE I NSAN ITY

(a) Intel lect ( the patient’s reason ing ) : ( I ) s ense percept ion (ha l lucinat ion s , i l lus ions ) ,

( 2 ) memory , recent and remote ( ari thmet ical prob l ems , dates , ages , names,

3 ) thought , flow of ideas ( retarded , accelerated , incoherent ) , (4 ) j udgment ( de

lusions , imperat ive ideas )

341:

( b ) Feel ings ( the pat ient’s mood ) : ( I ) depressed ( fear , gri e f , remor s e ) , ( 2 ) excited

( i rr itab i l i ty , turbu lence , con fus ion ) , 3 ) en feeb led ( indifference ,changeab l e

346

sel f, ( 2 ) of surroundings , ( 3 )

340

S pe c i al Sym ptom atol ogy

(A) FUNCTIONAL INSAN ITY

(a) I d i opathi c

Psychoses

1 ) melanchol ia

3 ) con fus ional insan i ty

(4 ) primary dement ia

TPsychic degenerations

( I ) epi lept i c insan i ty

( 2 ) hysterical insan ity

3 ) neurasthen i c insan ity

2 ) in san ity of arterio—scle ros i spre - sen i l e insan ity

sen i l e insan ity

(C) MENTAL D ISORDERS OR DEFECTS N OT CONSIDERED As I NSAN ITY ‘

( I ) idiocy , ( 2 ) imbeci l ity , (3 ) crime , (4 ) alcoholi sm , 5 ) del i rium

D iagn os i s determinat ion of insan ity , ( 2 ) feigned

P rogn o s is and cou rs e ( I ) of the acute psychoses of psych ic degenerat ion s, ( 3 )

organ i c insan i ty

Tre atm ent

369

S ign ifi cance o f haemogl ob in p e rc en t age : ( a ) Increased (plethora) , ( b )( ch lorosi s , leukaemia , pseudoleukaemia , and al l forms of anaemia )

percen tage of haemoglob in 100COLO R INDEX 100g

percen tage of red corpuscl es

( 0 ) Increased ( pern ici ous anaemia , ( b ) dimin i shed ( ch lorosi s and most forms of anaemia )

Te chn i c of e s t im at ing th e s p e c ifi c grav i t y o f t h e b l o o d ( I ) Hammerschlag’

s Method, ( 2 )

Schmalz

373

S ign ifi c an ce o f th e s p e c i fi c grav i t y o f th e b l o o dS P . GR. HAEMOGL. S P . GR. HAEMOGL S P. GR.

1 0 30 204 45% 1 0 5 1

1 035 304 504 1 0 52

1038 353 1 048 553 I OSS . S

1 04 1 404 1 049 604 1 0 56

(a) Varies with the haemoglob inHAEMOGL. S P . GR. HAEMOGL.

65% I OS7 5 90%

70% 1 0 59 1 004

7St"

8054

(b ) Increased relat ive ly to the Haemoglob in ( leukaemia ) . ( c ) re latively dimin i shed

n icious anaemia )

Te ch n ic of as ce rta in ing th e numb e r of red corpus cl e s

3 ) Haemocytometer

74

( 1 ) Thoma - Z ei ss, ( 2 ) Haematokrit ,

S ign i fi c an c e o f th e n umb e r o f re d c orpu s c l e s

( 0 ) Increase or polycythaemia after recovery from anaemia, ( 2 ) after t rans fus ion , ( 3 )

after profuse diarrhoea,sweating or vomit ing

, (4 ) h igh alt itudes, 5 ) phosphorous

poison ing ]

376

( b ) Decrease or anaemia , pr imary ( pern i cious ) or secondary after hemorrhag e , ( 2 )malaria , 3 ) acute sept icaemia , (4 ) toxic ( burn s , intest ina l parasi tes , ch lorate of potash

poi son ing , ( 5 ) anaemias of early ch i l dhood , (6 ) severe forms of al l anaemias ]

Te chn i c o f a s c e rt a in ing th e n um ber of Wh i t e c o rpu s c l e s ( I ) Z appert - Thoma - Z ei s s

377

S ign i fi c an c e o f th e n um b e r o f w h i te c e l ls

( a) Diminution or leucopen ia "always ( 1 ) starvat ion , sometimes ( 2 ) measles , (3 ) grippe ,

(4 ) tubercu losi s , uncompl icated , ( 5 ) malaria , (6 ) typhoid , often (7 ) pern ic ious

severe secondary anaemias , ( 8 ) splen i c anaemia ]

Te ch n i c o f exam inat i on of fr e s h s p e c im en Of b l o o d

In fo rm at i on de r i v e d from exam in a t i on Of fre sh b l o o d ( I ) plasmodium malariae, ( 2 ) spi

rochaete of relapsing fever , ( 3 ) fi laria sangu in i s homin i s , (4 ) anth rax and other bacteria ,

5 ) amount of fibrin , (6 ) approximate rat io of wh ite and red corpuscles , ( 7 ) approximate

rat io of d ifferen t variet ies of whit e corpuscle s, (8 ) deformities o f red corpuscl es , (9 ) amount

o f b l ood plates

381

Te chn i c of m ak ing a sm e ar of b l ood : ( 1 ) cover glass, ( 2 sl i des

, ( 3 ) fixing , (4 )

(Ehrl ick , J enner , Goldham) , 5 ) different ial count ing

382

In form at i on ob t a in e d from exam in a t i on Of'

b l ood sme ar

(a ) Red corpuscles : ( 1 ) normal , ( 2 ) endoglobular changes , 3 ) crenat ion and poik i loicytosi -s ,

(4 ) oval , 5 ) stain ing react ion , (6 ) nucleated (normob lasts , megalob lasts,micro

b lasts ) , ( 7 ) granular degeneration , (8 ) plasmodium malariae

384

P LATE I I I .

EXAM I N AT I ON OF THE B LOOD .

Fig . i . VARIETIES O F LEL'

COCY T ES — S T A I N ED BY J EN N ERS M ETHOD . 1 , Sma l l lymp hocy te2,Intermed iate between sma l l and larg e lymphocyte ; 3 , Larg e lymphocy te ; 4 ,

M y e locy te : 5 , Deg enera icd polymorphonuc lear ; 6

, Po lymorphonuc l ear ; Polymorphonuc l ear con taining a bac i l lus ; 7 .

Polymorphonuc l ear w i th Neusser g ranu l es : 8 ,Eos inoph i l e mye locyte ; 9 , Eos inop h i le : i o . M as t ce l l .

Fig . 2. VARIETIES OF RED CELLS S T A I N ED WI TH EOS I N AN D BLUE. 1 Norma l ;2, De fi cient in Haemog lobin ; 3 , M icrocyte ; 4 , Poik i locy te ; 5 , Vacu lo la tcd : 6

,M ega locyte ;

7. Polych romatop h i l ic : 8 , M icroblast : 9 , M eg a lob last : I o , Normob las t : I I , D iv is ion form ; 1 2 . Punctateery throcyte : 1 3 . Blood p lates .

T I I L' T aur u s: Fo rm or M A LA RI A L PARAS I T F:

re pre se nt the d e ve l o pmen t o r n - inn to 7.o o n w i thin th e s ubs tance of a re d b lood c e l l .Figu re s 2 to 7

I n fi g ure t o the re I s reproFig ure s 8 to t o re p rese n t the d i v is ion o f an adu l t to rm in to new paras i te s .

w n tt-tl a comp lc tv d e s t ruc tio n o t'

th e re d ce l l and th e yo ung paras i te s are free to ente r other b l ood ce l l s .

T ech n ic of aggl u t in a t i on t e s t , s e rum r e a c t i on (Widal ’ s test )

d Sedimentation in l ayers : ( 1 ) cavit ies , ( 2 ) chron i c bronch iti s and bronch iectas is , ( 3 )gangrene

Character of sputum : ( I ) watery or serous ( oedema ) , ( 2 ) vis'

cid or mucuous ( pneu

mon ia , influenza, b ronch iti s , tuberculosi s , whooping cough ) , ( 3 ) mucO—purulent

( chron i c b ronchit is , tuberculos is , pneumon ia , resolving ) , (4 ) puru lent ( cav it i es , empy

ema ) , ( 5 ) nummular ( tuberculos is , ch ron i c bronchiti s ) , (6 ) rusty (pneumon ia ) , ( 7 )prune j u ice and currant j e l ly (pneumon ia , can cer ) , (8 ) frothy (oedema , b roncho - pneu

mon ia, b ronch it is ) , (9) hemorrhagic ( tuberculos is , oedema , in farction ,

aneurism , purpura ,

hysteria ) , ( 1 0 ) b lack ( inhaled dust ) , ( 1 1 ) yel low or green (hepat ic abscess , perforat

ing ) , ( 1 2 ) b ronchial casts ( fi brinous or croupous b ronch it i s )

390

Mi c ros c op i c exam ina t i on

(a) Select ion o f specimen : ( 1 ) inspect ion , ( 2 ) boi l ing w i th alkal i , (3 ) centri fuging

( b ) Techn i c of examination o f fresh specimen

39 ]

( 6 ) Resu lts Of examinat ion of fresh specimen : ( 1 ) ep ithel ium , ( 2 ) pus cel ls ( empyema ,tuberculosis , chron ic bronchit i s and b ronch iectasi s ) , (3 ) eos inophyl ic cel ls ( asthma ) ,

(4 ) Charcot—Leyden ’s crystals ( asthma ) , 5 ) Curschmann ’s spi ral s ( asthma ) , (6)elast i c fibres (gangrene , cavit ies ) , 7 ) hematoidin crystals (Old hemorrhage , tubercu losis ,cardiac disease ) , (8 ) Echinococcus hoold ets , (9 ) actinomycoces

392

( 6 ) Results o f examination of dried specimen : ( 1 ) tubercl e baci l lus , (2 ) Fraenkel’s pneu

mococcus , ( 3 ) Fried laender’

s pneumococcus, (4 ) influenza baci l lus

, 5 ) st reptococcus

and staphylococcus , (6 ) aspergi l lus , (7 ) act inomycos i s

394

EXAM INAT ION OF THE URINE

Ph y s i c a l ch ara ct e r s

(0 ) "uant ity : ( 1 ) normal and phys iological variat ions, ( 2 ) increased or polyuria ( diabetes

mel l i tus,diabetes in s ip idus , chron i c interst i t ial nephrit i s . amyloid nephrit i s

,el iminat ion

of large eff us ions , angina pectori s , hysteria , tumors of brain stem ) , ( 3 ) dimin i shed or

O l iguria ( parenchymatous nephrit i s , cardiac disease , fever , diarrhoea , hysteria )

395

Specific gravity : ( 1 ) normal and physiological vari at ions , 2 ) varies in the quant i ty

secreted, ( 3 ) a measure Of the sol ids excreted by the kidney s , (4 ) large amount Of urin e

w ith high specific gravity ( diabetes mel l itus ) , ( 5 ) smal l amount of urine with low

c i fi c gravity ( uraemia threaten ing )

( c ) Transparency and sediment : ( 1 ) normal ( 2 ) urates , ( 3 ) phosphates , (4 ) mucus and

pus, ( 5 ) bacteria , (6 ) shreds

( d ) Color : ( 1 ) normal and physiological variat ions, ( 2 ) pale ( polyuria ) ( 3 ) dark ( ol i

guria ) , (4 ) red , reddi sh - b rown , smoky ( haematuria) , ( 5 ) green i sh - b rown or green i shb lack ( choluria ) , (6 ) b l ack ( alkapturia,

carbo-l i c acid,sal i cy l i c acid

,santon in

,naph

thOl in, ( 7 ) mi lky ( chyluria ) , (8 ) b lue ( indigo , methylene b lue )

396

( b ) Uric acid : ( I ) quant itative tests (Haycraft Heintz ) , ( 2 ) normal amount and phys io

logi ca l variations , ( 3 ) increased ( acute - fevers , l eukaemia , gout and rheumati sm ,food ) ,

(4 ) dimin i shed ( diabetes , anaemia , chron i c interstital nephrit i s )

( c ) Salts : ( I ) chlorides , ( 2 ) phosphates , ( 3 ) su lphates

Ab n orm a l ch em i c al con s t i t u en t s

(a) Albumen : ( I ) qual itative tests (n itr ic acid ,heat and n it ri c acid , Trich loracet ic test ) , ( 2 )

quant itative test (Esbach ) , 3 ) albuminuria ( all forms of nephrit i s , primary or second

ary,cystit i s

,urethrit is

,infectious fevers

,haemic diseases

,cardiac and pulmonary dis

eases,drugs

,high arteri al tens ion )

398

b ) Albumose : ( 1 ) test s ( heat ) , ( 2 ) albumosuria ( in fectious fevers , suppurat ion ,myelo

mata , osteomalacia )

( c ) Sugar : ( 1 ) qual itat ive test (Fehl ings , Haines , Nylander quanti tat ive

test ( Fehl ing ,fermentat ion ,

Einhorn ’s saccharometer ) , 3 ) glycosuria ( excess ive sac

charine and starchy food with sedenta ry l i fe and nerve stra in ,diabetes mell itus ) , in fect

ious fevers during convalescence,inj ury to nervous system

399

( d ) Acetone : ( 1 ) tests (Gunn ing ) , ( 2 ) acetonuria ( feve r , hunger , meat diet , diabetes mel l

itus digestive disturbances , carcinoma )

( e) Di —acet ic acid : ( 1 ) tests (Gerhardt ) , ( 2 ) diaceturia ( diabetes mel l itus , fever , dyspept ic

disturbances , autointox icatio-

n in drinkers )

(f ) Blood : ( 1 ) tests ( spectroscope , Schoenbe in —Almen ) , ( 2 ) Haematuria and Haemog lobi

nuria ( in fi ammations , tumors or in j uries of any part o f urinary tract , haemic diseases ,purpura

,in fect ious diseases )

400

M icros cop i c exam in a t i on of th e u r ine

(a ) Method of col lect ing sediment : ( I ) s edimentat ion , ( 2 ) centri fuging , ( 3 ) both

( b ) Urates : ( I ) appearance , ( 2 ) s ign ifican ce ( acid ,concentrated urine fevers )

( c ) Uri c acid : ( I ) appearance , ( 2 ) s ign ificance ( acid concent rated urine , gout , rheuma

t ism , fever )

Calcic oxalate : ( I ) appearance , ( 2 ) s ign ificance ( food , dyspeps ia )

( e ) Phosphates amorphous : ( I ) appearance , ( 2 ) s ign ificance ( alkal ine , decompos ing urine )

402

( f ) Fat : ( 1 ) appearance , ( 2 ) s ign ificance ( phosphorous poi son ing , obesity , fat

chyluri a )

( g ) Epithel ia l cel l s : ( I ) appearance , ( 2 ) s ign ificance ( inflammations of urinary t ract )

(h ) Pus cel l s : ( I ) appearance , ( 2 ) s ign ificance ( in flammat ions o f urinary tract )

( i ) Red b l ood cel l s : ( I ) appearance , ( 2 ) s ign ificance (hemorrhage of urinary tract )

403

( j ) Epithel ia l casts : ( I ) appearance , ( 2 ) s ign ificance ( renal inflammation or degenerat ion )

( le ) Granular casts ( I ) appearance ( 2 ) s ign ificance ( renal inflammat ion or degeneration )

( l ) Hyal ine casts ( I ) appearance. ( 2 ) s ign ificance ( renal inflammat ion or degenerat ion )

(m ) Fatty casts : ( I ) appearance , ( 2 ) s ign ificance ( renal inflammation or degenerat ion )

( n ) VVaxv casts : ( I ) appearance , ( 2 ) s ign ificance ( renal inflammation or degenerat ion )

404

( 0 ) Blood ,pus and bacter ia l casts : ( I ) appearance , ( 2 ) s ign ificance

(p) Cy l indroid s of unknown origi n and s ign ificance

( q ) Paras ite s ( 1 ) fi laria sanguin i s homin i s, ( 2 ) ech inococcus

( r ) Bacteria : ( I ) ty phoid , ( 2 ) tubercl e . ( 3 ) gonococcus , (4 ) col i communi s , ( 5 ) staphyl

ococcus and st reptococcus

EXAM INAT ION OF STOMACH CONTENT S

In t rod u c tory

Vom i t e d m at te r ( 1 ) quant ity , ( 2 ) odor, (3 ) reaction

(A) Contains remnants of food ( t ime and character of preceding meals )

( 1 ) Food completely digested ( vomiting nervous,reflex cereb ral , spinal , beginn ing of

gastric ulcer or catarrh )( 2 ) Food part ly digested (mucus present - gastrit is )( 3 ) Food not at al l d igested ( atrophy — i f there have been several hours between the

taking of food and the vomit ing )

406

(4 ) Bi le : O ften found in vomitus and seldom has a special s ign ificance ( acute gas e

trit i s,periton i t i s

,gastro - intest inal disorders

,reflex ly in di seases of the l iver , kidneys ,

ovaries,uterus and in tabes dorsal i s )

5 ) Fa ces

(6) Parasites : (Ascarides , taen iae , oxyures , vermiculares , anchylostoma,tri chinae )

(7 ) Tissue part icles (mucous membrane , tumors )

408

t r i c con t en ts aft e r t e s t m e a l s

( 1 ) Test b reak fast o f Ewald—Boas

Test meal of R i egel

(A) Appearance

( 1 ) Undigested, ( 2 ) part ial ly d igested , ( 3 ) completely digested

(4 ) Presence of abnormal elements : (a ) b lood , ( b ) mucus . ( c ) b i l e , ( d ) relation of

sol ids to l iqui ds —

3 l ayers . mucus , l iqu id ,chyme

(B) "uanti ty ( 2 0 -

50 c . l . ) (a ) dimin i shed (hy permot i l i ty ,gastri c neu roses

,chroni c gas

t rit i s . incont inence o f pylorus ) ( b ) increased (motor insufficiency )

( C ) Odor (markedly sour , stale , sweeti sh )

409

C h em i c a l exam in a t i on

I React ion

( 2 ) Presence of free aci ds ( congo red , T rOpa l in tests )

(3 ) Test for free hydroch loric acid (Phloroglucin ,van i l l a

,Resorcin

,dimethyl

,amido azo

benzol )

410

M i c ro s cop i c a l exam in at i on

( 1 ) Ch yme : (a ) starches , ( b ) meat , ( 6 ) fats

( 2 ) Abnormal element s : Epithel ial ce l l s , red and white,b l ood cel l s . sarc inae yeast cel l s ,

crystal s,bacteria , t i ssue part icles

D e t e rm in a t i on o f ga s t r i c m ot i l i t y

(a ) Test meals : ( I ) Leube test meal , ( 2 ) test b reak fast

Salad test : ( I ) Huber modificat ion

412

a s t r i e in s u ffi c ien cy du e t o

( I ) Weakness of contract ing muscles( 2 ) Obstruct ion to the con t racting muscles

( 1 ) Gastri c myasthen ia

(a ) Congen ita l condit ion ( rare )

( b ) Fol lowing const itut ional di seases ( anaemia , ch loros i s , phth i s i s pulmonal i s , chron ic

malaria,amyloid degenerat ion , syphi l i s , typhoid fever ,

n ervous aff ect ion s )

( 2 ) (a ) Ob struct ion s in the stomach itsel f ( ulcer , carcinoma of pylorus , polypus )

( b ) Obstruct ions due to conditi ons outs ide of the stomach ( tumors , adhes ion s , contract

u res,

float ing kidney , hern iae )

413

D i agn os t ic s ign ifi c an c e o f t h e ga s t ri c te s ts

( 1 ) Normal acidity : N O severe textural disease of stomach ,probab ly a neuros is . May also

occur with gastri c atony

Hyperacidity : Gastri c neuros is , ulcer , a ben ign glandular hypertrophy , carcinoma upon

the base Of an ulcer

Anacid ity : Chron i c gastrit i s , gastric neurosi s , carcinoma

Lactic acid : Occurs with stagnat ion and ab sence of hydrochloric acid ,carcinoma

Aceti c acid : Result of alcohol ic fermentation where there i s gastri c stagnation advanced

fermentat ion of carbohydrates

D iminution of peps in and Renn in : Marked diminut ion indicates a permanent in j ury of

the gastri c glands

Presence of yeast cel l s and sarcinae : They occur in smal l numbers in differen t gastric

d isease , but are Observed in large numbers on ly in excessive stagnation

4 14

EXAMINAT ION OF FZECES

In t rodu c tory

( 1 ) "uanti ty ( depends on food . oz . iv .

—v11 . )

(2 ) Color : Usual ly dark brown ( l ight yel low ,clay colored

,green

,b lack food , drugs , b i le ,

b lood )

( 3 ) Cons i stency : Soft sausage - shaped ( ribbon—s haped , scybala ; abnormal ly mushy or

l iqu id )

(4 ) Odor : Increased by retent ion in bowel ( sour , Offens ive , musty , putri d )

5 ) Reaction : N eutra l or sl ightly alkal ine ( vegetab le diet s l ight ly acid , oc'

clus ion of b i le

strongly acid )

416

(6 )'U'

nd igested food (normal ly smal l part icles of vegetab l e substances . Meat indicates

severe intest inal l‘

es ion . M i lk curds )

Abnorm a l c on t en ts

( 1 ) Blood : Red ,dark or tarry ( port ion of intest ine , state of peri sta ls i s ) . Most frequent

causes : hemorrhoids , typhoid fever , col it i s , cancer of colon . Large hemorrhages

( typhoid fever , portal engorgement , haemophi l ia , purpura , aneurism ) . Small hemor

rhag es (hemorrhoids , in j u ry to rectum ,fissure , u lcerat ion ,

intu ssuscept ion in chi ldren )

( 2 ) Mucus : Glas sy layer about faeces , membrane , yel low i sh in color and wel l mixed with

faeces , smal l part ic le s floating in watery dej ecta . ( I nflammat ion o f l arge or smal l

intestine,dysent ery proct it i s , impact ion o f faeces )

417

3 ) Pus : Large quant ity ( absces s , pelvic periproctitic perinephrit i c ) . Smal l quant ity ( dys

entery ,enterit i s , proctit is , ulcerat ion o f rectum or colon )

(4 ) Fatty stools ( obstruct ive j aundice , disease of pancreas , indigest ion or overfeeding in

infants )

5 ) Calcul i : (a ) gal l stones , (b ) pancreati c cal cu l i , ( c ) enterol iths , ( d ) coprol iths

(6) Fore ign bodies : Coins,marb l es , bones , needles

( 7) Paras ites ( ascari s lumbricoides , oxyuris vermicu lari s , taen i a sagin'

ata, taenia sol ium )

M icroscop i cal exam in at i on

( 1 ) Remnants Of food ( fat , starches , muscle fibres )

418

(b ) Vegetab l e : ( 1 ) comma baci l lus , baci l lus typhosi s , baci l lu s col i commun i s , baci l lus

tuberculos is

(7 ) Ova of entozoa : ( I ) oxyuri s vermiculari s . ( 2 ) ascaris lumb ri coides 3 ) tri chocephalus

drspar , (4 ) taen i a sol ium , 5 ) taen ia medrocanel lata, (6 ) Bothriocephalus latus , (7 )Distoma hepaticum, (8 ) Distoma lanceolatum , (9 ) anchylostomum duodenale

420

I N DEX

Absc ess o f the bra in ,112.

Aceton e and ace tonur ia , 400.

Ac id , free in g a str ic con ten t s , te sts for and s i g n i fi

can c e o f , 410.

Acrany , 9.

Acromeg a ly , 161 , 270.

Ag eus ia , 185 , 317.

Ag g lu t ina t ion te st , 387.

Ag raphia , 317 ; loca l iza t ion , 151 ; tes ts for , 7 .

Albumen in ur in e , te st s for , 398.

A lbuminur ia ,s ig n ifi cance of , 398.

Albumose i n ur in e , tes ts f or and s ig n i fi cance of , 399.

A lcohol ism , 88, 277, 278, 364.

A lex ia , 317 ; loca l iza t ion , 146, 148 ; te sts for , 7.

Amb ly op ia , 151 , 161 , 162.

Amen t ia , 314; t e s ts for , 3 .

Amn es ia , 314, 344 ; ep i l ept ic , 223 , 225 ; t es ts for , 3 , 344 .

Anaemia o f the bra in ,(53 .

A n encep ha ly , 9.

An eur i sm in bra in , 120; mi l iary , 72.

Anosm ia , 317 ; loca l iza t i on , 151 , 153 , 162 ; tes t s for , 7.

A pha s ia ,motor , 5 , 151 , 162, 316 ; opt ic , 148 ; s en sory , 5 .

153 , 316 ; te st s for , 5 ; tran scort ica l , 5 , 316.

Apoplexy , 71 ; di fferen t ia l d iag nos is o f , 87, 98Arter i t i s sy phi l i t ica , 131 , 135 .

A sta s ia , aba sia ,188.

As tereogn os i s , 142, 146, 317.

Ataxia , cer ebel lar , 160, 324 ; cerebra l , 151 , 159, 324.

A the tos i s , 324 ; loca l iza t ion , 155 .

Au to - in fec t ion , c erebra l d i sease s d ue to , 264.

B e l ladonna poi son ing , 283.

Blood , color index , 873 ; di fferen t ia l c oun t , 382 ; examima t ion o f , 371 , 381 ; fi x ing , 382 ; haemog lob in in , 371 , 373 ;

in faeces , 417 , 419 ; i n urine , 400 ; in vomi tu s , 407 ; red

corpusc l e s i n , 374, 376, 377 ; smear, 382 ; spec i fi c g rav i tyo f

, 373 ; sta in ing , 382 ; whi te corpusc l es in , 377, 378,

379, 385 .

B rachy c epha ly , 9.

B ra in ,ab sce ss o f , 112 ; anaemia o f , 63 ; hemorrhag e in .

71 ; hy peraem ia or, 67 ; inflamma t ion o f , 111 ; inj ur ie so f

, 47, 56 ; oedema of , 69 ; s o ften ing of, 93 ; tumor o f.119.

Ca s ts i n u rine , 404.

Ca ta le psy , 197 , 200, 324.

Cepha la lg ia , 297.

Cerebe l l um , loca l iza t ion in , 160.

Cerebra l absc e ss . 112 ; anaemia . 63 ; compre ss ion , 53

concu ssion . 47 ; con tu s ion , 56 ; d i pleg i a . 108 ; embo l ism93 ; hemorrhag e , 69 : hy peraem ia , 67 ; inj uri es , 47 , 56l oca l iza t ion , 141 , 151 ; oedema , 69 ; pa l sy o f ch i l dhood ,

104 ; s inus thrombos is , 100 ; soften ing , 93 ; syp hi l is ,

128 ; thrombo s i s , 93 ; tumo r. 119 ; ce rebra l di seas es ,

d iag nos i s o f , 327 ; e tiolog y o f , 305 ; examina t ion o f , 8 ;pa tholog ica l ana tomy o f. 310 ; patholog y o f , 325 ; progno si s o f , 328 ; symptomato log y o f , 313 ; trea tmen t o f ,328.

De l ir ium , 322, 364.

De lu sion s , 322.

Demen t ia,3 , 227, 228 , 314, 353 , 359.

Di - ac et ic ac i d in ur in e , 400.

D iag no si s o f bra in d isease , 327 ; of insan i ty , 366.

D iabe t ic coma , 275 .

D iaz oreac t ion , 401 .

D i pl eg ia , cerebra l , 108 , 319.

Doly cocep h a ly , 9.

E c stasy , 197.

Embo l i sm of the bra in , 93.

Enc epha l i t i s , 111 .

Encepha l oc e le , 9.

Endarte r i t i s sy ph i l i t ica , 131 .

Eos inoph i l e s and eo s inophi l ia , 385 .

Epi l ep sy , 89, 220 ; J ackson ian ,142 .

E p i le pt ic , aura , 223 . 225 ; insan i ty , m , m , 237 ,

in terva l . 228 ; maj or a t tack , 223 ; min or a ttack ,

s tate , 228 .

Et iolog y o f bra in d i sea se . 305 ; o f insan i ty , 3 8.

Examina t ion o f case s o f cerebra l d isease , 3.

Exoph thalmic g o i tre , 267 .

Faec es , abnorma l cons ti tuents . 417 ; b lood in. 417, 418 ;

cal cu l i i n , 418 ; examina t ion o f , 416 ; tat in, ( 18 ; microscop ica l examinat ion o f , 418 ; mucus in. 417. 419 ;

ova in , 420; para s i tes in , 418, 419 ; phy si ca l charac terso f

, 416 ; p us in , 418, 419.

F i laria sang u in is hom in is in b lo od , 381 ; in urine , 405 .

F ron ta l l obe , l ocal iza t ion in , 151.

Cerebro - sp ina l sy ph i l i s , 134.

Choked di sc , 114, 122.

Cho le s tea toma , 120.

Chorea , deg en era t ive , 240 ; hab i t , 206; Hun ti ng ton ’ s ,240; in fec t ive , 234 ; maj or , 207 ; minor , 234; rhy thm ic ,

207 ; Sy denham's , 234.

Co l or index of b l ood , 373.

Coma , 313 , 349 ; apoplec t ic , 80, 84 ; di abeti c , 275 ; differen t ial d iag no sis of , 87 ; ep i l ept ic , 223 , 225 ; hy s teri ca l ,197 ; tes ts for , 3 ; uraemic , 272.

Compre ssi on o f the bra in , 53.

Con cu ssi on of the bra in , 47 .

Con fu s iona l in san i ty , 352.

Con sc i ou sn e ss , 349 ; te st s for , 3.

Con trac ture , 188, 321 .

Con tu si on of the bra in , 56.

Convu l s ion s , 114, 122,188 , 321 , 349 ; ep i lepti c , 223 ; h y s

ter i ca l , 188, 197.

Convu l s ive d i sorder s , 220, 234, 248 .

Convu l s ive t i c , 205 .

Corpora q uadr ig emina , loca l iza t ion in , 159.

Cran ia l abn orma l i t i e s , 9.

Creti n i sm , 264.

Crime , 364.

Cy st o f bra in , 120.

I NDEX

Gastr ic con ten t s a fter test mea l s , 409 ; b i le i n ,408 ;

b lood in , 407 ; examina t ion o f , 406 ; faeces in ,408 ;

free ac ids in , 410; hy drochlor ic ac id in , 410; lac t icac i d i n , 411 ; microscop ic examina t ion of , 412 ; moti l i tyof

, 409, 412 ; mu cu s in , 407 ; p us in,407 ; to ta l ac idi ty ,

411 .

Gen era l p aresi s , 359.

G l i oma , 120.

G ly cosu r ia , s ig n i fi can ce o f , 399.

Goi tre, exophtha lmic , 267.

Gumma , 120; struc ture of , 130.

Haema t in and h aema top orp h y ri nur ia , 401 .

Haema toma of dura ma ter , 12, 14.

Haemog lob in te st , 371 ; percen tag e , 373.

Ha l lu c inat ion s , 322, 344; audi tory , 153 ; odor i ferou s , 153 ;opt ic , 148.

Headache , 297 , 323.

Hemiam bly opia , 148.

Hemianaesth es ia , 155 , 185 , 317.

Hemianopsia , 315 ; l oca l iza t ion , 146, 148, 155 ,

tests for , 5 .

Hemia thetosi s , 155 .

Hemichorea , 155 , 236.

Hemichroma topsia , 148.

Hemip leg ia , 82, 106, 142, 155 , 318.

Hemorrhag e , cerebra l , 71 ; men ing ea l , 61 .

Hy droc epha lus , 9, 29 ; acu t e , 41 ; chron ic. ex terna l , 41

chron ic in terna l , 42.

Hy drochlor ic ac id in g astr ic con ten ts , 410.

Hy drop hob ia , 252.

Hy peraesthes ia , 320.

Hy peraemia of the bra in , 65 .

Hy p n ot ism , 200.

Hy ster ia , 89, 177.

Hy ster ica l in san i ty , 197 , 358 ; maj or at tacks , 197 ; min ora t tacks , 191 .

157, 161 ;

Idiocy , 314, 364.

Imb ec i l i ty , 314, 364.

Indie -

an an d indicanur ia , 401 .

In er t ia , 324.

Inflamm a t ion of the bra in , 111 .

In j ury o f the bra in , 47 , 56.

In san i ty , 334 ; a lcohol ic , 277, 278, 364 ; c ircu lar , 355 ; c lass ifi ca t ion

" o f , 350; con fu s iona l 352 ; diag n os i s o f , 366;

ep i lep t ic 223 , 226, 227, 357 ; et io l og y of , 338 ; exam ina t ionf or , 337 ; fun c t iona l , 350; hy s ter ica l , 197 ; in tetany ,

246 ; n eu rasthen ic , 358 ; org an ic , 363 ; pa tholog y o f , 341 ;p rog nosi s of , 368 ; sen i l e , 361 ; symptomatolog y o f ,343 , 350; trea tmen t o f , 369.

In somn ia , 167, 280, 320, 343 .

In te l l ig en c e , test s f or , 3 .

In tern a l cap su l e , loca l iza t ion in , 155 .

In tracran ia l tumor , 119.

J ackson ian ep i l epsy , 142.

K ern ig ’ s symptom , 23 .

Lac t ic ac id i n g as tric con ten t s , 411 .

Lead poison ing , 284.

Leptomen ing i t is ,'

10; acu te , 18 ; chron ic , 37.

Leucocy te s and l euc ocy tos i s , 377, 385.

L eucopen ia , 378.

Lo ca l iza t ion , 141 , 151 ; at ba se o f brain , 161 ; cen tra lWh ite substance , 155 ; cerebel lar , 160; cerebra l , 141

c orp ora"uadr ig emina , 159 ; fron ta l lobe , 151 ; in terna lcapsu l e , 155 ; nu c leu s cauda tu s , 157 °

nuc l eu s l en t i cular i s , 157 ; occ ip i ta l l obe , 148 ; opt i c tha lamus , 157 ;par ieta l l obe , 146 ; temp ora l l obe

, 153 .

Lumbar p unctu re , 24, 27 , 31 , 35 , 44.

Lymp hoc y tes an d l ymp'

h oc i tos i s , 385 .

422

Man ia , 351 .

Melanchol ia , 350.

Memory , tes ts f or , 3 .

Men iere ’ s di sease , 291 .

Men ing ea l hemorrhag e, 61 ; irr i ta t ion , 22, 30, 290.

Men ing i t is , 10; c erebro - sp ina l , 18 ; chron ic , g um

mosa , 130, 132 ; puru l en t , 33 ; serous , 36; sy phi l i t ic , 130,

132 ; tubercu lar , 28.

Men ta l d isorders , 3 , 334.

Microcep ha l y , 9.

Mig ra in e , 300.

M i l iary an eur i sm , 72.

Monop l eg ia , 318.

Morph in e poison ing , 88, 280.

Motor c en ter s , loc a l iza t i on of , 142.

My elocy tes , 385 .

My oc l onu s mu l t iplex , 206.

My xoedema , 264.

Narco- l e-th arg y , 197, 200.

Narc ot i sm , 88, 280

N eurasthen ia , 164.

Neura sthen ic in san i ty , 358.

Neuroses , occup a t i on , 258 ; traumat ic , 261 .

Nicot in e poison in g , 282.

Nuc l ea ted red b lood corpusc l es ,Nuc l eu s cauda tu s , loca l iza t ion i n 157 .

Nuc leu s len t icu lar i s , loca l iza t ion i n , 157.

Ny s tag mu s , 160.

Oc c ip i ta l lobe , l oca l iza t ion in , 148.

Occupa t ion n euroses , 258.

Oedema , cerebra l , 69.

Olig ur ia, 395 .

Op htha lmop leg ia , 161 , 162, 163.

Optic , aphas ia , 148 ; neur i t i s , 114, 122, 136; thalamus ,loca l iza t ion in , 157.

Pachymen ing it i s , 10; ex terna ,10; in terna h aemor

rh ag i ca , 12 ; in terna pu ru'l en ta , 12.

Paramy oc lonu s mu l t iplex , 206.

Paran o ia , 355 .

Pares i s , 359.

Par ie ta l l obe , loca l iza t ion in , 146.

Pa thol og ica l ana tomy of cerebra l d isea ses ,in san i ty , 341 .

Pa tholog y o f c erebra l d iseases 327.

Pen e tra t ing wounds of th e bra i n , 59.

Per iarter i t i s sy phi l i t ica , 131 , 135 .

Per ineur i ti s sy phi l i t ica , 131 , 136.

P i tu i tary body , tumors of , 161 .

P la smodium mal ar iae i n b l ood , 381 , 384.

Poik i l ocy tos is , 381 , 384.

Poi son ing , 277.

Poly ur ia , 395 .

Poren cepha ly , 104.

Pos t - sy ph i l itic n ervou s d i sea ses , 128.

Prog nos is of bra in disea ses , 328 ; o f in san i ty , 368.

Psamom a , 120.

P toma in e p o ison ing , 276.

Psy ch ic b l indn ess , 5 , 148, 315 ; dea fn ess , 153 ; deg en erat i on s , 354; depress i on , 322, 343. 346, 350; d isorders , testsf or , 3 ; equ iva l en t , 227 ; exa l ta t ion , 322, 346; var iab i l i ty ,

322, 346.

Psy cho ses , 350.

310; o f

Red b lood corpu sc l e s , 374 ; coun t ing o f, 374 ; d im inu

t ion o f, 377 ; increase o f , 376.

Rev iew , 305 .

Sen i l e in san i ty , 361 .

S inu s thrombos is ,Soften in g o f the bra in , 93 .

Somnambu l i sm , 197 , 200, 226.

Spa sms , l oca l , 255 .

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