NEUROPATHOLOGY  , the See also:

• GENERAL
• GENERAL (Lat. generalis, of or relating to a genus, kind or class)

general name for the See also:

• SCIENCE (Lat. scientia, from scire; to learn, know)

science concerned with diseases of the See also:

• NERVOUS

nervous See also:

• SYSTEM

system . As regards the See also:

• ANATOMY
• ANATOMY (Gr. avaroyil, from ava-silo c', to cut up)

anatomy and See also:

• PHYSIOLOGY (from Gr. 4 i s, nature, and koyos, discourse)

physiology, see the articles See also:

• NERVE (Lat. nervus, Gr. vevpov, a bowstring)

NERVE, NERVOUS SYSTEM, See also:

• BRAIN (A.S. braegen)

BRAIN, See also:

• SPINAL

SPINAL See also:

• CORD (derived through the Fr. corde, from the Lat. chorda, Gr. xop(5rt, the string of a musical instrument)

CORD, and SYMPATHETIC SYSTEM . The morbid processes affecting the nervous system are numerous and varied, but usually they are clinically divided into two See also:

• GREAT

great See also:

• GROUPS
• GROUPS, THEORY

groups of (I) organic disease, (2) functional disturbance . Such a See also:

• CLASSIFICATION (Lat. classis, a class, probably from the root cal-, cla-, as in Gr. icaMce, clamor)

classification depends upon whether or not symptoms observed during See also:

• LIFE

life can be associated with recognizable changes of the nervous system, See also:

• GROSS

gross or microscopical, after See also:

• DEATH

death . Sometimes this is the morbid See also:

• PROCESS

process itself, sometimes only the ultimate result of the process . It must be remarked, however, that many diseases which we now look upon as functional may be found due to recognizable changes when suitable methods of investigation shall have been discovered . The paroxysmal neuroses and psychoses may be considered a priori to be due to temporary morbid functional conditions . Our knowledge of the first See also:

• GROUP

group is naturally much more advanced than of the latter, for, given certain symptoms during He, we are able, as a See also:

• RULE

rule, to predict not only the nature of the morbid process, but its particular locality . The histological elements which make up the nervous system may also be divided into two groups: (I) the nervous See also:

• UNITS, DIMENSIONS OF
• UNITS, PHYSICAL

units or neurones, (2) the supporting, protecting and nutrient tissues . Organic diseases may start primarily in the nervous units or neurones and cause their degeneration; such are true diseases of the nervous system . But the nervous units may be affected secondarily by diseases starting in the supporting, protecting and nutrient tissues of the nervous system; such are essentially diseases within the nervous system, and include diseases of the See also:

• BLOOD

blood-vessels, lymphatics, membranes and the See also:

• SPECIAL

special nervous connective See also:

• TISSUE (Fr. tissu, tissue, participle of tisser, Lat. texere, to weave)

tissue, neuroglia (a See also:

• RESIDUE (through the French, from the Lat. residuum, a remainder, from residere, to remain)

residue of the embryonal structure from which the nervous system was See also:

• DEVELOPED

developed) . Tumours and new growths must also be included .

The See also:

• MODERN

modern conception of the " neurone " as an See also:

• INDEPENDENT

independent complex See also:

• CELL (from Lat. cella, probably from an Indo-European kal —seen in Lat. celare, to hide; another suggestion connects the word with Lat. cera, wax, taking the original meaning to refer to the honeycomb)

cell with branching processes, in physiological rather than anatomical association with other neurones, has modified our ideas of the morbid processes affecting the nervous system, especially as regards degenerations of systems, communities or collections of neurones subserving special functions . It was formerly believed, and generally taught, that the See also:

• PRIMARY

primary systemic degenerations were due to a sclerosis; thus locomotor ataxy was believed to be caused by an overgrowth of the sup-porting glia tissue of the posterior columns of the spinal cord, which caused a secondary See also:

• ATROPHY (Gr. It- priv., rpo4, nourishment)

atrophy of the nervous tissue . We now know that this overgrowth of glia tissue is secondary to the atrophy of the nervous elements, and the only true primary overgrowth of glia tissue is really of the nature of the new growth (gliosis) . But even in this See also:

• CASE
• CASE, JOHN (d. 1600)

case it is doubtful if the See also:

• MERE
• MERE, ADALBERT (1838-1909)

mere proliferation of the glia tissue elements could destroy the nervous elements, if it were not for the fact that it leads to changes in the See also:

• VESSEL (O. Fr. vaissel, from a rare Lat. vascellum, dim. of vas, vase, urn)

vessel walls and to haemorrhages . The symptoms manifested during life depend upon the nature of the morbid process and the portion of the nervous system affected . A correct understanding of neuropathology involvesrecurrent or periodic See also:

• INSANITY (from Lat. in, not, and sanus, sound)

insanity and dementia-praecox or adolescent insanity . In 70 % of 15o cases of See also:

• IDIOCY (from Gr. iblwrrls, in its secondary meaning of a deprived person)

idiocy or imbecility in the See also:

• LONDON

London See also:

• COUNTY (through Norm. Fr. comae, cf. O. Fr. cunte, conk', Mod. Fr. comae, from Lat. comitatus, cf. Ital. comitato, Prov. comtat; see COUNT)

county asylums, Dr See also:

• TREDGOLD, THOMAS (1788-1829)

Tredgold found a See also:

• FAMILY

family See also:

• HISTORY

history of insanity in some See also:

• FORM (Lat. forma)

form or another . Strictly speaking, it is the tendency to nervous disease rather than the disease itself that is inherited, and this is frequently spoken of as a neuropathic or psychopathic taint . There are, besides, a number of inherited diseases, which, although somewhat rare, are of See also:

• INTEREST

interest inasmuch as they affect members of a family, the same disease frequently commencing in each individual at about the same See also:

• AGE (Fr. age, through late Lat. aetaticum, from aetas)

age . These are termed family diseases, and include hereditary ataxia (Friedreich's disease), myotonia (See also:

• THOMSEN, GRIMUR (182o-1896)
• THOMSEN, HANS PETER JORGEN JULIUS (1826–1909)

Thomsen's disease), hereditary (See also:

• HUNTINGDON
• HUNTINGDON, EARLS OF
• HUNTINGDON, SELINA HASTINGS, COUNTESS OF (1707—1791)

Huntingdon's) chorea, amaurotic idiocy and various forms of idiopathic See also:

• MUSCULAR

muscular atrophy . Alcoholism, See also:

• TUBERCULOSIS

tuberculosis and syphilis in the parents, especially if one or. both come from a neuropathic or psychopathic stock, frequently engender idiocy, imbecility, See also:

• EPILEPSY (Gr. &L, upon, and kaµ)3avew, to seize), or FALLING

epilepsy and general See also:

• PARALYSIS, or PALSY (from Gr. aapal,6a , to relax; Wycliffe has palesy, and another old form of the word is parlesy)

paralysis in the offspring, by the See also:

• PRODUCTION (Lat. productionem, from producere, to pro-duce)

production of defects in the vitality of the germinal plasm, causing See also:

• ARREST (Fr. arrester, arreeter, to stop or stay)

arrest, imperfect development or premature decay of groups, communities or systems of neurones, especially those which are latest developed—the symptoms manifested depending upon the portions of the nervous system affected . To explain the hereditary neuropathic tendency morphologically, we may suppose that there is an inherited defect in the germinal plasm which is concerned in the formation of the neurones .

We may regard the neurone as a complex cell, and the nervous system as a community of neurones arranged in systems and groups having special functions . Like all cells, the neurone nourishes itself and is not nourished; certainly it depends for its development, life and functional activity upon a suitable environment, but it must also possess an inherent vital See also:

• ENERGY (from the Gr. ivipyela; iv, in, ipyov, work)

energy by which it can assimilate and See also:

• STORE (from O. Fr. estor or estoire, Late Lat. staurum or instaurum, stock, provisions, supply, from the late use of instaurare, to provide, properly to construct, renew, restore)

store up nutrient material which may be regarded as potential (latent nerve energy), to be converted into nerve force as required . A See also:

• CONSTANT, BENJAMIN (1845-1902)

constant constructive and destructive bio-chemical process occurs in the neurones of a healthy nervous system, latent nervous energy is high and the sense of fatigue is the natural indication for See also:

• SLEEP (0. Eng. slcepan; Ger. schlafen; cf. Lat. labi, to glide, and " slip ")

sleep and repose, whereby it is constantly recuperated . In the neuropathic or psychopathic individual it may be conceived that in some portion of the nervous system, especially the brain, there may exist communities, systems or groups of neurones with inherited See also:

• LOW, SETH (1850- )
• LOW, WILL HICOK (1853- )

low potential, readily becoming exhausted, and, under the See also:

• INFLUENCE (Late Lat. influentia, from influere, to flow in)

influence of altered blood states or stress, especially liable to functional depression, from which arise See also:

• FUNCTION

function-paralysis and See also:

• MELANCHOLIA

melancholia . Again, the bio-chemical substance which represents potential in the nervous system may be in a chemically unstable See also:

• CONDITION (Lat. condicio, from condicere, to agree upon, arrange; not connected with conditio, from condere, conditum, to put together)

condition, so as readily to fulminate when excited by abnormal conditions (e.g. toxic conditions of the blood), thus acting as a centre of See also:

• DISCHARGE (adapted from the O. Fr. discharge, modern decharge, from a med. Lat. discargare, to unload, dis- and earn care, to load, cf. " charge ")

discharge of nervous energy, which may be manifested by See also:

• MENTAL

mental or bodily symptoms . We know that in strychnia and See also:

• TETANUS (from Gr. rei:vw, I stretch, on account of the tension of the fibres of the affected muscles), or LOCKJAW

tetanus poisoning the most localized peripheral excitation will cause general muscular spasm; in both toxic conditions the spread is probably due to a bio-chemical See also:

• CHANGE (derived through the Fr. from the Late Lat. cambium, cambiare, to barter; the ultimate derivation is probably from the root which appears in the Gr. «a urmu', to bend)

change in the See also:

• PROTOPLASM

protoplasm of the spinal neurones, whereby the excitability is greatly increased and a slight stimulus is sufficient to fulminate the whole system of motor neurones . In epilepsy and other paroxysmal neuroses and psychoses it is possible that some altered condition of the blood, when associated with an inherited bio-chemical instability of certain groups, systems or communities of neurones, may See also:

• ACT (Lat. actus, actum)

act as a fulminating See also:

• AGENT (from Lat. agere, to act)

agent . In See also:

• NEURALGIA (Gr. veiipov, nerve, and iXyos, pain)

neuralgia and See also:

• LOCAL

local hyperaesthesia the slightest general or distant local irritation suffices to produce See also:

• PAIN (from Lat. poena, Gr. robin, penalty, that which must be paid: O. Fr. peine)
• PAIN, BARRY (1867– )

pain; thus coughing, the vibration of a passing See also:

• TRAIN (M. Eng. trayn or trayne, derived through Fr. from Late Lat. trahinare, to drag, draw, Lat. trahere, cf. trail, trace, ultimately from the same source)

train or the slamming of a See also:

• DOOR (corresponding to the Gr. Bbpa,. Lat. fores or valvae; the English word, with other forms common in allied languages, comes from the same Indo-European stem as the Gr. Obpa and Lat. fares)

door may produce pain by the stimulation of the hyper-excitable neurones . Moreover, it must be See also:

• BORNE, KARL LUDWIG (1786–1837)

borne in mind that the symptoms of nervous disease are due as much to normal physiological functional activity improperly applied, as to actual loss of function occasioned by disease . 'Thus See also:

• SQUINT (possibly connected with Swed. svinka, to flinch; 0. Eng. swiccan, avoid)

squint, caused by paralysis of one of the muscles of the eyeball, causes less trouble to the patient than the See also:

• DOUBLE
• DOUBLE (from the Mid. Eng. duble, the form which gives the present pronunciation, through the Old Er. duble, from Lat. duplus, twice as much)

double See also:

• VISION (from Lat. videre, to see), or SIGHT

vision occasioned by the physiological activity of the two retinae, upon the corresponding points of which the images are prevented by the paralysis from falling . B . The See also:

• EXTERNAL

external causes producing morbid changes in the nervous elements are: I .

Abnormal conditions of the blood and See also:

• LYMPH

lymph, by which the neurones are poisoned and their See also:

• METABOLISM (from Gr. ,uera(3oXh, change)

metabolism morbidly affected . II . Excess or deficiency of normal stimulation, or existence of abnormal stimulation . III . Injury or diseases of supporting, enclosing or vascular tissues . I . Abnormal Conditions of the Blood and Lymph.—The immediate environment of all the cellular elements of the See also:

• BODY

body is lymph, and in the central nervous system there is a special form of lymph, the cerebro-spinal fluid, which is secreted by the choroid plexus in the venticles of the brain . The neurones, like other cellular elements, are bathed in the lymph, and See also:

• EXTRACT (from Lat. extrahere, to draw out)

extract from it the materials necessary for their growth and vital activities, casting out the See also:

• WASTE (O. Fr. wast, guast, gast, gaste; Lat. vastus, vast, desolate)

waste products incidental to the bio-chemical changes which are continually taking See also:

• PLACE (through Fr. from Lat. platea, street; Gr. IrAar6s, wide)

place . The lymph, there-fore, serves as a See also:

• MEDIUM

medium of See also:

• EXCHANGE

exchange between the blood and the tissues, consequently the essential causes of change in environment of the nervous elements (neurones) are: (I) Deficiency or See also:

• ABSENCE (Lat. absentia)

absence of blood-See also:

• SUPPLY (through Fr. from Lat. supplere, to fill up)

supply to the nervous system in general (as after severe See also:

• HAEMORRHAGE (Gr. atµa, blood, and prryvvvac, to burst)

haemorrhage), or to some particular portion, owing to local vascular disturbance or occlusion . (2) Alterations in the normal condition of the blood, due to (a) deficiency or absence of certain essential constituents, (b) excess of certain normal constituents, (c) the presence of certain abnormal constituents produced within the body, or entering it from without . (i) Quantity of.Blood Supply.—See also:

• SYNCOPE (Gr. vvyKO7n , a cutting up or short, from Kbirrew, to cut)

Syncope or fainting occurs when the blood supply suddenly fails to reach the higher centres of the brain; this usually arises from sudden reflex arrest of the See also:

• HEART
• HEART, LUNG

heart's See also:

• ACTION

action . If a portion of the central nervous system is cut off from its arterial blood supply by embolic plugging or by clotting of the blood in a vessel with diseased walls, the portion of the brain substance thus deprived of blood undergoes softening, the nervous elements are destroyed, and the systems of nerve See also:

• FIBRES
• FIBRES (or FIBERS, in American spelling; from Lat. fibra, apparently connected either with filum, thread, or findere, to split)

fibres, which have had their trophic and genetic centres in the See also:

• AREA

area destroyed, undergo secondary degeneration .

Clotting of the blood in the See also:

• VEINS

veins may also give rise to destructive softening of the brain, and similar secondary d eneration . z) Quality of Blood Supply.—(a) Insufficiency of See also:

• OXYGEN (symbol 0, atomic weight 16)

oxygen, due to poverty of the colouring See also:

• MATTER

matter or of the number of the red corpuscles, which constitutes the various forms of See also:

• ANAEMIA (from Gr. ay-, privative, and aiµa, blood)

anaemia, leads to functional depression, lassitude and mental fatigue . Impoverishment of the blood in See also:

• WOMEN

women by frequent pregnancies and excessive lactation causes neuralgia, nervous exhaustion and, in the neuropath, See also:

• HYSTERIA

hysteria, See also:

• NEURASTHENIA (Gr. veuupov, nerve, and lur%veta, weakness)

neurasthenia, melancholia and See also:

• MANIA

mania . The mental depression, and the tendency that the various neuroses and psychoses have to occur and recur at the See also:

• TIME (0. Eng. Lima, cf. Icel. timi, Swed. timme, hour, Dan. time; from the root also seen in " tide," properly the time of between the flow and ebb of the sea, cf. O. Eng. getidan, to happen, " even-tide," &c.; it is not directly related to Lat. tempus)
• TIME, MEASUREMENT OF
• TIME, STANDARD

time of the menstrual and See also:

• CLIMACTERIC (from the Gr. KAupaKr'Jp, the rung or step of a aXiµaE or ladder)

climacteric periods in women, suggests the possibility of an alteration in the See also:

• COMPOSITION
• COMPOSITION (Lat. compositio, from componere, to put together)

composition of the blood, either in the nature of an auto-See also:

• INTOXICATION (Lat. toxicare, intoxicare, to smear with poison, toxicum, an adaptation of Gr. 'r(*uK v, sc. ¢apµasov, a poison smeared on arrows; roEov, bow)

intoxication or " sub-minimal deficiency,' as the probable contributory See also:

• FACTOR (from Lat. facere, to make or do)

factor of the mental disturbance . It may be remarked that eclampsia, puerperal and lactational mania are relatively See also:

• COMMON

common forms of insanity in women; although sometimes of septic origin, they more frequently are occasioned by some morbid metabolism as yet little understood . The most striking examples we have, however, of the effect of absence or " sub-minimal " deficiency of a normal constituent of the blood upon the development and functions of the nervous system are afforded by cretinous idiots, who are See also:

• BORN, IGNAZ, EDLER VON (1742–1791)

born without See also:

• THYROID (Gr. Ovpoea3i'is, shield-shaped, from Ovpeos, a large oblong shield, shaped like a door, Obpa, and eiSos, form)

thyroid glands, and whose brains never develop in consequence; and by those See also:

• PEOPLE

people who suffer from the disease known as See also:

• MYXOEDEMA (or athyrea)

myxoedema, occasioned by the absence of iodothyrin, a product of the See also:

• INTERNAL

internal secretion of the thyroid gland . The See also:

• PROOF (in M. Eng. preove, proeve, preve, &°c., from O. Fr . prueve, proeve, &c., mod. preuve, Late. Lat. proba, probate, to prove, to test the goodness of anything, probus, good)

proof of this is shown by the disappearance of the nervous phenomena, slowness of thought, slowness of speech, &c., after a preparation of the gland has been continuously ad-ministered by the mouth . Even cretinous idiots when subjected in See also:

• EARLY
• EARLY, JUBAL ANDERSON (1816-1894)

early life to thyroid treatment improve considerably . The removal of the testicles in the male may produce a profound effect upon the nervous temperament; for probably there is an internal secretion of this gland in the male, as of the ovary in the See also:

• FEMALE

female, which has some subtle influence upon the functional activity of the nervous system . The seminal fluid contains a large amount of complex See also:

• PHOSPHORUS (Gr. 4ws, light, sPEpety, to bear)

phosphorus-containing substances, which, lost to the body by sexual excess or onanism, have to be replaced by the blood; the nervous system, which also needs these complex organic phosphorus compounds, is thereby robbed, and neurasthenia ensues . See also:

• BROWN
• BROWN, CHARLES BROCKDEN (1771-181o)
• BROWN, FORD MADOX (1821-1893)
• BROWN, FRANCIS (1849- )
• BROWN, GEORGE (1818-188o)
• BROWN, HENRY KIRKE (1814-1886)
• BROWN, JACOB (1775–1828)
• BROWN, JOHN (1715–1766)
• BROWN, JOHN (1722-1787)
• BROWN, JOHN (1735–1788)
• BROWN, JOHN (1784–1858)
• BROWN, JOHN (1800-1859)
• BROWN, JOHN (1810—1882)
• BROWN, JOHN GEORGE (1831— )
• BROWN, ROBERT (1773-1858)
• BROWN, SAMUEL MORISON (1817—1856)
• BROWN, SIR GEORGE (1790-1865)
• BROWN, SIR JOHN (1816-1896)
• BROWN, SIR WILLIAM, BART
• BROWN, THOMAS (1663-1704)
• BROWN, THOMAS (1778-1820)
• BROWN, THOMAS EDWARD (1830-1897)
• BROWN, WILLIAM LAURENCE (1755–1830)

Brown-Sequard's testicular injection treatment for many nervous complaints, based upon this See also:

• IDEA (Gr. Ibia, connected with i&eiv, to see; cf. Lat. species from specere, to look at)

idea, has not, however, met with much success . (b) Excess of certain Normal Constituents in the Blood.—Excess of carbonic See also:

• ACID (from the Lat. root ac-, sharp; acere, to be sour)

acid causes drowsiness, and probably in See also:

• ASPHYXIA (Gr. a- priv., a fn ts, a pulse)

asphyxia is one of the causes of the See also:

• CONVULSIONS

convulsions .

All the See also:

• SERIES (a Latin word from serere, to join)

series of the nitrogenous waste products—the most highly oxidized, most soluble and least harmful of which is See also:

• UREA, or CARBAMIDE, CO(NH2)2

urea—are normal constituents of the blood; butshould the oxidation process be incomplete, owing to functional or organic disease of the See also:

• LIVER (O. Eng. lifer; cf. cognate forms, Dutch lever, Ger. Leber, Swed. lefver, &c.; the O. H. Ger. forms are libara, lipora, &c.; the Teut. word has been connected with Gr. i'prap and Lat. jecur)

liver, or should these substances accumulate in the blood, owing to inadequate function of the kidneys, a toxic condition, called uraemia, may supervene, the nervous manifestations of which are headache, drowsiness, unconsciousness or See also:

• COMA (Gr. K(.7)

coma, epileptiform convulsions and sometimes symptoms of polyneuritis . Again, in See also:

• GRAVES, ALFRED PERCEVAL (1846— )

Graves's disease,nervous phenomena, in the form of exophthalmos, See also:

• FINE

fine tremors, palpitation and mental excitement, have by some authorities been explained by the excess of thyroid internal secretion, due to the enlargement and increased functional activity of the gland . The successful treatment of Graves's disease by the ad-ministration of the blood serum and See also:

• MILK (0. Eng. meoluc; from a common Indo-European root, cf. Lat. mulgere, Gr. ?t dXyetv)

milk of animals (goats), which had the thyroid glands removed, supports this theory . (c) The presence of abnormal constituents in the blood is a most important cause of disease of the nervous elements . We may consider the subject under the following headings : Poisons produced within the body (a). by perverted function of See also:

• ORGANS

organs or tissues, auto-intoxication; (S) by the action of micro-organisms, See also:

• PROTOZOA (Gr. 7rpwros, first, and i'woe, living thing)

protozoa and bacteria, upon the living fluids and tissues of the body; (y) poisons introduced into the body from without, in the See also:

• FOOD
• FOOD (like the verb " to feed," from a Teutonic root, whence O. Eng. foda; cf. " fodder "; connected with Gr. lrareicOae, to feed)

food and drink, or by inhalation . (a) Poisons resulting from perverted Function of the Organs.—In the process of digestion a number of poisonous substances, e.g. albumoses, &c., are produced, which, although absorbed in the alimentary See also:

• CANAL
• CANAL (from Lat. canalis, " channel " and " kennel " being doublets of the word)

canal, are prevented by the living epithelium, and possibly by the liver, from entering the systemic circulation . Fatigue See also:

• PRO

pro-ducts, e.g. sarcolactic acid in prolonged muscular spasms, may See also:

• LEAD
• LEAD (pronounced iced)

lead to auto-intoxication . Excess of uric acid in the blood is associated with high arterial pressure, deposits of lithates in the urine, headache and nervous irritability; it is an indication of imperfect metabolism and auto-intoxication, as shown by the fact that marked improvement occurs by suitable See also:

• DIET

diet and treatment . Phosphoruria, oxaluria and glycosuria, tokens of deranged metabolism, may be associated with various nervous phenomena . Bile in the blood, cholaemia, resulting from obstructive See also:

• JAUNDICE (Fr. jaunisse, from jaune, yellow), or IUTERUS (from its resemblance to the colour of the golden oriole, of which Pliny relates that if a jaundiced person looks upon it he recovers but the bird dies)

jaundice, may be attended by stupor and psychical depression; and the See also:

• TERM

term melancholia, signifying " See also:

• BLACK
• BLACK, ADAM (1784-1874)
• BLACK, JEREMIAH SULLIVAN (1810–1883)
• BLACK, WILLIAM (1841-1898)

black bile," indicates the importance which has See also:

• LONG, GEORGE (1800-1879)
• LONG, JOHN DAVIS (1838– )

long been attached to the liver as an See also:

• ORGAN

organ the derangement of which causes nervous depression . The rapidly fatal results attending acute yellow atrophy of the liver, namely, the profound changes in the urine, the jaundice and the nervous phenomena of See also:

• DELIRIUM (a Latin medical term for madness, from delirare, to be mad, literally to wander from the lira, or furrow)

delirium, motor irritation, delusions, stupor and coma, demonstrate the important See also:

• PART

part this organ plays in pre-serving the normal quality of the blood . The delirium and coma which sometimes supervene in See also:

• DIABETES (from Gr. &a, through, and faivecv, to pass)

diabetes, heralded by acetonaemia, is another instance of auto-intoxication .

The coma is very possibly due to the saturation of the See also:

• SODIUM [symbol Na, from Lat. natrium; atomic weight 23.00 (0=16)]

sodium salts of the blood by aceto-acetic and oxybutyric acids, products of imperfect proteid metabolism . The effect of this would be an interference with the elimination of carbonic acid in the processes of tissue and pulmonary respiration . Again, in pernicious and certain See also:

• GRAVE

grave anaemias, the degenerative changes in the spinal cord found in some cases is due, not so much to the defect in the red corpuscles, as to some neuro-toxin,which probably arises from imperfect metabolism or absorption from the alimentary canal . In this question of auto-intoxication, it must be remarked that all the tissues of the body are mutually interdependent . If one suffers, all suffer, and a disease cf one organ or tissue is thereby See also:

• APT

apt to establish a vicious circle which is constantly enlarging; therefore nervous symptoms manifesting themselves in the course of a disease add much to the gravity of the complaint . (t) Poisons produced by Infective Micro-organisms.—Some of these poisons have a general devitalizing influence, by an alteration of the blood and the production of See also:

• FEVER (Lat. febris, connected with fervere, to burn)

fever . In the course of the acute infectious diseases, typhoid, typhus, smallpox, See also:

• SCARLET

scarlet fever, See also:

• MEASLES, (Morbilli, Rubeola; the M. E. word is maseles, properly a diminutive of a word meaning " spot," O.H.G. m¢sa, cf. " mazer "; the equivalent is Ger. Masern; Fr. Rougeole)

measles, See also:

• INFLUENZA (syn. " grip," la grippe)

influenza, also tuberculosis and septicaemia, delirium is a frequent complication; it may be the result of high fever or prolonged fever, or directly due to the See also:

• POISON

poison, or the two combined . In severe cases stupor and coma may occur, and it has been shown that in this extreme See also:

• STAGE (Fr. 6/age; from Lat. stare, to stand)

stage the nerve cells undergo an acute morbid bio-chemical change . These particular poisons have no selective toxic action upon a particular part of the nervous system, and symptoms not only during, but after, the acute illness are liable to supervene, especially in a neuropathic individual . Thus many cases of neurasthenia, insanity, neurosis, also See also:

• NEURITIS (Gr. veupov, nerve)

neuritis, date their origin from an acute specific fever . In cerebro-spinal See also:

• MENINGITIS (from Gr. z veyE, a membrane)

meningitis, tubercular meningitis, acute delirious mania and leprous neuritis, the inflammation of the membranes of the brain and spinal cord is due to the growth of the specific organism in the lymph and interstitial tissue elements . Poisons may have a selective influence upon some part of the nervous system .

The syphilitic poison is the most important factor in the production of two progressive degenerations of the nervous system—one affecting especially the afferent conducting tracts of the spinal cord, namely, locomotor ataxy, and the other affecting especially the frontal and central convolutions of the cerebral hemispheres, namely, general paralysis of the insane . A striking instance of the selective action of the syphilitic poison is shown in the fact that only in persons affected with acquired or inherited syphilis is a symptom known as See also:

• ARGYLL, EARLS AND DUKES OF

Argyll-See also:

• ROBERTSON, FREDERICK WILLIAM (1816-1853)
• ROBERTSON, GEORGE CROOM (1842-1892)
• ROBERTSON, JOSEPH (1810-1866)
• ROBERTSON, THOMAS WILLIAM (1829-1871)
• ROBERTSON, WILLIAM BRUCE (182o-1886)

Robertson See also:

• PUPIL (Lat. pupillus, orphan, minor, dim. of pupus, boy, allied to puer, from root pm- or peu-, to beget, cf. "pupa," Lat. for " doll," the name given to the stage intervening between the larval and imaginal stages in certain insects)

pupil found; this is the absence of the pupil reflex contraction to See also:

• LIGHT

light, while that for See also:

• ACCOMMODATION (Lat. accommodare, to make fit, from ad, to, cum, with, and modus, measure)

accommodation persists . Seeing that this is the most common See also:

• OBJECTIVE, or OBJECT GLASS

objective phenomenon in the two diseases mentioned, it strengthens the presumption, based on experience, that the syphilitic poison is the cause of these diseases in the See also:

• MAJORITY (Fr. majorite; Med. Lat. majoritas; Lat. major, greater)

majority of instances . Again, syphilis, when it attacks the supporting, enclosing and nutrient vascular tissues, shows a predilection to affect structures about the See also:

• BASE

base of the brain, and paralyses of the third nerve are almost pathognomonic of this disease . In rabies, although the whole nervous system is charged with the poison, the medulla oblongata (as shown by the symptoms) is especially affected . Again, in tetanus the bacilli are only found in the See also:

• WOUND (O. Eng. wund,connected with a Teutonic verb, meaning to strive, fight, suffer, seen in O. Eng. winnan, whence Eng. " win ")

wound; they must therefore be comparatively few in number, but they elaborate a virulent poison, which affects particular groups of neurones . The fact that lockjaw nearly always occurs first, shows chat the poison selects the motor See also:

• NUCLEUS (Lat. for the kernal of a nut, nux, the stone of fruit)

nucleus of the fifth nerve; but it is remarkable that experiment has shown that the tetanus toxin, if mixed with an emulsion of nervous matter before injection into an See also:

• ANIMAL
• ANIMAL (Lat. animalis, from anima, breath, soul)

animal, loses its toxicity . This fact indicates its See also:

• AFFINITY (Lat. affinitas, relationship by marriage, from offinis, bordering on, related to; finis, border, boundary)
• AFFINITY, CHEMICAL

affinity for nervous matter, and also a See also:

• POWER [WILLIAM GRATTAN] TYRONE (1797-1841)

power of absorption of the poison by some chemical substance in the nervous matter . Another example is offered by See also:

• DIPHTHERIA (from 8c4BEpa, a skin or membrane)

diphtheria . A neuro-toxin is produced by the local action of the bacilli, for they do not become freely generalized in the blood and tissues . Whether the poison is a See also:

• DIRECT

direct production of the bacilli themselves, or is an auto-toxin created in the body itself, by an influence exerted on the living fluids and tissues by a ferment-like product of the bacilli, is not determined . But whatever may be the source of the toxin, its effects upon the neurones are constant, as shown by the sufferings of the patients—paralysis of the soft See also:

• PALATE (Lat. palatum, possibly from the root of pascere, to feed)

palate, with nasal speech and regurgitation of fluids through the See also:

• NOSE (O.Eng. nosu, cf. Dutch neus, Swed. nos, snout; the Aix in Provence. Both at Aix and at Lyons he acquired great connexion with O.Eng. nasu is obscure, cf. Ger. Nase, Lat. pares, distinction by his labours during outbreaks of the plague. In nostrils,

nose when swallowing is attempted; inability to read, owing to the paralysis of the muscle of accommodation; weakness and into-ordination of the limbs, which may amount to paralysis; absence of the See also:

• KNEE (O. E. cneow, a word common to Indo-European languages, cf. Ger. Knie, Fr. genou, Span. hinojo, Lat. genu, Gr. ybvv, Sansk. janu)

knee-jerks; and often skin See also:

• ANAESTHESIA

anaesthesia The relation of protozoa to the existence of widespread diseases Protozoa affecting men and animals is becoming yearly of and greater importance and interest .

Certain hitherto obdiseases scure diseases in which the nervous system is profoundly of affected are now explained by the invasion of the tissues of the body by these lowly organisms, for example, fig . I) . The See also:

• DISCOVERY

discovery by Schaudinn of the presence of the Spirochaete Pallida (see See also:

• PLATE

Plate II. fig . 2) in the primary and secondary lesions of seventy successive cases of syphilis, and the general See also:

• ACCEPTANCE (Lat. acceptare, frequentative form of accipere, to receive)

acceptance of this organism as the cause of the disease, taken together with the fact that in many respects it simulates the trypanosome in its mode of See also:

• DIVISION (from Lat. dividere, to break up into parts, separate)

division and other characters, tend to prove that syphilis is also a protozoal disease . The bacterial invasion of tissues is generally characterized by a See also:

• MIGRATION

migration of polymorpho-nuclear leucocytes, but protozoal invasion is characterized by a formative hyperplasia of the fixed cell tissues, endothelial, See also:

• EPITHELIAL, ENDOTHELIAL

epithelial and conjunctival, and there is a See also:

• CLOSE
• CLOSE (from Lat. clausum, shut)
• CLOSE, MAXWELL HENRY (1822-1903)

close similarity in the defensive reaction of the tissues to all forms of protozoal invasion (see Plate II. with explanatory See also:

• TEXT (Lat. textum, woven fabric, from texere, to weave)

text) . If the cause of rabies be regarded as proved since the discovery of See also:

• NEGRI, ADA (187o– )

Negri bodies, we may assume that just as in See also:

• MALARIA

malaria the Haematozoon malariae undergoes its endocellular development in the red blood corpuscle, the protozoon of rabies undergoes its endocellular development in the nerve cell . Only a See also:

• SHORT, FRANCIS JOB (1857– )

short time has elapsed since Negri showed that in cases of rabies, whether experimental or otherwise, curious bodies measuring from I e to 20 µ could be constantly found in the nerve cells, and that these bodies are not found in the nerve cells in any other disease; so that even if the theory advanced that they are endocellular forms of protozoa prove not true, yet the discovery affords a valuable and expeditious means of determining whether a suspected animal suffered with rabies or not . It is known that the salivary glands and saliva contain the See also:

• VIRUS, CHRISTOBAL DE (1550?-1615?)

virus, even before the animal shows symptoms . It is known too that the central nervous system contains the virus and that it multiplies there . Experimental inoculation can be made either from the saliva or an emulsion of the central nervous system of an animal suffering with rabies . Moreover, the virus can pass through a Berkfeldt See also:

• FILTER (a word common in various forms to most European languages, adapted from the medieval Lat. fi-ltrum, felt, a material used as a filtering agent)

filter; and if the filtrable product be injected into an animal, the animal thus inoculated will See also:

• DIE
• DIE (Fr. de, from Lat. datum, given)

die of rabies and exhibit the Negri bodies . There are only two conclusions to be See also:

• DRAWN

drawn from these observations: (I) If it be a protozoal disease, the organism at one See also:

• PERIOD
• PERIOD (Gr. irepioSos, a going or way round, circuit, aepi, round, and &Sis, way, road)

period of its developmental See also:

• CYCLE
• CYCLE (Gr. KUK)^os, a circle)

cycle must be so small as to be able to pass through the pores of the Berkfeldt filter .

(2) Negri bodies are the result of See also:

• INTRA

intra-cellular degenerative changes caused by an elective affinity of the virus for the protoplasm of the nerve cell . The virus, whatever it may be, does not exist in the blood and other organs and tissues . Seeing that the Negri bodies cannot be found in the saliva, although the saliva contains the virus, nor can they be found in the peripheral nerves, although the virus passes by the lymphatics of the nerves to the nerve cells of the spinal ganglia and central nervous system, it must be concluded that the filtrable virus travels to the central nervous system and there increases . It is a remarkable fact that before the discovery of the Negri bodies, the diagnosis of rabies was made by microscopic examination of the spinal and sympathetic ganglia, particularly the ganglia of the vagus and fifth nerves . Changes were found similar to those met with in other protozoal diseases, namely, sleeping sickness, dourineand syphilis . These changes were proliferation of the interstitial connective tissue cells forming the supporting structure ~f the ganglion and hyperplasia of the lymphatic endothelial cells forming the See also:

• CAPSULE (from the Lat. capsula, a small box)

capsule containing the nerve cells . The See also:

• DIAGRAM

diagram here given (fig . I) after Volpino explains the supposed developmental cycle of the protozoon which is presumed to be the cause of rabies . The weak See also:

• LINK

link in the See also:

• CHAIN (through the O. Fr. citable, chcene, &c., from Lat. catena)

chain is the assumed sporozoit which is so small as to be capable of passing through a Berkfeidt filter . It has taken twenty years to lead to the See also:

• COMPLETE

complete knowledge of the life history of the malarial See also:

• PARASITE (From Gr. irapa, beside, Tiros food)

parasite and its relation to the disease, and all we can say is that there is now a certain amount of See also:

• EVIDENCE (Lat. evidentia, evideri, to appear clearly)

evidence forthcoming which tends to show that rabies is due to a protozoon, which Calkins, who discovered a similar body in the epithelial cells of variola, places among the rhizopods . There are certain chronic trypanosome infections in which the nervous symptoms form a special feature of the disease, Trypar+o. notably sleeping sickness (see Plate II. fig . I) and a some disease affecting horses, termed mal de coit or dourine. diseases The chronic trypanosome affections resemble in many and respects syphilis; they are characterized by local infection, affections enlargement of the nearest lymphatic glands, a general of the polyadenitis and successive eruptions, accompanied by nervous fever .

The tissue changes are the same whether we system. examine the primary seat of infection, papular eruptions on the mucous membrane or the skin, or the lymphatic glands . When the nervous system is affected a local or general chronic meningo-encephalitis is set up, characterized by a meningeal and 1 perivascular infiltration with lymphocytes and plasma cells, occasioned by a chronic irritative process, presumably caused in the case of sleeping sickness by the presence of See also:

• TRYPANOSOMES, or HAEMOFLAGELLATES

trypanosomes in the cerebro-spinal fluid (see fig . 8, Plate II.) . The same perivascular and meningeal infiltration with plasma cells and lymphocytes is found in syphilitic and parasyphilitic diseases of the nervous system (see Plate II., See also:

• FIGS

figs . 7 and 9) . The significance of pathological changes in the cerebro-spinal fluid has recently become of great importance in the diagnosis of nervous diseases, and a short See also:

• ACCOUNT
• ACCOUNT (through O. Fr. acont, Late Lat. comptum, cornputare, to calculate)

account of the subject in this See also:

• ARTICLE (from Lat. articulus, a joint)

article will therefore not be out of place . The cerebro-spinal fluid is clear like See also:

• WATER

water; it has a specific gravity of ioo6 and resembles in its composition the blood minus its corpuscular and albuminous constituents . It is secreted by the choroid plexus, and if any cause, such as See also:

• TUMOUR (Lat. tumor, a swelling)

tumour or meningitis, should interfere with its See also:

• ESCAPE (in mid. Eng. eschape or escape, from the O. Fr. eschapper, modern echapper, and escaper, low Lat. escapium, from ex, out of, and cappa, cape, cloak; cf. for the sense development the Gr. iichueoOat, literally to put off one's clothes, hence to sli

escape from the ventricles it gives rise by pressure to internal hydrocephalus and cerebral anaemia which may occasion epileptic convulsions and various degrees of drowsy stupor, lethargy, unconsciousness and even coma . Withdrawal of the fluid by lumbar puncture and by tapping the ventricles of the brain has been employed in treatment, but without very satisfactory results . If, however, lumbar puncture has proved of but little use in treatment, it has proved of inestimable service in the diagnosis of various diseases of the central nervous system . The fluid withdrawn may be examined in various ways which are complementary to one another . It should be centrifuged and the See also:

• DEPOSIT (Lat. depositurn, from deponere, to lay down, to put in the care of)

deposit examined microscopically if necessary after staining by suitable methods; the existence of cells Z;,r Stadia del virus fiftrabils i .3 5 From a coloured plate in Ceniralhkii Jtir Bakkriologie, by permission of Gustav See also:

• FISCHER
• FISCHER, EMIL (1852– )
• FISCHER, ERNST KUNO BERTHOLD (1824–1907)

Fischer .

4 nervous Sleeping Sickness, the cause of which has been definitely system. proved to be the Trypanosoma gambiense (see Plate II . 8 See also:

• PATHOLOGY (from Gr. raBos, suffering)

Pathology of the cerebrospinal fluld . 432 in a fluid which normally contains no cellular elements indicates disease of the central nervous system . In general paralysis, syphilis of the nervous system and tabes dorsalis even in early stages of these diseases, the deposit is seen to consist almost entirely of lymphocytes . Some evidence of the progress of the disease and the effect of treatment may be' obtained by counting the number of cells at different periods . In tubercular meningitis there are also lymphocytes in abundance although usually tubercle bacilli cannot readily be found, yet bacilli are See also:

• PRESENT

present, for injection of the fluid into a See also:

• GUINEA

guinea See also:

• PIG
• PIG (a word of obscure origin, connected with the Low Ger. and Dut. word of the same meaning, bigge)

pig is a certain means of determining whether it is tubercular meningitis or not; for if it is, the animal is sure to develop tubercle . In epidemic cerebro-spinal meningitis the cells in the deposit are polymorphonuclear leucocytes, and in the leucocytes can be seen the specific organism Diplococcus intracellularis with its characteristic staining and cultural characters . Septic, pneumonic and pyogenic organisms may also invade the central nervous system giving rise to meningitis, and in these cases the deposit will be polymorplio-nuclear leucocytes, and perhaps the specific organisms may be seen in stained preparations; but if not, they can be obtained by cultural methods . In all operations of this See also:

• KIND (O. E. ge-cynde, from the same root as is seen in " kin," supra)

kind antiseptic precautions must be adopted both for the safety of the patient and the reliability of the findings, other-See also:

• WISE, HENRY ALEXANDER (1806-1876)
• WISE, ISAAC MAYER (1819-1900)

wise organisms in the skin may contaminate the fluid withdrawn . Other formed elements which may be found are large cells, macrophages containing blood pigment; these cells indicate that some haemorrhage has occurred . One of the most important uses of lumbar puncture has been the discovery of the cause of sleeping sickness . The fluid withdrawn and centrifuged contains, as one would expect from the lesions in the brain and spinal cord, large See also:

• NUMBERS, BOOK OF
• NUMBERS, PARTITION OF

numbers of lymphocytes and plasma cells (see Plate II. fig. to), but besides, the actively moving organisms (Trypanosome gambiense) (see Plate II. fig .

I) which are the essential cause of the disease . It has been remarked that the normal cerebro-spinal fluid is devoid of proteins, but in the various forms of disease above described as containing cells in the centrifuged deposit, there is also in the fluid an appreciable amount of proteins . If pathological cerebro-spinal fluid be added to an equal quantity of saturated See also:

• SOLUTION (from Lat. solvere, to loosen, dissolve)

solution of sodium sulphate there will be a distinct turbidity indicating the presence of proteins in appreciable quantity . This appreciable quantity of proteins is especially significant in the case of fluid withdrawn from cases of general paralysis or tabes, for it goes pari passu in amount with a reaction which is known as the Wassermann sero-diagnostic reaction for syphilis; a reaction, however, which is too complicated to explain here, but which is of the greatest importance for the diagnosis of general paralysis and tabes dorsalis . The finding of the Try panosoma gambiense in the cerebro-spinal fluid in sleeping sickness led to the belief that the specific organism of syphilis, Spirochoete pallidum might be found in the cerebro-spinal fluid in syphilitic diseases of the nervous system, but although in a few instances successful inoculation of animals with syphilis by injection of the cerebro-spinal fluid has been effected, yet the organism has only once been found in the fluid withdrawn by lumbar puncture . 'It has long been a See also:

• PUZZLE

puzzle why only certain individuals, about 5 %-8 %-of" those infected with syphilis, should subsequently suffer with diseases of the nervous system . The skin and mucous orifices are the most common sites of secondary and See also:

• TERTIARY

tertiary lesions and after this the nervous system, but no tissue or structure in the body is exempt . It is probable that the virus attacks tissues when in a low See also:

• STATE
• STATE, GREAT OFFICERS OF

state of resistance in a See also:

• RANDOM (older forms randon, randrun; from the French, cf. randir, to run quickly, impetuously; generally taken to be of Teutonic origin and connected with Ger. Rand, edge, brim, the idea being possibly of a brimming river)

random metastatic manner . It is necessary to distinguish between these true syphilitic lesions which are the result of the reaction of the tissues to the living virus and the parasyphilitic affections, which own a different cause . The former may be most successfully treated with See also:

• MERCURY
• MERCURY (MERCU1uus)
• MERCURY (symbol Hg, atomic weight = 2oo)

mercury, which has the power of devitalizing the specific virus and preventing its multiplication, the same as atoxyl prevents the multiplication of the trypanosomes . Iodide of See also:

• POTASSIUM [symbol K (from kalium), atomic weight 39.114 0=16)]

potassium favours the absorption of the degenerative products of the cells, and syphilitic tumours may rapidly resolve and disappear under the influence of these drugs . Nervous symptoms even so severe as to threaten a rapidly fatal termination may disappear with energetic treatment when they are due to the syphilitic virus producing an inflammatory reaction of the tissues; not so, however, when the symptoms are slow, insidious and progressive, due to a primary decay of the neurones, e.g. the parasyphilitic affections tabes dorsalis and general paralysis of the insane, which are really one and the same disease owning the same cause .

We can understand that it may be a See also:

• CHANCE (through the O. Fr. cheance, from the Late Lat. cadentia, things happening, from cadere, to fall out, happen; cf. " case ")

chance whether a See also:

• MAN
• MAN, ISLE OF (anc. Mona)

man suffers with true brain or spinal cord syphilis, because it may be a chance whether the virus is carried there by the blood-vessels and lymphatics, and if carried there finds a suitable nidus to develop . But the parasyphilitic affections appear to be due to a premature primary decay of the neural elements owing to bio-chemical changes in the body induced by reaction to the syphilitic virus: There are a See also:

• GOOD, JOHN MASON (1764-1827)

good many facts now forthcoming which show that the subjects of parasyphilis present mild symptoms of syphilis, and upon an See also:

• AVERAGE

average it is not until ten years later that they develop nervous symptoms, which are aggravated rather than benefited by mercury . Such subjects are immune to a second attack of syphilis, and the examination of the blood and cerebro-spinal fluid by the Wassermann reaction of the deviation of the See also:

• COMPLEMENT (Lat. complementum, from complere, to fill up)

Complement reveals the fact that there is a bio-chemical change; the presence of this reaction may be correlated with the fact that these fluids contain lipoid sub-stances and a globulin in excess . The cerebro-spinal fluid contains these lipoid substances and globulin in proportion to the degree of decay of the neural structure; they arise from the destructive metabolism of the neural elements . But the same lipoid substances and globulin are found only in the blood of syphilitic individuals, consequently it must be supposed that in general paralysis and tabes certain groups and systems of neurones undergo decay from excessive metabolic activity which is brought about by two factors (i) a bio-chemical stimulus, the syphilitic poison, (2) excessive physiological stress, which in non-syphilitic individuals would only lead to cerebral or spinal neurasthenia . Sleeping Sickness is characterized by a progressive lethargy, paresis, tremors and the signs and symptoms of neural exhaustion without neural destruction; it comes on slowly and insidiously often years after infection and eventually terminates fatally by intercurrent disease or paralysis of the bulbar centres . Examination of the central nervous system explains the fatal lethargy; the perivascular and meningeal lymphatics are filled with lymphocytes and plasma cells (Plate II. fig . 6.); moreover, the neuroglia supporting cells have undergone a rapid formative proliferation (Plate II. figs . 3 and 5) . The effect of this morbid process is to deprive the neural elements of oxygen and See also:

• NUTRITION

nutrition; the neurones in consequence, although not destroyed, are nevertheless unable to function for more than a brief period . (y) Poisons introduced into the Body.—The most widespread and potent cause of nervous and mental disease is the abuse of alcoholic stimulants . At least 20 % of the inmates of the asylums of London are admitted with a history of alcoholism .

In not more than to % is See also:

• ALCOHOL

alcohol the efficient cause of the mental disease; in many it is only a contributory factor, and in not a few the See also:

• LAPSE (Lat. lapses, a slip or departure)

lapse from moderation to intemperance is the first sign of the mental breakdown . Most of the patients admitted inherit the neuropathic tendency, and it is a rare thing, among such, to find cirrhosis of the liver with See also:

• ASCITES (Gr. aaKLTl7s, dropsical, from a.QKOS, bag; sc. v6aos, disease)

ascites, a condition which indicates long persistent spirit-drinking . The writer, from a very large experience as pathologist to the asylums of London, only remembers one such case, and that was in a notorious woman who was convicted nearly four See also:

• HUNDRED

hundred times for See also:

• DRUNKENNESS

drunkenness before she could be certified as of unsound mind, a fact which indicates that she inherited a very See also:

• STABLE

stable nervous constitution . To people with unstable nervous systems a relatively small quantity of alcohol may act as a poison . Thus epileptics, imbeciles, criminals, potential lunatics, hysterics, neurasthenics and the subjects of See also:

• HEAD (in 0. Eng. heafad; the word is common to Teutonic languages; cf. Dutch hoofd, Ger. Haupt, generally taken to be in origin connected with Lat. caput, Gr. KerbOvi7)
• HEAD, SIR EDMUND WALKER, BART
• HEAD, SIR FRANCIS BOND, BART

head injury are liable to become See also:

• ANTI, or CAMPA

anti-social and dangerous to themselves and others by See also:

• INDULGENCE (Lat. indulgentia, indulgere, to grant, concede)

indulgence in quantities of alcohol which would have no harmful effect upon the mentally stable and See also:

• SOUND
• SOUND, THE (Danish Oresund)

sound individual . Alcohol may produce acute delirium, with fine tremors, and, generally, visual hallucinations of a horrible nature, indicating acute toxic influence upon the brain . This apparently acute form of alcohol poisoning is met with in chronic inebriates especially; it is much commoner in men than in women, and it is remarkable how a severe injury or illness, such as See also:

• PNEUMONIA (Gr. ?rveu AMP, lung)

pneumonia, will bring out delirium tremens in a drunkard . Chronic alcoholism manifests itself in a variety of ways according to the inborn temperament of the individual . The well-fed man with an inborn stable well-balanced mental organization is able to consume daily large quantities of alcohol with no other obvious effect than the lowered moral sense of indulgence in a vicious See also:

• HABIT (through the French from Lat. habitus, from habere, to have, hold, or, in a reflective sense, to be in a certain condition; in many of the English senses the French use habitude, not habit)

habit . However, chronic alcoholics form a large proportion of those convicted for crimes of violence, See also:

• HOMICIDE (Lat. homicidium)

homicide, See also:

• SUICIDE (from Lat. sui, of oneself, and cidium, from cued ere, to kill)

suicide and sexual offences . Alcohol acts especially upon the higher centres of the brain, and a drunken man may exhibit " the abstract and brief See also:

• CHRONICLE (from Gr. Xpovos, time)

chronicle of insanity, going through its successive phases in a short period of time " (Maudsley) . The effect on the nervous system of chronic tippling may be dementia, a very characteristic manifestation of the mental degradation being absence of knowledge of time and place, See also:

• PERSONAL

personal illusions and loss of memory of See also:

• RECENT

recent events, indicating a failure of receptivity and of the formation of memory-pictures in the higher centres, mental confusion, delusions of persecution, and especially a morbid See also:

• JEALOUSY (adapted from Fr. jalousie, formed from jaloux, jealous, Low Lat. zelosus, Gr. j'i os, ardour, zeal, from the root seen in '&u', to boil, ferment; cf. " yeast ")

jealousy with suspicions of fidelity of the See also:

• HUSBAND

husband by the wife or of the wife by the husband .

A certain amount of improvement may occur when See also:

• TOTAL

total See also:

• ABSTINENCE (from Lat. abstinere, to abstain)

abstinence is enforced, which shows the poison has damaged but not destroyed the nervous elements . There is also a form of mental disease characterized especially by hallucinations of See also:

• HEARING (formed from the verb " to hear," O. Eng. hyran, heron, &c., a common Teutonic verb; cf. Ger. Koren, Dutch hooren, &c.; the O. Tent. form is seen in Goth. hausjan; the initial h makes any connexion with " ear," Lat. audire, or Gr. &Kobew very doub

hearing and vision, associated with delusions usually of a persecuting nature, unaccompanied by other marked mental disorder . Abstinence and proper See also:

• CONTROL (Fr. contrdle, older form contre rolle, from Med. Lat. contra-rotulus, a counter roll or copy of a document used to check the original; there is no instance in English of the use of " control " in this, its literal, meaning)

control generally ends in recovery, but such cases so frequently relapse that it is fairly certain that alcohol is an exciting factor to a morbid or insane temperament . Besides mental symptoms of chronic alcoholic poisoning, there is frequently paralysis, affecting especially the See also:

• LOWER

lower limbs (structures suffer most where vitality is least), although the upper limbs, and even the See also:

• RESPIRATORY

respiratory muscles, may be affected in severe cases . The patient, usually of the female See also:

• SEX (Lat. sexes; possibly connected with secure, to cut)

sex, becomes help-less and bedridden, and death frequently occurs from heart failure . Characteristic features of this See also:

• AFFECTION (Lat. ad, and facere, to do something to, sc. a person)

affection are great tenderness on pressure of the muscles, especially of the calves, absence of reflexes, a variable degree of skin anaesthesia, wasting of muscles and alteration of the normal See also:

• ELECTRICAL
• ELECTRICAL (or ELECTROSTATIC) MACHINE

electrical reactions, and frequently pyrexia . There is no loss of control over the See also:

• BLADDER (from A.S. blaeddre, connected with bl¢wan, to blow, cf. Ger. blase)

bladder and bowels, unless there is very marked dementia . This "complex of symptoms points to a peripheral polyneuritis, although frequently changes occur also in the ganglion cells, from which the See also:

• AXIS (Lat. for " axle ")

axis cylinders of the nerves have their origin (vide figs . 2, 3, 4, and 5) . Alcoholic polyneuritic psychosis affecting women in many ways resembles delirium tremens; the fact that neuritis occurs much more frequently in women is probably associated with a greater liability to the influence of microbial toxins by absorption from the organs of See also:

• REPRODUCTION

reproduction . Many other poisons, notably lead and See also:

• ARSENIC (symbol As, atomic weight 75.0)

arsenic, the specific fevers before mentioned, syphilis and alterations of the blood due to imperfect metabolism, such as occur in diabetes and See also:

• GOUT

gout, may produce, or become important factors in producing, peripheral neuritis . The outbreak of arsenical neuritis from See also:

• BEER

beer containing this poison in See also:

• MANCHESTER
• MANCHESTER (popularly Manchester-by-the-Sea)
• MANCHESTER, EARLS AND DUKES OF

Manchester in 1900 is of interest, from the fact that the symptoms closely resembled acute alcoholic neuritis .

A distinctive feature, however, was the pigmentation of the skin and the severity of the nervous symptoms . A disease which is common in the See also:

• EAST
• EAST, ALFRED (1849- )

East, termed Beriberi, is a form of neuritis, the cause of which is not exactly known (see BERIBERI) . Anaesthetic leprosy is an interstitial inflammation of the nerves due to the Lepra bacillus . Among the nervous diseases due to occupation may be cited lead-poisoning . This, is See also:

• PECULIAR

peculiar in selecting the nerve which supplies the extensor muscles of the See also:

• WRIST

wrist and fingers, so that dropped wrist is almost characteristic of this form of toxic neuritis . Lead also produces a chronic inflammation of the cerebral cortex, Encephalitis saturnina, causing a complex of symptoms, namely, dementia, loss of memory, weakened See also:

• INTELLECT (Lat. intellectus, from intelligere, to understand)

intellect, paresis and epileptiform seizures, hallucinations of sight and hearing, and mental exaltation or depression . See also:

• MIRROR (through O. Fr. mirour, mod. miroir, from a sup-posed Late Lat. miratorium, from mirari, to admire)

Mirror-makers suffer with characteristic fine tremors, from the slow absorption of mercury into the system . Workmen at indiarubber factories may suffer from severe mental symptoms, owing to the inhalation of the fumes of bisulphide of See also:

• CARBON (symbol C, atomic weight 12)

carbon . Serious nervous symptoms have followed carbon monoxide poisoning . Cases which have re-covered from the immediate effects have suffered with dementia and symptoms of disseminated sclerosis, the result of multiple haemorrhagic softenings . There are a certain number of poisons, besides alcohol, which act upon the nervous system when continually entering the body as the result of a habit, namely, See also:

• ABSINTHE

absinthe, See also:

• ETHER, (C2H5)2O

ether, See also:

• COCAINE, C17H21NO4

cocaine, See also:

• OPIUM (Gr. amov, dim. from Orbs, juice)

opium, morphia, See also:

• HASHISH, or HASHEESH

hashish and See also:

• TOBACCO

tobacco . Each of these poisons produces a train of symptoms denoting a selective influence upon certain parts of the nervous system .

In See also:

• ILLUSTRATION

illustration thereof may be mentioned impairment of central vision in tobacco amblyopia . The disease See also:

• PELLAGRA (Ital. pelle agra, smarting skin)

pellagra, an affection of the skin associated with de-generative changes in the brain and spinal cord and characterized by See also:

• MELANCHOLY (Gr. µe)tayXotia, from µEtas, black, and Xotii, bile)

melancholy with suicidal impulses, sometimes mania associated with paresis, was long considered to bedue to the eating of See also:

• BAD, BCD

bad