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Lorsque le document est trop grand pour Atre reproduit en un seul clichA, 11 est filmA A partir de Tangle supArieur gauche, de gauche k droite, et de haut en bas, en prenant le nombre d'images nAcessaire. Les diagrammes suivants illustrent la m6thode. 1 2 3 1 2 3 4 5 6 The Alimentary Canal and Human Decay in Relation to THE Neurons. -■ ST SIR JAMES GRANT. M.D., F.R.C.P., (Lond.) COnsultinK Physician, General Hospital and St. Luke's Hospital, Ottawa. KEPBlNtfD PKOM THK !J|l0nt«cat p^cxlljcaX ^onxn^X November, 1898, THE ALIMENTARY CANAL AND HUMAN DECAY IN RELATION TO THE NEURONS.' BY Sir James Grant, M.D., F.R.C.P. (Loiui.), Consulting Physician, General Hospital and St. Luke's Hospital, Ottawa. Death is a complex pi-oblem. In the varied stages of growth in the Imman system, we trace frequent indications of decay. At an early age, the hair bulb dies, the hair drops out, and disappears. In the same way, teeth decay, and tlie masticatory process is being rapidly accomplished, more by artificial than natural grinders. Such evi- dences of lessened vitality, are not confined to these tissues alone. Nerves and nerve centres participate readily. No part of the human system is attracting closer or more careful oKservation than nerve tissue and the part it plays in the promotion of the vital spark, so essential to every act of life. The brain is the great battery, plastic, pliant, thought producing, and having as its matrix, cells, which com- municate with the cells (nervous) in all parts of the human frame. This linking of cell agency is all important, any interruption to such connection being at once marked by functional inactivity. Recent discoveries, in the line of nerve tissue formation, have defined small cellular, almost rod shaped bodies, as component parts of cell nervous tissue, known as neurons, which doubtless play an exceedingly impor- tant part, as to the elimination of normal nerve power, without which, no positively healthy function can be established. For some time, n)y attention has been directed towards a study of tlie alimi-n- tary canal, so peculiarly constituted. Into this canal, from the mouth to the anus, are poured the .secretions of the vai'ious glands, outside and inside of which, is more than a life's study. Sanitary science is mak- ing rapid progress, but outside sewage cannot compare, as to import- ance, with the internal sewage of the human system. It is a well known fact what the toxic effect of an impure gas is upon the system under the most ordinary circumstances. So in the intestinal canal supplied by a nervous system of a most elaborate and connile.x struc- ture, it is most reasonable to suppose that the activity of these very neurons, in the ganglionic centres around this very canal, shouM in time become subject to marked functional inactivit}', and long prior to any evidence whatever of organic disease. The gases of the human system are not so noxious as carbonic acid, and still, the wantT ' P-: ) . the Medical Society, Ottawa, October 27th, '1898. a**i 2 of care in the digestive process, cannot, ond in fact does not, fail to bring about results of a most telling character in the very process of sanguification. The death process in life, is often slow, and yet, progressive in character. Intestinal villi, and the mucous membrane of this complicated alimentary canal, depend largely on the distribu- tion of normal nerve force, in order to keep up normal activity. In this very canal, the death process frequently sets in, long prior to a recognition of the fact. One of the most interesting topics, recently brought to notice by at least four or five writers, two in Germany, one in France and one in America, is the idea, that the nerve cells, were capable of movement, to such an extent as to enable them, to alter the degree of their relationship to one another. The only physiological observation quoted in behalf of this theory, is that in 1890, by Wiedershein, a German, who saw in " Leptodora Hyalina," an inver- tebrate, one of the Entomosti-aca, the nerve cells of the oesophageal ganglion move in a slow flowing fashion. Altered relationship of the neurons may be connected with a retarded distribution of nerve power, and thus become closely as,sociated with the development of the hysteri- cal paralytic condition, so transitory in character. The explanation given, is that the neurons of the arm centre of the cortex, retract their processes in such a way, that their end tufts, no longer bear the normal relation to the spinal neurons. We must acknowledge that a new sphere of observaticm, is opened up, by this attractive departure in neurological structure, having so wide a range, and yet so closely a.sso- ciated, with the normal distribution of nerve power. The process of renewal of old combinations of neurons, has been ingeniously_ worked out, and may lead to the discovery of new truths, of much practical value, as to the regulating power of nervous energy. " Experiments " appear to aftbrd adequate evidence that, in a normal state of the body, " the integrity of the medullary vaso-motor centre, is essential to the " production and distribution of those continued constrictor impulses, " by which the general arterial tone of the body is maintained, and that " an increase or decrease of vaso-constrictor action in particular artiries- " or in arteries generally, is brought about by means of the sam.e " medullary vasomoter centre. But we must not conclude therefore " that this small portion of the meduUa-oblongata is the only part of " the central nervous .system which can act, as a centre for vasomotor " fibres. We are rather to suppose, that the spinal cord, along its whole " length, contains, interlaced with the reflex and other mechanisms by " which the skeleton umscles are governed, vaso-motor centres and " mechanisms of varied complexity, the details of whose functions and " topography, have yet largely lo be worked out." {Foster's Physiology^ 1893. p. 281 and 284.) 8 That there is much new ground to be broken, in the line of obser- vation, connected with the spinal vaso-motor centres, is conceded by leading physiologists. " It has been demonstrated that the body is " constantly subjected to the risks of poisons produced within itself, " many of the poisons produced, such as the ptomaines and leucomaines, " are of the chemical nature of the previously known alkaloids, in " toxic power, and reproduce their leading effects. The organism, " even in a state of (supposed) health, is a veritable storehouse of these " toxic substances. The respiratory passages, and intestinal canal, are " crowded with micro-organisms. In these circumstances it is of " interest to enquire, what defence, man can oppose to the disease " and death producing poisons, by whicli he is so constantly endan- " gered." (Address in Medicine by Thomas Richard Fraser, M.D., British Medical Association.) Long prior to disease, the result of toxic origin, we have the indications of toxic functional di.sturbance, and nowhere more so, than in the intestinal canal. According to Foster's (p. 285) Physiology, the chief and usual cause of the move- ments of the stomach and intestines, is the presence of food in the interior. " The afferent impulses from the stomach travel apparently by the vagus, but we do not know the exact manner in which the food 'produces the movevient, and again (on page 384) the alimentary canal, like the heart, though to a less degree, possesses within itself such mechanisms, as are requisite for carrying out its own movements, and as in the case of the heart, there is no adequate evidence that the ganglia scattered in its muscular walls, viz., those forming the plexus of Auerbach, play any part in developing these movements." Thus far it is quite evident, a considerable degree of doubt exists, as to the exact physiological ground work, on which rests the remarkable changes which take place in food transformation, prior to becoming incorporated with human tissue. The conversion of vegetable matter into muscle or blood, is unique in character, and entirely in advance of the finest external laboratory manipulation. The plexus of Meissner in the submucous coat of the bowels ; the plexus of Auerbach, in the thin sheet of connective tissue of the muscnlar lajers of the intestine ; and lastly, the vaso-motor centres of the spinal cord, constitute a trio of nerve generating power alike interesting and attractive, and which doubtless are intimately associated, in the transforming process of food to tissue, and yet we must acknowledge, with Prof. Charcot, that \ there still exist numerous lacunse in this ntudy. The nervous :?ystem, reduced to very simplest form, is represented by two elements, a nerve cell, and a conducting tube, and the tissociation of these two elements constitutes nerve centres, and nerves, which guide and direct capillary cii'culation in every part of tlie liunian frame. The point to whicn I desire to call attention at present, is with reference to the influence j^radually produced in the system, by defective intestinal sevvaj^e, and how it is to be remedied. That such at times produces a poisonous in- Huence on nerve tissue and capillary circulation, is undoubted in character, and of much greater importance and frequency, than generally supposed. While noting the effect of electricity, through the neurotone, on the muscular tissue of the dilated or ballooned bowel, I was impressed by the marked improvement othei'wise, in the system, in consequence of which, a series of observations was made, on the alimentary canal, which led to the following deductions : 1st. The irregularities of the digestive process in the alimentary canal, are of much more frequent occurrence than generally supposed. 2nd. The internal sewage of the system, cannot be too critically examined. 3rd. The toxic effect of such accumulations leads to a condition of the nerve centres, changed in character, and destructive in a great measure to the elimination of normal nerve energy, in the ganglionic nerve centres. That the recently discovered neui'ons, play an important part in the vitalizing power of nerve energy, is a reasonable deduct a. A path is now open, in which life, under ordinary circumstances, viay be prolonged, providing no organic disease is present. There is little doubt, that as years pass on, in a quasi indifferent manner, the neurons, of the ganglionic centres, particularly in close relationship with the alimentary canal, becom influenced, by the toxic effect, of defective internal sewage, and as the result, blood making power becomes defective, as photographed in facial expression. The question is, how to counteract this condition, and bring about, as near as possible, a normal state of the system. One of the first points to observe, beyond the ordinary conditions of the alimentary canal, is the state of the abdominal nervous system. Under ordinary circumstances the application of the Electro-Neurotone of Hodgkinson, to the abdo- minal walls, produces a sensation electric in character, which must be adjusted, to the needs of the patient. The power of static electricity seems to be chiefly as a regulator of functions, according to Alunnell, of Brooklyn. It increases metabolism, so a person can absorb more oxygen, and this impi'ovement in nutrition, is a vast power for good. The spark of its action, sets up a molecular change, and acts as a stimulating massage. At the convention of the Ameri.-an Electro- therapeutic Association, Dec. 29, 1894, (The Tivies and Register) it was reported, that static electricity causes contraction of the protoplasm, both animal and vegetable, it excites nerve fibres, nerve centres, and nurvi' cells, to functional action, and to produce their separate effects, motor, sensory, secretory, sympathetic and vaso-motor. These data, electric in character, induced me to make further en(|uiry, by which it was ascertained that many cases of constitutional debility had their ori^'in iti the alimentary canal, aud that the nervous system partici- pated lari^tly in such abnormal conditions. In the discussion of Dr. Buzzard's paper (Edinburgh Meeting Bi'itish Medical Association) on the Selective Action of Toxic Bodies on the Nervous System, the following stat ment was made : " It seems " likely from the clinical symptoms, that whwst at the outset there is '• profound interference with the nutrition of ' the neurons ' over a " widely extended area, recovery rapidly occurs, in such as do not " suffer change in tlieir nucleus." It is this class of cases particularly, to which I refer, of a purely functional character, and not associated with inmUar sclerosis, or even uiultlple ncaritis, both of which con- ditions are most likely the result of degenerative changes in nerve structure. (Jon.stitutional deltility, the result of defective intestinal assimilati(m, protracted in character, is undoubtedly a powerful factor, in the poisoned nervous .system, to keep up that condition. The neurons of the nerve centres, although not changed in structure, are in a measure defective as to function. Here, as well as in other neurotic states of the system, the precise condition is not, as yet, defined. However, when by the neurotone treatment, so marked im- provement as to function takes place, the inference is, that tlie electric current, in a measure re-vivified the nerve centres, and their neurons, in direct connection, so as to re-establish the normal distribution of nerve power, in those parts defective in that particular. The follow- ing recent observations of E. duller and Manicatide (March 3rd, 1898, Deutsche Medlcinische Wochenschrift). " Examined the cells in the central nervous system, of seven infants, under three months of age, who had suff'ered from gastro-intestinal diseases. In all seven, changes were found in the cells, of the brain and spinal cord. The cells were found to lose their form, become indistinct and even the processes of the cf Us disappear, and the nucleus, as well as the nucleolus, often displ'iced." These observations point beyond a doubt, to a close relationship between alimentary assimilation and nerve cell agency. Everything has a beginning, and the problem is, how to obviate the difficulties, which may take place even in ordinary intestinal functional disturb- ance, at a time when treatment may be of service and life's span thus 'prolonged. The physiological action of electric currents plays an important role, in the treatment of diseases of the nervous system. True, the nerve current has been compared to electricity, but this idea, 6 has recently been abandoned. The important point is, that by the action of the electric current, we modify the electric state of the nerve, and the properties of the sensory or motor nerves reappear, and perform their regular part in the economy. There, by the influence of currents, nutrition is sure to improve the vitality of the tissues stimulated to renewed energy, brought about by a direct action on the trophic nerves, and on the tissue molecules of the organism, whose vitality is thus summoned into inci'eased activity. Alexander James, M.D. (Edinburgh, British dical Association), in his paper on the Clinical Varieties of Hepatic Cirrhosis, stated " that the effect of an irritant on living tissue is increased metabolic activity, and the effect of increased metabolic activity is the sacrifice of growth and development to reproduction." The systemic condition on which I now base these observations, is in cases of diminished metabolic activity in the neurons, prior to a sacrifice of growth and development, as after that stage, little if any influence in an electric method can be exercised. Fully aware of the doubt and uncertainty of biological problems, and while seeking for the explanation of certain functional disturbances, these few facts have been noted. The alimentary canal and its distubances, have within the past few years, attracted more than ordinary attention. The impression is gaining ground, that various manifestations of disease may arise thi'ough the ab.sorption of toxic substances from within the canal. The arguments in favour of the toxaimic origin of intestinal disturb- ance are not sufficiently clear, owing to the absence of clinical data based on the pathological conditions involved. The important fact announced in 1880 by Baumann, that the various aromatic substances formed within the intestine, such as indol, phenol, cresol, etc., produced by " anwrobic bacteria" upon proteids, are passed off by the body, when absorbed through the urine, in combination with sulphuric acid in the form of etherial sulphates (Herter, M. Y. Medical Journal, July, 1895). This fact forms the basis of the study of intes- tinal putrifaction, on which line of chemical research, this subject requires much careful enquiiy. The frequency of perityphlitis is an acknowledged fact, and the discovery by Salkowski, of pathological quantities of indican in connection with that disease, leads to a line of investigation of much interest. The symptoms which usually direct attention to the alimentary canal, are often so slight as to readily escape notice, while at the same time, the constitutional results may be well defined. The following cases are presented as an illus- tration of clinical manifestations occurring in individuals with whom intestinal indigestion and neurotic disturbance were prominent factors. The sensation of pain in cases of intestinal indigestion is not a usual symptom, and it is in quasi indifferent cases, where putrefactive changes are slowly progressing without even spasm of the muscular coats of the intestines, that careful information should be obtained, not only as to the rapidity of the digestive process, but also as to the peculiarity of the alvine evacuations. In no part of the entire system, does functional disturbance proceed more steadily and quietly than in the alimentary canal, and it is remarkable how its mucous lining accommodates itself to the high living of the present age. Diminution as to firmness of muscular fibre ; occasionally indica- tions of lassitude ; a feeling of emptiness, described as a " gone feel- ing," indisposition for either mental or physical exertion, without any assignable cause, are marked pointers for nenrotone treatment to correct functional, neurotic, and digestive irregularities, in the alimentary canal, prior to the advent of structural change. The treatment in such cases, beyond ordinary tonics and purgatives, as required, consists in neurotone applications, to the abdomen and spinal column alternately, at intervals of two or three days, and not over ten minutes at any one time, the parts being first moistened by a sponge. Such may be continued, until the nerve centres, recover their tone, which usually occupies from three to four weeks, in ordinary cases. When objec- tions are experienced, the applications may commence on the arms and legs. ' ' Case I. E. G., aet. 58 years of age, of temperate habits, has had in- different health, for some months, at times depressed and despondent, indications of debility, insomia and irregular appetite. Occasional headache, coated tongue, flatulence, and at times a sense of cardiac uneasiness, urine voided in normal quantity, with excess of lithic acid ; these symptoms alternated considerably, just as abdominal functional disturbance fluctuated. Baths, tonics and diet, prescribed ad yet the almost hypochondriac condition continued, until placed under neurotone treatment. After three weeks, he was greatly improved in health, and quite equal to his usual official duties. Case II. Mrs. McQ., a^t. 68 years, mother of four children, weight 103 lbs., temperate in every way. Experienced a feeling of general debility, languid, wanting in tone, and in fact, indisposed to undertake any bodily exertion whatever, appetite small, and digestive power feeble. Cardiac action regular, but weak. Muscular system flabby and deficient as to normal tenacity, slight constipation, intestinal flatulence, but no abdominal pain. Sleep only moderately conjpo.sed. Urine voided in normal quantity, with no presence of sugar or albu- men. The indisposition extended over a period of fully two years. June 5, 1898, placed under neurotone treatment ; as she improved the 8 sensitiveness of the skin became more acute, and in about two months she looked like a different person, active, willing to walk, and without fatiguft ; appetite much improved ; the entire tone of the nervous system was such as not experienced for years previous, and returned to her home in British Columbia, with every hope of many years of increased usefulness. Case III. Mr. B., aet. 28 years, weight 128 lbs., temperate. Has i'ounil of late that he tires readily, and awakes in the morning not sufficiently refreshed. No oi'ganic disease. For fully three years, experienced indications of debility, without any special cause except irregularity as to intestinal absorption, abdomen at times consider- ably distended with gas. Marked palor of face and lips, and an exsanguine condition of the body generally. A peculiar leaden feel- ing about the abdomen, with a ballooned duodenum. Bowels not regular. No nausea or vomiting. Appetite as a whole good, but the strength and support gained, not in proportion to food taken, evidenc- ing the escape of nutrient material. Urine voided in normal quantity, but overcharged with lithates. About twelve months ago became indisposed, owing to the peculiar feeling in his bowels, which continued until Ma}', 1898, when I placed him under neurotone treatment twice a week for two months, after which the improvement as to his general cuiidition was mcst marked. Prior to that date, tonics had little etlect. At present he can wheel 15 to 20 miles a day, without incon- venience, which he could not undertake for months previous. The tone of the entire nervous system is most marked, and life now most enjoyable. Ca.se IV. Mrs. F., set. 78 years, mother of a large family, weight 108 lbs. Temperate. No evidence of organic disease. Muscles thin and riabby. Functions of the system, regular as a whole. For several years experienced flatulence and constipation, regulated by occasional castor oil. About two years ago, the digestive system, particularly the alimentary canal, was the seat of very considerable irregularity. A degree of general debility followed, attended by marked weakness, almost approaching heart failure, and inability to move about, with accustomed activity. In May, 1898, placed her under i^ewrotone treatment, continued twice each week, for a period of two months. At the expiration of that time, markedly improved, as to alimentary digestive power, and the general vigor of her .system. Oct. 12, 1898. Moves about her home with the activity of twenty years ago, and now expresses herself as f(!eling almo.st youthful once more. This is an illustration of neurons, almost on the shelf, called into action again and becoming useful factors in the promotion of renewed life and activity.