DYNAMICS OF NERVE & MUSCLE BY CHARLES BLAND RADCLIFFE, M.D., F.R.C.P., PHYSICIAN TO THE WESTMINSTER, HOSPITAL, AND TO THE NATIONAL HOSPITAL THE PARALYSED AND EPILEPTIC. Le nom de Galvani ne perira pas ; les siecles futurs profiteront de sa decouverte, et, comme le dit Brandes, ils reconnattront " que ia physiologic doit a Galvani et a Harvey ses deux bases principales." VON HUMBOLDT. MACMILLAN AND CO. 1871. LONDON : HARRISON AND SONS, PRINTERS IN ORDINARY TO HER MAJESTY, ST. MARTIN'S LANE. 3J PREFA CE. ORE than twenty years ago I was not a little puzzled by seeing what happened to a rabbit after death by strychnia. The animal at death was propped up against the side of a box, touching the ground only by the tips of its toes, with its legs rigidly stretched out, and with its neck and body arched backwards until the head almost pressed upon the tail, and so it remained until the putrefactive unstiffening of the muscles caused it to fall down. The contraction which had kept the body fixed in this position for some time before death had evidently not been relaxed by death, for, if it had been, the body would have then fallen as it fell eventually. The spasms before death and the rigidity after death the true rigor mortis seemed to be confounded the one with the other, and I did not know what to think until I began to wonder whether the interpretation of the spasm might be found, not on the side of life, but on the side of death whether the key to the spasm might not be hid in rigor mortis whether the spasm, instead of being the sign of a life in muscle which expressed itself in contraction, might not have to do with death rather than life, being in very deed b 2 PREFACE. a transitory step towards rigor mortis a change brought about by something being abstracted from the muscle, not by something imparted to or awakened in it even a physical rather than a vital pheno- menon. Is it possible, I asked myself, that life may show itself, not in causing contraction, but in keeping the muscle relaxed, and that the doctrine of muscular motion may need reforming in accordance with this idea ? Nor was I long undecided as to the answer which had to be returned to this question. Shortly after this time, I published a small volume* with the object of showing that the doctrine of muscular motion did need reforming in accord- ance with this idea, and about which I may say what Dryden said concerning one of his own plays " it was only a confused mass of thoughts tumbling over one another in the dark, when the fancy was yet in its first work, moving the sleeping images of things towards the light, there to be distinguished, and then either chosen or rejected by the judgment." Nor can I look back with feelings of pride at later effortsf in the same direction not even at that, the latest of all, which took the form of lectures delivered at the Royal College of Physicians of London, in 1863, and published soon afterwards.^ I did the best I could * "Philosophy of Vital Motion." 8vo. London: Churchill, 1851. f "Epileptic and other Convulsive Affections of the Nervous System: their Pathology and Treatment (incorporating the Gulstonian Lectures for 1860). 3rd edition, post 8vo. London : Churchill, 1861. t "Lectures on Epilepsy, Pain, Paralysis, and certain other Dis- orders of the Nervous System," delivered at the Royal College of Physicians of London. Post 8vo. London : Churchill, 1864. PREFACE. at the time, but I can easily see now that the best I did was not done well enough to carry conviction to a mind which did not share my own convictions. I can see that I succeeded better with the pathological part of my argument than with the physiological. I can see that the latter part was very faulty for want of work with which my leisure moments have been a good deal occupied during the last two years, and of which the results are incorporated in these pages. Very soon after my thoughts upon this subject began to take definite form it became apparent to me that the key to the dynamics of nerve and muscle lay hid among the facts belonging to animal elec- tricity. Fascinated by the results to which the investigations of Dr. Du Bois-Reymond had led, my attention was at first solely directed to the aspect of animal electricity which is made known by the galvanometer. At this time the muscle-current and the nerve-current, and their changes when passing from the state of rest into that of action, seemed to be the all-important facts which ought to be noticed. Afterwards I slowly began to apprehend that there was another aspect of animal electricity which is ignored in these investigations. The fact, discovered by Matteucci, that muscular contraction was accom- panied by a discharge analogous to that of the torpedo, seemed to point, not to the muscle-current and nerve-current as primary and fundamental con- ditions of animal electricity, but to a state of charge, and for the evidences of this charge I began to seek, first with this electrometer and then with that, first PREFACE. with this condenser and then with that, and not alto- gether fruitlessly even at first. I made out something by an electrometer of my own contriving. I thought I had done more by means of the Potentiometer of Mr. Latimer Clark, but the end proved that I was deceiving myself, this instrument being in fact a gauge, not of tension, but of current Only, indeed, did I begin to arrive at satisfactory results when, not long ago, I became possessed of the New Quadrant Electrometer of Sir William Thomson, together with the means for measuring the resistance of animal tissues to electrical conduction, for it was only when I began to work with these instruments that I was able for the first time to distinctly realize the facts with which I had to do, and for which I had been groping almost in the dark previously. Working for myself with the instruments for measuring the resistance of animal tissues to elec- trical conduction, the fact, which I had not before sufficiently apprehended, became impressed upon me that these tissues might take rank under the head of non-conductors rather than under that of conductors. I found, for example, that the resistance of an inch of the sciatic nerve of a frog was not less than 40,000 B. A. units as much, that is, as eight times that of the whole Atlantic cable. Seeking for tensional phenomena of animal elec- tricity in muscle and nerve by means of the new quadrant electrometer, I soon found that the sides and ends of the fibres were charged differently, the former positively, the latter negatively, and that these PREFACE. evidences of charge disappeared in great measure during action. I soon found the evidences of the charge for which I had searched before almost in vain ; but I found more than I expected. Expecting to find a single charge I found a double charge ; and what to think of this state of things I could not at all see at first. The facts would not chime in with pre- conceived conceptions, and the end was that the con- ceptions had to be modified to suit the facts. The view I had entertained almost from the very beginning of these investigations was that in some way or other the natural electricity present in muscle during rest produced the state of rest by keeping the muscular molecules in a state of mutual repulsion, and that muscle contracted when this elec- tricity was discharged, by virtue of its elasticity, the muscular molecules being then left free to obey the common attraction which is inherent in their phy- sical constitution. The idea was that the muscular fibres were charged \v\\h one kind of electricity during rest, and that in this way the molecules were kept in a state of mutual repulsion. The idea was one which it was difficult to reconcile with the fact that there was a double charge of electricity in muscle. It was one which would agree well enough with the presence of a single charge, whether positive or negative ; it was one which seemed to clash altogether with the double charge, seeing that the mutual repulsion of molecules arising from the presence of either charge would be counteracted by the mutual attrac- tion of molecules charged differently. What then ? PREFACE. Did the natural electricity present in the muscle produce the state of muscular relaxation and elonga- tion in a different way ? Was it possible that the great resistance of animal tissues to electrical conduction might have an all-important part to play in the process under consideration ? Was it possible that the sheaths of the fibres in muscle might be so wanting in conductibility as to allow them to act as dielectrics ? Was it possible that, the sheaths being dielectrics, a charge of one kind of electricity de- veloped on the outsides by the reactions of the blood there circulating, or in any other way, might induce a charge of the other kind of electricity on the insides, and that the electrical antagonism of the sides and ends of the fibres might be accounted for by the charge induced on the insides being conducted to the ends by the contents of the sheaths ? Was it possible that the fibres might be kept in the state of relaxation or elongation by the compression of the sheaths arising from the mutual attraction of the two opposite charges, disposed as in a charged Leyden jar, upon the two surfaces of the sheaths ? These were the ques- tions which in turn presented themselves to my mind, and which, as it seemed, required to be answered in the affirmative. The idea was definite and free from many objections attaching to the idea whose place it had taken. It accounted for the difficulty of detect- ing the charge present in the fibre, and for the fact that the fibre could keep its charge through itself uninsulated ; for the two charges, disposed thus Leyden-jar-wise, upon the two opposite surfaces of PREFACE. the sheath of each fibre, masked each other, and at the same time imprisoned each other, just as they do in the ordinary charged Leyden jar. It was also an idea definite in this particular that all the tensional phe- nomena of the muscular fibre, and all the currrent phenomena too, could be easily imitated upon a wooden model of the fibre, left bare at the two ends, and sheathed at the sides with a coating formed of two layers of tinfoil separated by an intermediate layer of thin gutta-percha sheeting, if only a charge was sup- plied to the outer layer of tin-foil. And in this also was the idea definite -that the elongation of the fibre, assumed to be brought about by the mutual attraction of the two opposite charges disposed Leyden-jar-wise upon the two surfaces of the sheath, was found to be reproducible on a narrow band of india-rubber covered on its two surfaces with a thin metallic coat- ing so as to allow of its being charged as a Leyden jar is charged ; for, on thus charging, this band was seen to elongate under the mutual attraction of the two charges disposed upon its surfaces, just as the sheath of the muscular fibre is supposed to do. Nay, by this apparatus everything that is supposed to happen in muscular motion can be fully illustrated, contraction as well as relaxation, for this band, which had elongated under the charge, is seen to contract when this charge is discharged. Nor does the galvanometer tell all that has to be told of what happens when animal tissues are in- cluded in the voltaic circuit. It tells of the voltaic current ; it does not tell of the charge which, under PREFACE. ordinary circumstances, is associated with this cur- rent. It does not tell, as does the electrometer, that the parts between the poles are charged, half posi- tively, half negatively, the former half being on the side of the positive pole, the latter half on the side of the negative pole. And yet this is information which cannot be dispensed with ; for, as will be proved in due time, the workings of voltaic electricity upon muscle are found to be resolvable into those of the charge and discharge of these very charges, and not into those of the constant current. As with the workings of animal electricity, indeed, so here, the key is to be found in the revelations made by the electrometer rather than in those made by the galva- nometer. In a word, the result at which I have arrived is that the workings of all kinds of electricity, artificial and natural, upon muscle, are resolvable into those of charge and discharge, the charge elongating the fibres, the discharge of this charge bringing about the state of contraction, while at the same time strong confirma- tion of the view taken of the way in which the charge and discharge operate is found in the history of electrotonus (a subject now gone into for the first time), for there is every reason to believe that the increased contraction which is met with in electrotonus, and which is referred to " exalted irritability," is nothing more than the return of the fibres, by virtue of their elasticity simply, from a previous state of in- creased elongation, which state of increased elon- gation, now pointed out for the first time, may be the PREFACE. necessary result of the sheaths of the fibres being more highly charged, and therefore more compressed, than they are naturally, by the charge imparted to them in electrotonus. All this and more will appear in its proper place and in due time ; indeed, the sub- ject is only glanced at now in order to show that there is much new matter behind, and that the electrometer does really give a new key to the inter- pretation of these matters. Nor is it otherwise with the problem of sensation. On the contrary, the electrometer is still the instru- ment which sheds light upon the phenomena to be dealt with rather than the galvanometer, and, in short, all, or nearly all, the conclusions arrived at respecting the action of electricity, natural and artificial, upon muscle, are found to be applicable in this case also. For the rest, I must only say broadly that the general view of the dynamics of nerve and muscle proves to be in strict accordance with this partial view, and not with the view which assumes that muscle and nerve have a special life which ex- presses itself in contraction or sensation, as the case may be. The action of the blood upon muscle, when it is enquired into fully, is found to be one which antagonizes muscular contraction rather than causes it. The case is not one in which excess of blood in the parts which have to do with the pro- duction of motion shows itself in excess of muscular contraction, as it would do if this latter excess were, as it is assumed to be, expressive of heightened life, but it is in every way the reverse of this. PREFACE. The blood, in fact, would seem to act as does the natural electricity, producing rest rather than action producing rest, it may be, by keeping up the natural electricity of the parts. And so likewise with the action of " nervous influence " in the production of muscular motion and sensation. The case is one in which it is far more easy to believe that muscular action and sensation are produced by the abstrac- tion rather than by the communication of this in- fluence one which accords more readily with the idea that nervous influence, like the natural elec- tricity, acts by antagonizing action in muscle and nerve acts, it may be, through the natural electricity of the parts. The facts are all in harmony, not with the view which looks upon action in muscle and nerve as the expression of the special life with which muscle and nerve are supposed to be endowed, but with the view which is based upon the notion that there is along with the state of rest a state of charge, and that the change from the state of rest to that of action is brought about by the discharge of this charge ; and with this general statement I must con- tent myself, for the few preliminary words which I are here permissible would not serve to give any clear idea of the subject as it presents itself in detail. CONTENTS. DYNAMICS OF NERVE AND MUSCLE. PART I. THE SUBJECT FROM A PHYSIOLOGICAL POINT OF VIEW. PAGE CHAPTER I. On some preliminary particulars respecting animal electricity .. ... ... ... ... I CHAPTER II. On the electrical phenomena belonging to living nerve and muscle during the state of rest ... ... ... 12 CHAPTER III. On the electrical phenomena which mark the passing of nerve and muscle from the state of rest into that of action 26 CHAPTER IV. On the history of the so-called " inverse" and "direct" currents, as indicating the way in which muscular motion is affected by voltaic electricity 41 CHAPTER V. On the history of electrotonus, as indicating the way in which muscular motion is affected by voltaic electricity 74 CHAPTER VI. On the way in which sensory nerves are affected by voltaic electricity 113 CHAPTER VII. On the way in which nerve and muscle are affected by electricity in general 122 CHAPTER VIII. On the action of the blood in the production of muscular motion... ... ... ... ... ... ... 129 CHAPTER IX. On the action of nervous influence upon the muscles ... ... ... ... ... ... ... ... 135 CHAPTER X. On the phenomena of rhythmical muscular action as elucidating the action of nerve and muscle ... ... ... 147 CHAPTER XI. On the nature of muscular action ... ... 174 CHAPTER XII. On the nature of rigor mortis 188 CHAPTER XIII. On the nature of nervous action 198 CONTENTS. PART II. THE SUBJECT FROM A PATHOLOGICAL POINT OF VIEW. PAGE CHAPTER I. On the history of muscular motion as exhibited in epilepsy and other forms of convulsion ... ... ... ... 209 CHAPTER II. On the history of muscular motion as exhibited in common trembling and other forms of tremor ... ... ... 235 CHAPTER III. On the history of muscular motion as exhibited in tetanus and other forms of spasm ... ... ... ... 241 CHAPTER IV. On the history of sensation as exhibited in neu- ralgia and other forms of neuralgic disorder ... ... ... 270 PART III. A FEW WORDS IN CONCLUSION. Pages 285288. DYNAMICS OF NERVE AND MUSCLE, PART I. THE SUBJECT FROM A PHYSIOLOGICAL POINT OF VIEW. CHAPTER i. ON SOME PRELIMINARY PARTICULARS RESPECTING ANIMAL ELECTRICITY. SHORT time before the close of the last century the illustrious author of " Cosmos" wrote :* " Le nom de Galvani ne perira point ; les siecles futurs pro- fiteront de sa decouverte, et, comme le dit Brandes, ils reconnaitront que la physiologic doit a Galvani et & Harvey ses deux bases principales." This is saying much, but, as I believe, it is not saying more than what is now fully borne out by the facts ; and on this account I think it will not be waste of time to take a cursory glance at the history of the discovery of animal electricity before proceeding to deal with problems in which, as I hope to show before I have done, this agent supplies us with the master key. The discovery of animal electricity dates as far * "Experiences sur le galvanisme, et en general sur 1'irritation des fibres musculaires et nerveuses." F. A. von Humboldt, Traduit par J. F. N. Jadelot. 8vo. Paris, 1799, p. 361. B DYNAMICS OF back as 1786. One day in the course of this year, while amusing himself with a common electrical machine near a dish on which lay a number of frogs' legs prepared in the way in which it is usual to pre- pare them for purposes of cookery, Galvani, seeing that these limbs jumped whenever he drew a spark from the primary conductor, was led to think that discharges of atmospheric electricity might make themselves known by similar jumpings. Needing a more delicate electroscope than the one he then had in order to carry on some investigations in atmospheric electricity with which he was then engaged, and wish- ing to know whether he had found what he needed, he at once took the dish, with its contents, and went out of doors, his nephew, Camillo Galvani, who was with him at the moment, going with him. The time was a clear and calm evening in September. It did not promise success, for the sky was free from all signs of electrical disturbances : it proved to be propitious in an unexpected direction. The place was a high terrace belonging to the house at Bologna in which Galvani lived then the Casa Panfili-Colonna, now the Casa Monti, in the Strada S. Gervasio. The house, the terrace, the railings, are still to be seen at No. 96 in the Strada S. Felice, the only change of moment being in the name of the street. Each pair of limbs was suspended by a small iron hook from the horizontal bar of the iron railings which fenced in the highest part of the terrace, the hook transfixing the portion of spine which had not been cut away. Galvani says " Ranas itaque consueto more paratas uncino ferreo earum spinali medulla perforata atque appensa, sep- NERVE AND MUSCLE. tembris initio (1786) die vesperascente supra parapetto horizontaliter collocavimus. Uncinus ferream lami- nam tangebat ; en motus in rana spontanei, varii, baud infrequentes ! Si digito uncinulum adversus ferream superficiem premeretur, quiescentes excita- bantur, et toties ferme quoties hujusmodi pressio adhiberetur."* How, then, were these contractions to be accounted for ? They could not be due to discharges of atmospheric electricity, for the sky presented no indications of electric disturbance : they could not be due to the sparks which gave rise to them within the house, for the electric machine, which had also been left behind, was not in action : they could not be due, that is, to discharges of either of the two kinds of electricity then known. Could there be electricity in the limbs themselves, and were the contractions the consequences of the workings of this agent? Were the contractions arguments in favour of the existence of animal electricity ? From this time until the day of his death, Galvani went on performing experiment after experiment, sacrificing hecatombs of frogs, always firm in his belief that these questions ought to be answered in the affirma- tive, and unceasingly striving to bring others to the same mind with himself. He was, however, destined to be foiled, and that, too, by a weapon which lay hid in one of his own experiments. The experiment in question was one in which a galvano- scopic frog was thrown into a state of momentary contraction by placing a conducting arc, of which one half was silver and the other half copper, between the * "De Viribus Electricitatis in Motu Muscular! Commentarius. " 1791 B 2 DYNAMICS OF lumbar nerves and the crural muscles.* Galvani, as was his wont, explained these contractions by suppos- ing that the conducting arc had served to discharge animal electricity, and that the contractions were the result of the discharge. Volta, on the other hand, was of opinion that the electricity producing these contractions originated in certain reactions between the silver and copper portions of the conducting arc ; and he was not shaken in this view by what he did afterwards, for, wishing to confirm it, he began a series of investigations which ended in the discovery of the voltaic pile and battery a discovery which rilled all minds with wonder, and for a long time afterwards diverted attention altogether from the consideration of the claims of animal electricity. In the meantime, however, while Volta was demonstrat- ing the existence of that electricity which originates in the reaction of heterogeneous bodies, and which is now known as voltaic electricity, Galvani continued his search after animal electricity, and made many important discoveries as he went along. He dis- covered, among other things, that a galvanoscopic frog would contract without the help of a conducting arc composed of heterogeneous metals. He dis- covered not only that these contractions would happen when this arc was composed of a single metal, but also that an arc composed of muscle or nerve would answer the same purpose as the metallic arc. He also discovered that the limb of a galvanoscopic frog, of which the nerve had been divided high up in the * The galvanoscopic frog was prepared from the hinder half of the animal, by stripping off the skin, and cutting away all the parts between the thighs and the fragment of the spine, except the principal nerves. NERVE AND MUSCLE. loins, would contract at the moment when the end of the nerve below the line of division was brought down and made to touch a part of the trunk of the same nerve. At last, indeed, he hit upon an experiment in which he seemed to have to do with an electricity other than that arising from the reaction of heteroge- neous bodies an electricity which must belong to the animal tissues themselves. He did much, but he did not do enough to win the battle in which he was engaged, for Volta still kept his position, denying the existence of animal electricity, and maintaining that the electricity which produced the contractions in the galvanoscopic frogs was always due to electricity arising in the reaction of heterogeneous bodies of one kind or other silver and copper, metal and organic tissue, muscle and nerve, nerve in one state with nerve in another, as the case might be.* In 1799, Humboldt took up the question at issue between Galvani and Volta, and published a workj in which he shows by many new and curious experi- ments that there was error on both sides that Volta was wrong in ignoring altogether the influence of animal electricity in Galvani's experiments, and that Galvani was not less wrong in recognising nothing but this influence. He, himself, as is proved in the extract already given, was a firm believer in animal electricity ; but he failed to supply reasons for this belief which can be thoroughly satisfactory to others. Still, he did something in this direction by making out first, that the agent assumed to exist and to be animal electricity has this in common with * " Ann de Chim.," t. xxiii., p. 276 and 301. f " Op. Cit." DYNAMICS OF electricity, that its action is permitted by conductors and prevented by non-conductors ; and, secondly, that it is not to be confounded with voltaic electricity, because the action, which is permitted by conductors, is possible across a gap in the circuit which would allow the passage of frictional electricity, but which would altogether prevent that of voltaic electricity which would, that is to say, allow electricity of high tension to pass, but not electricity of low tension. What Humboldt did, in fact, was to increase the probabilities of the existence of animal electricity not a little, and at the same time to make it appear that this electricity would prove to be of higher tension than voltaic electricity. In 1803, Aldini, Galvani's nephew,* published an an account of certain experiments which furnish further evidence in favour of the existence of animal electricity, by showing that living animal tissues are capable of giving rise to attractions and repulsions which seem to be no other than electrical attractions and repulsions. " I held," he says, " the muscles of a prepared frog in one of my hands, moistened with salt and water, and brought a finger of the other hand, well moistened in the same way, near to the crural nerves. When the frog possessed a great deal of vitality, the crural nerves gradually approached my hand, and strong contractions took place at the moment of contact." And again : " Being desirous to render this phenomenon more evident, I formed * " Account of the late Improvements in Galvanism, with a series of curious and interesting experiments performed before the Commis- sioners of the French National Institute, and repeated in the Anatomical Theatres of London, &c." 410. London, 1803. NERVE AND MUSCLE. the arc by applying one of my hands to the spinal marrow of a warm-blooded animal, while I held the frog in such a manner that its crural nerves were brought very near to the abdominal muscle. By this arrangement, the attraction of the nerves of the frog became very evident." About this time, however, the discovery of the voltaic battery had given the victory to the opinions of Volta a victory so complete that nothing more was heard about animal electricity for the next thirty years. In 1827, Nobili* brought back the subject of animal electricity to the thoughts of physiologists by discovering an electric current in the frog. He made this discovery by means of the very sensitive galvano- meter which he himself had invented a short time previously an instrument which, as perfected by M. Du Bois-Reymond and others, by Sir William Thompson more especially, ought to be as prominent an object as the microscope in the laboratory of every physiologist. Immersing each end of the coil of the instrument in a vessel containing either simple water or brine, and completing the circuit between the two vessels with a galvanoscopic frog, the fragment of the spine being immersed in one vessel, and the paws in the other, he found that there was a current in the frog from the feet upwards, which current would cause a considerable permanent deflection of the needle, to 30 or more if brine were used, to 10, or thereabouts, if water were substituted for brine. Nobili supposed that this current was peculiar to the * " Bibl. Univ.," 1828, t. xxxvii, p. 10. DYNAMICS OF frog, and in this he erred ; but he did, nevertheless, a great thing, for, [by this experiment, he furnished, perhaps, the first unequivocal proof of the real exist- ence of animal electricity. Twelve or thirteen years later, Matteucci pub- lished an essay* which, as M. de la Rive says,f " restored to animal electricity the place which it ought to occupy in electrical and physiological phenomena." This essay, moreover, had a great indirect influence upon the fortunes of animal elec- tricity, for M. Du Bois-Reymond, as he himself tells us, was led to undertake the investigations which have made his name famous in this department of physiology by the inspiration arising from its perusal. The joint labours of MM. Matteucci and Du Bois- Reymond have left no room for entertaining any doubt as [to the reality of animal electricity. This will appear sufficiently in the sequel, when many of the experiments which furnish the demonstration will have to be referred to particularly. In the mean- time, it may be said that Manteucci has demon- strated in the most unequivocal manner that animal electricity is capable of decomposing iodide of potas- sium, and of giving "signes de tension avec un condensateur delicat,":f as well as of producing movement in the needle of the galvanometer ; and not only so, but also a fact, the discovery of which * "Traitedes Phenomeiies Electro -physiologiques des Animaux." Paris. 1844. f "A Treatise on Electricity, in theory and practice. Translated by C. V. Walker." 8vo. Longman. 1853-1858. J "Cours d'Electro-physiologie." Paris. 1858. NERVE AND MUSCLE. will always give Matteucci a place in the very foremost rank of physiological discoverers that musclar contraction is accompanied by an electrical discharge analogous to that of the Torpedo And as for M. Du Bois-Reymond* it may be said that he has demonstrated that there are electrical currents in nerve in brain, spinal cord, and other great nerve- centres, in sensory, motor, and mixed nerves, in the minutest fragment as well as in masses of considerable size, that the electrical current of muscle, which had been already discovered by Matteucci, may be traced from the entire muscle to the single primi- tive fasciculus, that Nobili's " frog current," in- stead of being peculiar to the frog, is nothing more than the outflowing of the currents from the muscles and nerves, that the law of the current of the muscle in the frog is the same as that of the current of the muscles in man, rabbits, guinea- pigs and mice, in pigeons and sparrows, in tortoises, lizards, adders, glow-worms, toads, tadpoles, and salamanders, in tench, in freshwater crabs, in earth- worms in creatures belonging to every depart- ment of the animal kingdom, that the law of the current in muscle agrees in every particular with the law of the current in nerve, and also with that of the feeble currents which are met with in tendon and other living tissues, and that there are sundry changes in the current of muscle and nerve under certain cir- cumstances, as during muscular contraction, during nervous action, under the influence of continuous and interrupted galvanic currents, and so on, which changes, * " Untersuchungen Uber thierische Electricitat." Berlin. 1849, I8S3- io DYNAMICS OF as I shall hope to show in the sequel, are of funda- mental importance in clearing up much that would otherwise be impenetrable darkness in the physiology of muscular action and sensation. Before the discovery of the galvanometer, the atten- tion of those who cared to meddle in these matters was directed exclusively to the static phenomena of animal electricity. Then the only definite electrical ideas were, charge on the one hand, and discharge on the other. After the discovery of the galvanometer, the original point of view was abandoned altogether, or almost so, and the attention diverted from the static to the current phenomena of electricity. And herein, as I believe, was an unmixed misfortune. As I take it, indeed, it is necessary to go back to the standpoint occupied by Galvani and Humboldt, and to work with the electrometer rather than with the galvanometer ; and this conviction has now so much gained upon me, that I am disposed to regard the New Quadrant Electrometer of Sir William Thomp- son the instrument which for the first time makes it possible to arrive at an accurate knowledge of the statical aspects of animal electricity as an instru- ment which is, to say the least, quite as indispensable as the galvanometer itself to those who would do the work in question. Already, indeed, as it will appear in due time, this instrument has supplied proof of the existence of a definite charge of electricity in nerve and muscle during rest, and of the discharge of this charge when this state of rest is changed for that of action, as well as of other facts without which it is impossible to arrive at any clear view of the dynamics of nerve and musle ; and with this general statement I must now NERVE AND MUSCLE. ii content myself, for it is high time to leave these pre- liminary matters, and proceed to the consideration of the several physiological problems which wait for solution. CHAPTER II. ON THE ELECTRICAL PHENOMENA BELONGING TO LIVING NERVE AND MUSCLE DURING THE STATE OF REST. I. HILE at rest, living nerve and muscle supply currents to the galvanometer which gradu- ally come to an end before the establishment of rigor mortis, and which with certain exceptions in which this course is reversed pass through tJie coil in a direction which shows that the surface made up of the sides of the fibres is positive in relation to either one of the two surfaces made up of the ends of the fibres, and tJiat the positive surface becomes more positive, and the negative more negative, as the distance increases from the line of junction between these surfaces. Living muscle, while at rest, supplies a current to the galvanometer if the electrodes are brought into contact, the one with the surface made up of the sides of the fibres, the other with the surface made up of either one of the two ends of the fibres. This current, called the muscle-current, has a very definite history. It ceases gradually as the muscle loses its DYNAMICS OF NERVE, ETC. 13 impressibility,* and comes to an end altogether before the establishment of rigor mortis. It passes through the coil from the surface made up of the sides of the fibres to eitJier one of the two surfaces made up of the ends of the fibres, unless it be that it is much enfeebled and upon the point of ceasing altogether, in which case its direction may be reversed. It behaves in this manner whether the ends of the fibres supplying it be covered with tendon or not, with this difference only, that it is a little weakened when this covering remains. The muscle-current, in fact, is a phenomenon of living muscle during the state of rest, which is too definite to be confounded with anything else, and too prominent to be overlooked. Living nerve, while at rest, supplies a current to the galvanometer, in this case called the nerve-current, if the electrodes are applied, the one to the surface made up of the sides of the fibres, the other to either one of the two surfaces made up of the ends of the fibres, and the history of this current is in all essential respects that of the muscle-current. Like the muscle- current, the nerve-current takes its departure pari passu with the impressibility of the nerve. Like the muscle-current, the nerve-current, as a rule, passes through the coil from the surface made up of the sides of the fibres to either one of the two surfaces made up of the ends of the fibres in a direction which * Here and aftenvards the state of nerve and muscle to which the name of irritability is commonly given, is called impressibility \ and the excuse for this change is that a doctrine is involved in the former word, which, as will appear in the sequel, is but little in harmony with the facts of the case. 14 DYNAMICS OF shows that the former surface is positive in its elec- trical relations to the latter. Like the muscle- current, the nerve-current may be occasionally re- versed. Thus, the nerve-current of the brain and spinal cord of several animals may be reversed at the time when the nerves generally are on the point of ceasing to be impressible, in the brain and spinal cord of frogs, for example, though curiously enough, there is no corresponding reversal of the muscle- current in these animals. Thus, again, the nerve- current may be reversed in nerves which have been the seat of violent and prolonged action, or which have been exposed for a time to great heat. This change does not involve destruction of the impressi- bility of the nerve, neither is it always final. On the contrary, the nerve in which this reversal has hap- pened from excessive action, or exposure to heat, may be as impressible after the reversal as it was before, or nearly so, and the nerve-current may return to its original direction if the nerve be placed where it can recover the natural moisture it had lost by dessication if it be put back, for example, among the structures from which it had been dissected out, and left there for a short time. Besides these major currents between the surfaces made up of the sides, and either one of the surfaces made up of the ends of the fibres of nerve and muscle, each of these surfaces is also capable of sup- plying minor currents, of which the direction through the coil shows that the positive surface becomes more positive, and the negative surface more negative, as the distance increases from the line of junction be- tween these surfaces. These minor currents are NERVE AND MUSCLE. brought to light if the points to which the electrodes are applied are at unequal distances from the centre of the surface, but not if they are equidistant are brought to light, that is to say, if the two points connected by the coil are of unequal electric ten- sion, but not if they are of equal tension ; for in order to account for the current being present in the first case, and absent in the second, all that is necessary is that this should be the state of things as to tension. At all events, the minor currents remain as facts, and the inference from the direction they take in the coil of the galvanometer must be that which has been mentioned, namely this, that the positive surface becomes more positive, and the nega- tive surface more negative, as the distance increases from the line of junction between these surfaces. II. While at rest, living nerve and muscle furnish sup- plies of free electricity to the electrometer, which gradually disappear before the establishment of rigor 'mortis, and which show with certain exceptions, in which this state of things is reversed that the surface made up of the sides of the fibres and the surface made up of either one of the two ends of the fibres are charged differently, the former surface positively, the latter negatively, and also that the tension of these opposite charges rises as the distance increases from the line of jtmction between these surfaces. Signs of free electricity, positive as well as negative, which gradually come to an end before the esta- 1 6 DYNAMICS OF blishment of rigor mortis, are now readily detected in nerve and muscle while they are alive and at rest by the New Quadrant Electrometer. Applying the electrodes of this instrument so as to bring them into contact, the one with the surface made up of the sides of the fibres of a piece of fresh muscle, and the other with the surface made up of either one of the two ends of the fibres, and examining the electrical condition of each surface separately, the ray of light is found to move upon the scale in a way which shows, not only that the electrometer has become charged, but that a dif- ferent charge has been supplied by each surface. If the surface connected with the electrometer be that which is composed of the sides of the fibres, the ray moves as it moves under a positive charge ; if the surface so connected be that which is made up of either one of the two ends of the fibres, it moves as it moves under the negative charge ; and, with the ex- ception of a reversal in direction which may happen shortly before their final cessation, these are the movements which are noticed from first to last. A positive charge is supplied by one surface, of which the tension, measured by the degree to which the ray moves on the scale, is equal to about the tenth of that of a Daniell's cell ; a negative charge of the same tension is supplied by the other surface. The case is not one in which the charge of the one surface differs from that of the other in tension merely, for if it were, the movements of the ray caused by the charge proceeding from the two surfaces would be to different degrees in the same direction, and not to the same degree in opposite directions. The case is NERVE AND MUSCLE. one in which the charges of the two surfaces must differ in kind, for only upon this view are the move- ments of the ray in opposite directions to be ac- counted for. Moreover, the movements of the ray indicate differences of tension in different parts of each of these surfaces singly, which differences are indicated by different degrees of movement in the same direction for each surface, and which show, when analysed, that the positive surface is most posi- tive, and the negative surface most negative, as the distance increases from the line of junction between these surfaces, at which line the tension is at zero. And so likewise with the nerve. If a detached piece of fresh nerve be tested by the electrometer in the same way as that in which the muscle has just been tested, the movements of the ray are found to tell a precisely similar story of a positive charge sup- plied by the surface made up of the sides of the fibres, of a negative charge supplied by the surface made up of either one of the two ends of the fibres, and of differences of tension at different parts of the former surface from which it is plain that the tension diminishes in the neighbourhood of the latter sur- faces. In all these particulars the agreement between the nerve and the muscle holds good, and also in the degree of tension, for this still proves to be about a tenth of that of a Daniell's cell. Indeed, the agree- ment only fails in the proof of the existence of differences of tension on different parts of the sur- face made up of the ends of the fibres, and here the failure may be manifestly due to the mere fact of the parts being too minute to admit of exact examina- tion. c 1 8 DYNAMICS OF All this I have made out by experiment, and this also that, as with the current phenomena of nerve and muscle, so with these tensional phenomena, the evi- dences of them gradually come to an end as the nerve and muscle lose their impressibility, and that there may be a reversal involving the change from positive to negative, or vice versd, when this loss is all but com- plete. III. The very imperfect conductibility of muscle and nerve makes it not impossible that the sheaths of the fibres in mttsle and nerve may rank as non-conductors rather than as conductors that they may act as dielectrics, in fact. The measurements made by E. Weber, Matteucci, and Eckhard, as well as those which I have made myself, all go to show that the animal tissues gene- rally are very imperfect conductors of electricity. E. Weber, the pioneer in this inquiry, made out broadly that certain of these tissues, nerve not excepted, con- ducted electricity as much as 50,000,000 times less readily than copper. Matteucci, comparing pieces as nearly as possible of the same size and shape, taken from the sciatic nerve, the brain, the spinal cord, and the adductor longus muscle of a recently killed rabbit, found that the three substances first named, nerve, brain, and spinal cord, conducted electricity at very nearly the same rate, and that the last, muscle, was the better conductor in the proportion nearly of two to one. Professor Eckhard, of Giessen, also confirms in the NERVE AND MUSCLE. 19 main the statement of Matteucci as to the relative conductibility of nerve and muscle, and shows in addition that the resistance of tendon and cartilage is the same, or very nearly the same, as that of nerve, the mean of the means of three groups of experiments upon each substance, the muscle being put down as i, being for the nerve, 3-3, for the tendon, 3-3, and for the cartilage, 3. And these results, so far as nerve and muscle and tendon are concerned, are borne out by some measurements which I have myself made with a Siemen's Resistance Table. In three experiments, for example, in which I measured the resistance of pieces, as nearly as possible of the same shape and size, taken from the sciatic nerve, the tendo-achillis, and the ad- ductor longus of a rabbit, recently killed, I found the mean resistance to be, in the nerve 40,000 'units as much, that is, as eight times that of the whole Atlantic cable in the tendon 38,000 units, and in the muscle 1 2,000 units. Undoubtedly many experiments have yet to be made before any accurate results can be arrived at. Undoubtedly care has not been taken in the experi- ments already made to eliminate effectually all the errors arising from secondary polarization and other disturbing influences. But of this there can be no doubt, that nerve and muscle, and certain other animal tissues also, are very imperfect conductors. Even now, indeed, enough is known to make it not impossible that certain parts of nerve and muscle may take rank as non-conductors rather than as conductors, and to give countenance to the notion that this want of conduc- tion may have an important part to play in the animal economy. In point of fact, nerve and muscle are such imperfect conductors as to make it possible that C. 2 20 DYNAMICS OF the sheaths of their fibres may act as dielectrics, in a way which will be indicated presently. And certainly there is nothing intrinsically improbable in the assump- tion that these sheaths may act in this manner, for water, as is well known, may also act as a dielectric. IV. A charge of either kind of electricity, developed (by oxidation, or in some other way) on the outsides of the sheaths of the fibres of nerve and muscle, may, if these sheatJis be dielectric, induce the opposite charge on the insides, and in this way the electric antago- nism between the sides and the two ends of the fibres may be accounted for, for in order to this all that is required is to suppose that the cJtarge on the insides of the sheaths, which, according to this view, is necessarily antagonistic to that on the outsides, is conducted to each of the two ends by the contents of the sheaths, while at the same time the gain in tension in each of the two charges as the distance increases from the line of junction between the two stir faces may have its explanation in the mutual annihilation of opposite charges along this line. If a charge of electricity, positive or negative, be developed on the outside of the sheaths of the fibres of nerve and muscle by the respiratory and other mole- cular changes which are there at work and this surely is no unsupposable idea and if these sheaths are capable of acting as dielectrics, a charge of the opposite kind of electricity must be induced on the insides of the sheaths. That must happen, in fact, by NERVE AND MUSCLE. 21 which the sheath of each fibre will be converted into a Leyden jar, with, as is the rule, the positive elec- tricity outside, and the negative inside, thus,- or, as is the exception, with the negative outside, and the positive inside, thus, And certainly this view is one which will very readily supply the explanation of all the current and tensional phenomena of nerve and muscle. It will explain why the electrical condition of the two ends of the fibres is opposed to that of the sides, for in order to this, all that is necessary is to suppose that the contents of the sheaths are comparatively good conductors, and that the charge induced within the sheath is conducted to the ends of the fibres by these contents. It will explain why the positive surface is more positive, and the negative surface more negative, as the distance increases from the line of junction between these sur- faces, for the reaction of opposite charges over this line 22 DYNAMICS OF must lead to a mutual annihilation of charge, which will alter the tension in this manner. It will explain, too, the current phenomena no less than the tensional, for in order to this, all that is necessary is to change the electrometer for the galvanometer, and to suppose that the tensional differences made known by the electrometer are kept iip by the continuance of those actions (oxygenation, and others) in which they ori- ginate. All that is supposed, indeed, may be imitated upon a wooden cylinder, covered at its sides with a coating made of two layers of tinfoil with an inter- mediate layer of thin gutta-percha sheeting, and left uncovered at its two ends, if the outer layer of foil be charged as a Leyden jar is charged ; and this imitation is in every way to the purpose, for the cylinder exem- plifies perfectly the conditions which are supposed to exist in nerve and muscle, the cylinder being, in fact, nothing more than an artificial model of nerve and muscle according to this view, and the charging nothing less than what is supposed to happen with nerve and muscle. What, then, is it that happens when the outer layer of tinfoil on this artificial model of nerve and muscle receives a charge ? The case is plain. The outer layer of foil remains charged with the charge communicated to it, and the inner layer of foil becomes charged with the opposite kind of charge induced in it. That happens, in fact, by which the two uncovered ends of the cylinder will become elec- trically opposite to the outer covering of the sides, and for this simple reason, that the charge induced in the inner layer of foil is conducted to the ends by the wooden core within the Leyden coating. That happens, also, by which, supposing the sides exter- NERVE AND MUSCLE. 23 nally to be positive, and the two ends negative, the sides will become more positive, and the ends more negative, as the distance increases from the line of junction between these surfaces, for the mutual reaction of opposite charges over this line must lead to annihilation of charge on each side of this line, which must be complete at this line, and which must diminish on each side as the distance from the line increases. All this is easily verified by the new quadrant electrometer, and I have often so verified it all. In this model, thus charged, indeed, every- thing tensional is precisely as it is in the actual nerve or muscle. And these being the tensional conditions, it follows that all the conditions for imitating all the current phenomena are present also, if only the gal- vanometer be substituted for the electrometer, and if the charge to the outer layer of foil be kept up. Indeed, there is no single current phenomenon, major or minor, belonging to nerve or muscle, which I have not, over and over again, got out of this artificial fibre of nerve or muscle by thus keeping up the charge, and at the same time bringing the electrodes of the gal- vanometer to bear in a suitable manner. V. It is not improbable that the electrical condition of nerve and muscle during rest is, not current, but static, the sheatJts of the fibres at the time being so many charged Ley den jars, and the " nerve- current " and " muscle-current " no more than purely accidental phenomena. 24 DYNAMICS OF The view taken by Dr. Du Bois-Reymond is that the fibres of living nerve and muscle are made of an infinite number of what this physiologist calls peri- polar molecules of molecules, that is to say, which are electrified negatively at the two poles turned towards the two ends of the fibres, and positively in the interpolar portion turned towards the sides of the fibres, or else the reverse. According to this view, the ends of the fibres are negative, because the negative poles of the peri-polar molecules are turned in this direction, and the sides positive, because the positive interpolar belts of the molecules are so turned, or else the ends of the fibres are positive, because the poles of the peri-polar molecules pointed towards the ends are positive, and the sides negative, because the interpolar portion of the molecules pointed in this direction are in this case negative. According to this view, the nerve-current and muscle-current are derived portions of infinitely stronger currents ever circulating in closed circuits around the peripolar molecules. According to this view, indeed, the pri- mary and fundamental electrical condition of nerve and muscle during rest is, not static, but current ; and this is the view which has met with general acceptance. As it seems to me, however, the primary electri- cal condition of nerve and muscle during rest is, not current, but static, the condition of the sheath of each fibre at this time being in fact nothing more or less than that of a charged Leyden jar. As it seems to me, indeed, the "nerve-current" and "muscle-current" are no more than accidental phenomena, the simple result of applying the electrodes of the galvanometer NERVE AND MUSCLE. 25 to points of dissimilar electric tension. This, as I believe, is the view which arises naturally out of the premises, and harmonizes with all the evidence re- maining behind ; and, therefore, without further com- ment, I venture to adopt it provisionally as the view which has the best claim to attention. CHAPTER III. ON THE ELECTRICAL PHENOMENA WHICH MARK THE PASSING OF NERVE AND MUSCLE FROM THE STATE OF REST INTO THAT OF ACTION. I. [HE phenomenon of secondary or induced con- traction appears to show that in passing from the state of rest into that of action a discharge of electricity, analogous to that of the torpedo, is developed in and around both nerve and muscle. Secondary or induced contraction is a form of con- traction to which attention was first called by Matteucci, and for the demonstration of which all that is wanted is a couple of rheoscopic limbs, just taken from a very lively frog, the rheoscopic limb, so called, being the lower half of the hind leg, stripped of its skin, and with the whole of the sciatic nerve remaining in attachment. The simplest experiment, which is also the original one, consists (i) in placing the two limbs, which may be distinguished as limb a and limb b, upon a plate of glass, or some other insulating material ; (2) in DYNAMICS OF NERVE, ETC. 27 putting the free end of the nerve of limb b upon the muscles of limb a; and (3) in pinching the nerve of limb a. If the frog from which the limbs were taken was not sufficiently lively, the result of pinching the nerve of limb a is simply to cause contraction in the muscles of this limb ; if, on the other hand, the limbs belonged to a very lively frog, the contraction caused by pinching the nerve of limb a is, not in this limb only, but in the limb b as well, the latter contraction being the secondary or induced contraction. And this is also the result if, instead of placing the nerve of limb b upon the muscles of limb a directly, a piece of cotton wick, soaked in salt water, be placed between the nerve and the muscles, so as to form a bridge of considerable span between the two. Secondary or induced contractions are also pro- duced in the same way by placing the nerve of limb b, not upon the muscles, but upon the nerve of limb a, nerve upon nerve, not nerve upon muscle as before, only the experiment is apt to miscarry more fre- quently in this than in the former case. Commenting upon the first two of these experiments, Becquerel hazarded the conjecture that the cause of the contraction in limb b was a discharge of electricity developed during action in and around the muscles of limb a ; and this also is the view taken by Matteucci. Moreover, as will appear in the sequel, Matteucci gives good reason for thinking, not only that this is the true explanation of secondary or induced con- traction, but also that the discharge developed during action in muscle is analogous to that of the torpedo for thinking, in fact, that the causation of the secondary or induced contraction is identical 28 DYNAMICS OF with that of the contraction witnessed in a rheoscopic limb, of which the end of the nerve is made to touch the skin of the torpedo in the neighbourhood of the electric organ, whenever this organ is put in action. And certainly this view is as applicable to the last experiment which brings to light the variety of induced or secondary contraction discovered by Dr. Du Bois-Reymond as to the other two, if only it be assumed that action in nerve, as well as action in muscle, is accompanied by a similar discharge. Indeed, it is difficult to know where to turn to find another explanation, for if the idea of the discharge of electricity be excluded, what agent is there remain- ing which can disturb the atmosphere outside the acting muscle or nerve so as to give rise to contrac- tion in a muscle of which the nerve is merely con- tiguous to the acting nerve or muscle, and which at the same time can traverse a wetted cotton wick, as it is seen to do in the second experiment, without losing its power of thus acting ? II. There are certain anatomical and physiological ana- logies between the electrical apparatus of the torpedo and the muscular apparatus of this or any other animal, which make it more than probable that in passing from the state of rest into that of action, a discharge of electricity is developed in and around both nerve and muscle, and that this discharge is analogous to that of the torpedo. The muscles and the electric organs of the torpedo agree so far in their relation to the nervous system, NERVE AND MUSCLE. 29 and in their manner of action, as to make it in the highest degree probable that the state of action in muscle and motor nerve is accompanied by a discharge analogous to that of the torpedo. Like the nerves of the muscles, the nerves of the electric organs originate in the same track of the spinal cord, and terminate in the same loop-like plexuses. Like the muscles, the electric organs are paralysed by dividing their nerves. Like the muscles, the electric organs, after they have been paralysed by dividing their nerves, may be made to act by pinching the end of the nerve below the plane of section. Like the muscles, the electric organs are thrown into a state of involuntary action by strych- nia. Like the muscles, the electric organs cannot go on acting without intervals of rest. And lastly, the nerves of the electric organs, like the nerves of the muscles, respond in the same curiously alternating way to the action of the " inverse " and " direct " voltaic currents when the nerves are somewhat exhausted, if only discharge be taken as the equivalent of con- traction. In a word, the physiological and anatomical analogies between the electric organs of the torpedo and the muscular apparatus of this or any other animal, may be said almost to necessitate the conclu- sion to which Matteucci was led in regarding them, namely this, that muscular action is accompanied by a discharge of electricity, and that this discharge is analogous to that of the torpedo. III. The almost complete disappearance of the muscle- current from the muscle, and of tJu nerve-current 30 DYNAMICS OF from the nerve, when nerve and muscle pass from the state of rest into that of action, may be looked upon as a reason for believing that there is a discharge of electricity at this time. Professor Du Bois-Reymond is the author of several experiments which show that the passage from rest to action in both nerve and muscle is attended by disappearance of the proper nerve-current and muscle- current. One experiment, of which the object is to ascertain what happens to the muscle-current during contrac- tion, is performed upon the gastrocnemius of a frog, with the whole length of the sciatic nerve remaining in connection with it. This preparation is placed, with the muscle upon the cushions of the galvano- meter, and with the end of the nerve most distant from the muscle across the electrodes of an induction apparatus, not then in action. When the needle of this galvanometer has taken up the position into which it diverges under the action of the muscle- current of the relaxed muscle, the muscle is made to contract by exposing its nerve to the action of in- duced electricity, and not until then. What is done, that is to say, is first to get the muscle-current of the relaxed muscle, and then, by setting up contraction in this muscle, to get the muscle-current of the con- tracting muscle. This is what is done. What happens is this that the needle, which stands at a consider- able distance from zero under the muscle-current of the relaxed muscle, swings back to zero, or beyond it, when this muscle is made to contract. It seems as if the muscle-current acting upon the needle while NERVE AND MUSCLE. 31 the muscle is relaxed, is reversed during contraction. In fact, however, the current at this time is weakened only, not reversed, and that it is so is easily proved by simply shutting out the muscle-current of the con- tracting muscle from the galvanometer, and not re- admitting it until the needle has come to rest at zero; for on doing this the needle is found to move from zero under the muscle-current of the contracting muscle, in the same direction as that in which it moved under the muscle-current of the relaxed muscle, only not to the same distance by a great deal. Under the current of the relaxed muscle, the position taken up by the needle may be at 50 or 60 ; under that of the contracting muscle it may be at 3 or 4, or still nearer to zero. In every case the difference is very marked, and in every case this difference is one which shows that there is a great weakening of the muscle-current during contraction. Nor is a different conclusion to be drawn from the experiments of which the object is to find out what happens with the nerve-current when the nerve passes from the state of rest into that of action. In one of these experiments, which exhibits the action of the tetanus caused by strychnia upon the nerve-current of the sciatic nerve of a frog, the plan pursued is to fix the animal upon a convenient frame, to expose the sciatic nerve by a suitable dis- section, to lay the lower end of the nerve, (which is liberated by a cross-cut at the ham,) upon the cushions of the galvanometer, and to inject a few drops of solu- tion of strychnia under the skin. This is what is done. Before the poison takes effect, the needle of the galvanometer is acted upon by the nerve-current 32 DYNAMICS OF of the quiescent nerve : after the poison takes effect, the needle is acted upon by the nerve-current of the acting nerve, for tetanus involves nervous action in its highest degree. And this is what happens. Be- fore the tetanus the needle diverges under the nerve- current of the quiescent nerve, and takes up a posi- tion, say at 30 ; during the tetanus, the needle, now responding to the nerve-current of the acting nerve, returns towards zero, and takes up a position very near this point, and on the same side of it. There is no reversal of the nerve-current during action in this case. It is with the nerve-current during action, as it was with the muscle-current during action, there is obvious and unmistakeable weakening, and this only. Another experiment, from which a similar lesson is to be learnt, is also upon the sciatic nerve of a frog. The nerve, in this case altogether separated from the body, is arranged so that one end is included in the circuit of the galvanometer, and the other laid across the electrodes of an induction-apparatus, which appa- ratus is not put in action until the needle of the galvanometer has taken up the position into which it diverges under the nerve-current of the quiescent nerve. Before the nerve is put in action by the electricity, the needle stands, it may be, at 30 ; after the nerve is thus put in action, the needle, which now of course responds to the nerve-current of the acting nerve, returns towards zero, and takes up a position a degree or two from this point on the same side. These are the simple facts. As in the former experiment, so in this, the nerve-current is much weakened during action, not reversed. NERVE AND MUSCLE. 33 There is also another experiment to the same effect which may well find a place here an experi- ment upon a rheoscopic limb from which the skin has not been stripped off, and of which the result is to show that the nerve-current is weakened co- incidentally with the action set up in the periphery of the nerve by heat. In this case the method of procedure is : (i) to place the limb in a small vessel of sufficient depth, with the nerve hanging over the edge ; (2) to bring the free end of the nerve within the circuit of the galvanometer ; (3) to wait until the needle is stationary at the point to which it has diverged under the action of the nerve-current of the quiescent nerve; and (4) while the needle is fully divergent under the nerve-current of the quiescent nerve, to set up a state of action in the nerve, by pouring boiling water into the vessel to a depth suffi- cient to cover the limb. On the addition of the hot water, the needle, which before stood at a con- siderable distance from zero, at once moves towards zero, and takes up a position close to this point, sometimes on one side, sometimes on the other. This is the result. During the action thus set up in the nerve, that is to say, the nerve-current is much weakened without being reversed, or much weakened and reversed, much weakened in either case. And this is the result also if the nerve be thrown into a state of action by other modes of heat, as, for example, by bringing a hot wire near the nerve. Dr. Du Bois-Reymond does not speak of this disappearance of electricity from muscle and nerve during action, of which proof is supplied in these experiments, as a discJiarge of electricity. He speaks D 34 DYNAMICS OF only of a negative variation of a nerve-current, or a muscle-current, as the case may be. Thinking only of a current, he ignores altogether the evidence in support of a discharge which is supplied by Matteucci. As it seems to me, however, the very proof which Matteucci requires is supplied in these experiments of Dr. Du Bois-Reymond, for if these experiments show anything plainly it is this, that electricity dis- appears in the very cases in which it is supposed to be discharged. IV. The almost complete disappearance of all tensional signs of electricity from muscle and nerve when the state of rest changes into that of action, may be looked iipon as a direct proof that this change is attended by discharge of electricity. With Sir William Thompson's New Quadrant Elec- trometer, there is little or no difficulty in acquiring exact information respecting the tensional aspect of the electrical phenomena of muscle in the opposite conditions of rest and action. The lower half of the thigh of a frog, without its skin, and with a long portion of the principal nerve remaining in attachment, is the part made use of in the experiment which most readily serves to show what are the tensional electrical phenomena of muscle during rest and during action, and which has now to be described. The electrodes of the electrometer are applied, the one to the uncut longitudinal surface of the muscular fibres, the other to the cut transverse NERVE AND MUSCLE. 35 surface ; the free end of the nerve is placed across the poles of an induction-apparatus, not then in action. In order to get the tensional phenomena of the relaxed muscle, the muscle is left at rest by not putting the induction-apparatus in action, and while at rest, it is included in the circuit of the electrometer by removing the plug which short-circuits the instru- ment In order to get the tensional phenomena of the contracting muscle, the muscle^-the electrometer being short-circuited is made to contract by putting the induction-apparatus in action, and while it is con- tracting, it is made to act upon the electrometer by removing the short- circuiting plug. When the elec- trometer is short-circuited, the reflected ray of light upon the scale rests at zero ; when the muscle is included in the circuit of the instrument by removing the short-circuiting plug, this ray moves more or less from zero, to the extent of several degrees if the muscle be relaxed, to a very short distance in the same direction, or not all, if it be contracted. The tensional phenomena, which were evident enough while the muscle was at rest, are scarcely, if at all perceptible when the muscle is put in action, the ray moving to 15 or 20, or more, in the former case, and at most to 2 or 3 in the latter. These are the facts. Charge has disappeared from the muscle during action, or, in other words, discharge has happened during contraction. And as with the muscle, so with the nerve, there is evidence to show that the tensional signs of electricity present during rest disappear in great measure or altogether in action. Such evidence, for example, is to be found in an experiment like the one which was D 2 36 DYNAMICS OF used to show the disappearance of nerve-current in the case in which the state of action is set up in the nerve of a rheoscopic limb by the operation of heat upon the peripheral expansion or upon the trunk of the nerve, with this difference, that (in order to get a larger nerve-surface) two rheoscopic limbs are used in place of one, and that the elec- trometer is substituted for the galvanometer. The electrodes of the electrometer are applied, the one to the surface made up of the sides of the fibres, the other to the surface made up of the ends of the fibres. First, the electrical condition of the nerve during rest is examined by removing the plug which short- circuits the electrometer, while the nerve is at rest. Then, the electrical condition of the nerve during the state of action set up in it by heat is tested in the same manner, the electrometer having been first dis- charged, and the ray on the scale so brought back to zero, by re-introducing the plug which short-circuits the instrument. This is what is done. When the nerve acting upon the electrometer is at rest, the ray on the scale moves one way or the other, to the extent of 1 5 or 20 from zero ; when the nerve is put in action by heat, this ray moves in the same direction as that in which it moved in the first instance, but only to the extent of a degree or two, or else it does not move at all. These are the results. There is a charge present in the nerve during rest, which disappears in great measure or altogether when the nerve is thrown into a state of action by the operation of heat ; in other words, there is a discharge of the electricity present during rest when nerve passes from the state of rest into that of action ; and thus with nerve as with muscle, the pass- NERVE AND MUSCLE. 37 ing from the state of rest into that of action would seem to be marked by discharge of electricity. V. The occurrence of discharge when imiscle and nerve pass from the state of rest into that of action, be- comes all the more probable if the state of muscle and nerve during rest be one of charge ; and, vice versti, the occiirrence of discharge during action, may be looked upon as a strong additional argument in favour of the conclusion that the state of muscle and nerve during rest is really one of charge. The conclusion arrived at when speaking of the electrical condition of muscle and nerve during rest was to the effect that this condition was, not current, but static, each fibre at this time being, in fact, a charged Leyden jar. Each fibre during rest was looked upon as being in that very state which provided for the discharge which is supposed to happen in action in that very state which would almost seem to necessitate discharge in action. It is indeed permissible, not only to argue in favour of the occurrence of discharge during action from the evidence in support of the existence of charge during rest, but to turn round and to look at the several proofs of the occurrence of dis- charge during action as so many strong additional arguments in favour of the conclusion that in muscle and nerve the electrical state during rest is really one of charge, for with so many independent proofs of charge and discharge, to argue in this manner is not to argue in a vicious circle. 38 DYNAMICS OF VI. In the electrical apparatus of the torpedo during rest tJiere would seem to be a charge in every respect like that which is met with in muscle and nerve during rest, and the discharge of the torpedo, instead of being peculiar, may be only another form of the discharge which attends upon the action of muscle and motor nerve. The electrical apparatus of the torpedo is made up of from 500 to 1000 polygonal prisms, enclosed in aponeurotic cases, with the ends in contact, the one with the dorsal, and the other with the abdominal integument. Each prism consists of a very large number of horizontal laminae, the electrical diaphragms of Pacini, separated by thin layers of fluid. Each lamina is formed of vascular nucleated texture, largely supplied with centrifugal nerve-fibres, the vessels and nucleated cellular texture, disposed in a wide meshed fibrous layer, occupying the upper surface of the lamina, the nerves being exclusively distributed on the under surface. The two ends of the prisms are in oppo- site electrical conditions, the end applied to the dorsal integument being positive, the other end being nega- tive. And this also is the general construction of the electrical apparatus in other electrical fishes. There are the same polygonal prisms formed of the same transverse laminae, separated by thin layers of fluid, the only difference being that these prisms may be disposed with their ends, the one to the head, and the other to the tail, not the one to the back and the other to the abdomen, and that the two surfaces of the NERVE AND MUSCLE. 39 laminae, the vascular and nervous, instead of being fused together as in the torpedo, may be separated by a thin layer of fluid. This, then, being the appa- ratus in which the discharge of the torpedo is developed, the question is as to the method of de- velopment. Is it that the two ends of the prisms are kept in opposite electrical conditions, because the two surfaces of each one of the component laminae are oppositely electrified? Is it that a charge of positive electricity is generated by the reaction of the blood upon the vascular surface of each lamina, and that this charge, acting through a dielectric substance, induces a charge of negative electricity on the other surface of the lamina ? Is it that the prisms are in this way kept charged during rest, so as to have the discharge ready when they are called upon to act ? Is it that the nerves have to do less with charging the prisms than with discharging them ? These questions arise naturally out of the premises, and as naturally admit of answers in the affirmative. Indeed, after the conclusions arrived at when speaking of the elec- trical condition of muscle and nerve during rest and during action, it is difficult to return answers which are other than affirmative. And if the condition of the electrical apparatus of the torpedo during rest be like that of muscle and nerve during rest one of charge, then it may be that the discharge of the torpedo, instead of being at all peculiar, may be only another form of the dis- charge which attends upon the action of muscle and nerve, the two discharges differing chiefly in that the circuit of the latter is wholly within the body, while that of the former is not wholly within the body. 40 DYNAMICS OF NERVE, ETC. Nay, it may even be that the discharge of the muscle and nerve would prove to be as powerful as that of the electrical apparatus if it could be got at so as to be measured fully, for, as it is, the discharge which can be got from a muscle or nerve after removal from the body, and when the tissue must be more than half dead, is sufficient to give rise to secondary or induced contraction. VII. There is reason to believe that the passage from the state of rest to that of action in both muscle and motor nerve is attended by a discharge of electricity analo- gous to that of the torpedo. The more the evidence advanced in this chapter is weighed, the more it seems to justify the con- clusion that the transition of muscle and nerve from the state of rest into that of action is marked by the discharge of the charge of electricity present during the state of rest, and that this discharge is analogous to that of the torpedo. Indeed, this and no other would seem to be the conclusion which must be deduced from all the evidence adduced hitherto, from that contained in the second chapter, as well as from that contained in this. CHAPTER IV. ON THE HISTORY OF THE SO-CALLED "INVERSE" AND "DIRECT" CURRENTS, AS INDICATING THE WAY IN WHICH MUSCULAR MOTION IS AFFECTED BY VOLTAIC ELECTRICITY. I. "N passing a voltaic current along the leg of a frog from the foot upwards to the other foot along the other leg downwards, it is found (i) that the muscles contract at the moments of closing and opening tJie circuit, or at one of these moments singly; (2) that the muscles remain relaxed so long as the circuit is kept closed; (3) that the contractions continue for a longer time in the limb in which tJie current is upward or " inverse " tJmn in the limb in which it is downward or "direct ;" and (4) that by reversing the direction of the ciirrent the contraction may be more than once brought back in the latter limb after it has ceased, provided it have not then ceased in the former limb. The parts commonly used in demonstrating the 42 DYNAMICS OF action of voltaic electricity upon muscle and motor nerve are the hind limbs of frogs prepared in one of two ways. One of these ways is to remove both the limbs by a cross-cut a little above the point at which the lumbar nerves are connected with the spine, to strip off the skin, and to leave all the natural connec- tions between the limbs undisturbed. The other is to remove the limbs at the same point, to strip off the skin in the same way, and then, after disarticulating at the symphysis pubis, to dissect away all the remain- ing connections between the limbs except the lumbar nerves and the intervening portion of spine. The current in each case is passed along one leg from the foot upwards to the other foot along the other leg downwards, by applying the positive pole to the first foot and the negative pole to the second ; and in each case the broad results to be noticed are the same. In each case there is contraction on closing and open- ing the circuit, or at one or other of these moments. In each case the muscles remain relaxed while the circuit is kept closed. In each case the contrac- tion continues longer in the limb in which the current is upward, or " inverse," than in the limb in which it is downward, or " direct." In each case, after it has ceased, contraction may more than once be made to show itself again in the limb in which the current is "direct," by reversing the direction of the current, provided only the contractions have not yet ceased in the limb in which the current is " inverse." At first it seems to be immaterial whether the limbs along which the current is passed have their nerves exposed or not ; afterwards it becomes evident that the results of passing the current are not strictly the same in the NERVE AND MUSCLE. 43 two cases, and that the only way of avoiding consider- able confusion is to take each case and to study it separately. II. The results of passing the " inverse " and " direct " currents along limbs which have been prepared so that the principal nerves are not exposed, differ in some respects from those which mark the passage of these currents along limbs which Jiave been prepared so tJiat these nerves are exposed. (i.) In the case where the nerves are NOT exposed. (a.) Under the "inverse" and "direct" currents in- differently, the result of closing and opening the circuit is contraction first at both these moments, afterwards at tJic moment of closing only. ($.) Under the "inverse" and "direct" currents in- differently, the muscles remain relaxed so long as the circuit is kept closed. (.) The contractions attending the closing and open- ing of the circuit continue longer under the " inverse " than under the "direct" current contimie for an hour and more in the former case, and for not more tJian fifteen minutes in the latter. (d.) After the contraction which attends upon the closing and opening of the circuit has come to an end imder the direct ciirrent, it may be brought back by re- versing the direction of the current, and this too more than once, provided it be still continuing itnder the inverse current. DYNAMICS OF (2.) In the case where the nerves are exposed. (a.) Under both currents the result of closing and opening the circuit is contraction, first at both these moments under both currents indifferently, and after- wards at only one of these moments under each current differently, the contraction in the end being at the moment of opening the circuit, but not at that of closing under the inverse current, and at the moment of closing, but not at that of opening, under the direct current. (&) Under the " inverse " and " direct " currents in- differently, the muscles remain relaxed so long as the circuit is kept closed. (c.) The contraction attending the closing and open- ing of the circtdt continues longer under the " inverse " thammder the "direct" current continues for an hour or more in the former case, and for not more than fifteen minutes in the latter. (, - "3 20 ... 113-22 35 - JI 3'55 55 ... 113-67 60 ... -113*65 7o ... II3*22 90 ... 113 100 ... 111*8 6 he urs ... 106*25 9 ... 104 12 ... 102 13! ... 101 The second case was one of traumatic tetanus in a man aged 20, fatal on the tenth day. Up to twenty- four hours before death, the spasms were well marked, and the mind was quite clear : from this time, and especially during the last six hours, unrest, talkative- ness, jactitation, and slight delirium, were the most prominent symptoms. The appearances after death agreed with those met with in the first case. The notes of the temperature are these : Temperature. Fahr. Three hours before death 105*8 At death ... ... ... ... 107*6 10 minutes after death 107*8 15 108 20 107*8 4 8 106*45 58 105*8 68 105-35 80 104-45 95 103*55 120 10175 2 4 , 99'3 The third case was one of well marked idiopathic or rheumatic tatanus, proving fatal on the third day, NERVE AND MUSCLE. 245 from, as it would seem, pneumonia beginning on the second day, rather than from the spasmodic disorder, the only appearances met with after death pointing to the pneumonia. Here the notes of the temperature are : Temperature. Fahr. 3^ hours before death 102-85 I o minutes after ,, ... ... 103-32 21 103-55 Along with these cases also may be ranked others by Drs. Wunderlich, Erb,* Ringer,| Weber,! Mur- chison,! Sanderson,! and others, which complete the story by showing that this strange rise in temperature up to the time of death and afterwards is not peculiar to tetanus, and of which two or three by Dr. Erb, and one recently noticed by myself, may serve as illus- trations. One case, recorded by Dr. Erb, is that of a man, aged 22, who died from tubercular inflammation of the base of the brain without convulsion, profuse perspiration, unconsciousness, respirations from 44 to 60, and an uncountable pulse being the more pro- minent symptoms of the last 24 hours of life. In this case the notes of the temperature are Temperature, Fahr, 24 hours before death 102.65 At death 104-9 13 minutes after death 105-12 15 I0 4'67 55 10 4 * "Deutsches Archiv. fur Klin. Med.," vol. i, 1866. f "Med. Times and Gaz.," voL ii, 1867. t "Clinical Soc. Trans.," vol. i, 1868. 246 DYNAMICS OF Another case, also recorded by Dr. Erb, was one of purulent meningitis, the patient being a woman, aged 22, six months gone in pregnancy, the more promi- nent symptoms being, not convulsion, but coma setting in suddenly an hour and a half before death, with very laboured breathing and a full and frequent pulse. In this case the notes taken of the tem- perature are these Temperature. Fahr. 6 minutes after death 10 15 20 35 45 100 160 104 104 '67 104-9 IOC'12 I05-I2 104 101-22 A third case, which came under my own notice in the course of last summer, and of which the notes taken of the temperature before and after death are subjoined, was one of sunstroke, fatal in 24 hours, in a man, aged 60, the symptoms being sudden coma, with great oppression of the breathing and pulse, without convulsion. Temperature. Fahr. 12 hours before death 103*25 3 104 At death not ascertained 7 hours after death IO 5'5 Moreover, it is very well known, though the fact has not been verified in the same exact way by the thermometer, that the body may become very hot shortly before death, and remain very hot for some time after death, in cholera, in scarlet fever, and in NERVE AND MUSCLE. 247 several other cases, which in reality occur so frequently as to have little claim to be regarded as exceptional. If, then, the temperature rises in this manner under these circumstances, it is more than difficult to con- nect the increased heat of tetanus with increased activity of the circulation with anything like fever in the true sense of the word. Rising as death draws near the temperature continues to rise after actual death ; and thus the facts would seem to show that the increased heat must be connected, not with in- creased activity of the circulation, not with anything like true fever, but with a contrary state of things. Nor is it more easy to connect the increased heat with the spasms. A part of the addition may be accounted for in this manner, but only a small part. Indeed, the simple fact that in one of the cases which has been instanced the mercury continued to rise co- incidently with a decided abatement in the severity of the spasms, and that in all the cases the rise continued after death, when all spasm was at an end, is in itself a proof that it is not in the excessive muscular action that the explanation of the increased heat of tetanus is to be found. Moreover, the fact that the tempera- ture rises in the same way before and after death in cases where neither convulsion nor spasm were among the symptoms during life, must lead of necessity to the same conclusion. How to explain the phenomenon in question is another matter. Increased heat is an effect of injuries by which the cord or medulla ob- longata is torn or cut across. Increased heat, as is shown in some of the cases which have been cited, is an accompaniment of certain diseases which annihilate more or less completely cerebral action, without 248 DYNAMICS OF causing convulsion. It seems as if one condition of this rise in temperature might be the removal of some cerebral regulating power, and beyond this it is diffi- cult to see further, except it be that this paralysis, reaching to the vaso-motor nerves, allows the minute vessels to dilate and receive more blood, and that this state of congestion, even though the blood be stagnant, as it is after death, may lead to increased molecular changes, of which the additional degree of heat is the effect. What is necessary, however, is not to find the cause of the increased heat in tetanus, but simply to point out the fact that this phenomenon does not imply increased activity of circulation that true fever in the ordinary sense of the word is no part of the his- tory of tetanus. And this, as it seems to me, is the legitimate inference from the evidence which has been cited. And certainly there is nothing in the history of other forms of spasmodic disorder to set aside the conclusions which are to be drawn from the history of tetanus. During the attack of catalepsy the appearance of the patient is not unlike that of a corpse, and it may even be necessary to apply the ear to the chest to know of a certainty that the heart continues to beat. In cholera, the cramps are coincident with a state of almost pulseless collapse, and any increase of temperature before and after death is evidently to be accounted for in the same way as is the analogous phenomenon in tetanus. In hydrophobia the con- dition of the circulation is the very opposite of true fever. In spasmodic ergotism there is no evidence of vascular excitement throughout the whole course of NERVE AND MUSCLE. 249 the malady. And, certainly, no contrary inference with respect to the state of the circulation is to be drawn from the history of the seizures of cramp in the leg and elsewhere which are so often met with in aged people and in those in whom the nerveless and marrowless period of old age is anticipitated by softening of the brain. In a word, there is reason to believe that tetanus and other forms of spasm are all associated with a condition of the circulation which is the very reverse of increased or feverish activity, and that the increased temperature which accompanies spasm in some cases is no evidence to the contrary. III. TJtere is reason to believe tJiat spasm is antagonized rather than favotired by an excited condition of tfo circulation. In tetanus it appears to be the rule for the spasm to gain ground almost in exact proportion to the degree in which the pulse loses true power. In hydrophobia it would seem as if the same law held good, for on analyzing the histories of a considerable number of cases, I find that there was less agitation, less convulsion, less spasm, where the circulation was less depressed than it is in the ordinary run of cases. Nor is a different conclusion to be drawn from the history of spasm as it is set forth in whooping-cough. For what is the fact ? The fact is simply this that the whoop, which is the audible sign of the spasm, does not make its appearance until the febrile or catarrhal stage has passed off; that it disappears if 250 DYNAMICS OF pneumonia, bronchitis, or any other inflammation be developed in the course of the malady ; and that it returns again when the inflammation has departed. Taken by itself this evidence, it is true, may not amount to much ; taken in connection with what has gone before, and with what has still to come, it justifies the notion that spasm, like convulsion and tremor, is a disorder which is antagonized, rather than favoured, by an excited condition of the cir- culation. (C.) ON THE HISTORY OF MUSCULAR MOTION AS EX- HIBITED IN THE STATE OF THE NERVOUS SYSTEM DURING TETANUS AND OTHER FORMS OF SPASM. I. There is reason to believe that spasm is associated with failure of brain-power. In the more severe forms of spasmodic disorder, the mental state during the spasm is one of abstrac- tion, exhaustion, or prostration. In catalepsy the mind is either in a deep sleep, or else rapt in some dreamy vision. In tetanus the patient is alarmed, agitated, alive only to suffer. The cramps of cholera are attended by indifference to the future and by hopelessness, than which are no surer signs of mental prostration. In hydrophopia, the mind is in a state which may be said to be the exaggeration of delirium tremens. In spasmodic ergotism the state borders very closely upon fatuity. And in the minor forms of spasm, the evidence, so far as it goes, is to the same effect. Thus, for example, cramp in the calf of NERVE AND MUSCLE. 251 the leg is a common accompaniment of general or partial dementia, and thus again, spasm in the stomach and bowels is not unfrequently the imme- diate result of sudden mental depression. II. TJiere is reason to believe that spasm is connected, not with a state of inflammation in the spinal cord or any other part of the nervous system, but with a state which may or may not issue in such inflammation a state to which tJie name of " irritation " is given, and which is marked not by relaxation of vessels and Jiypercemia, but by contraction of vessels and ancemia. It is a common impression that spasm is in some especial manner a characteristic symptom of certain inflammatory conditions of the spinal cord, but it may be doubted whether this impression is justified by the facts. There is no good reason to connect the spasms of tetanus with inflammation in the spinal cord or else- where. " Serous effusion with increased vascularity," says Mr. Curling, " is generally observed in the membranes investing the medulla spinalis, and also a turgid state of the blood-vessels about the origin of the nerves," and the same changes may be met with within the cranium, but not in so marked a degree or so frequently. Out of 70 fatal cases collected by Mr. Curling, there were only two in which changes in the nervous system, unequivocally the result of inflammatory action, were discovered after death, and these two were cases where there had been a blow or a wound in the back, where the symp- 252 DYNAMICS OF toms had plainly to do with the inflammation of the cord or its membranes rather than with the tetanus, and where the signs of inflammation found after death were, to say the least, as easily referrible in the injury as to the tetanus ; and at the same time it is pointed out as a fact, not to be overlooked, that the turgid state of the vessels of the pia-mater, together with the effusion of serum which is met with in the spinal cord and brain after death from tetanus, is also met with in those persons who have been poisoned by opium, hydrocyanic acid, and other powerful drugs agents often employed in the treatment of tetanus as well as after death from delirium tremens, hydro- phobia, epilepsy, and many other diseases. It is also a fact, to be remembered in relation to this point, that Majendie, Ollivier, and Orfila failed to detect any perceptible lesion in the spinal cord of animals killed by the tetanus resulting from poisoning by strychnia. Nor do recent microscopic investigations into the condition of the spinal cord in tetanus bring to light any clearer signs of inflammatory changes in this organ. Mr. Lockhart Clarke* finds the vessels in- jected, and the substance of the cord in a state vary- ing from simple softening to complete solution, the softened or dissolved portions forming irregular " areas of disintegration " filled with the debris of blood-vessels and nerves, or with a finely granular or perfectly pellucid fluid. These areas of disintegration were chiefly in the grey substance around the canal, but they were also in the white substance. They were, in fact, in no one part particularly and exclusively. Here and there were extravasations of blood and * "Med. Chir. Trans.," vol. xlviii, 1865. NERVE AND MUSCLE. 253 " other exudations," but pus corpuscles are not men- tioned. " In the walls of the blood-vessels," Mr. Clarke says, " there was no morbid deposit, nor any appreciable alteration of structure, except where they shared in the disintegration of the part to. which they belonged ; but the arteries were frequently dilated at short intervals, and in many places sur- rounded, sometimes to a depth equal to double their diameter, by granular and other exudations, beyond and amongst which the nerve-tissue, to a greater or lesser extent, had suffered disintegration." And else- where Mr. Clarke adds, " the appearances met with are exactly similar in kind to the lesions or disinte- grations which are found in various cases of ordinary paralysis, in which there has been little or no spas- modic movement." In short, the cord is broken up, as at a certain time in all cases it is broken up, by ordinary putrefaction, and, the dilated vessels, and, cer- tain exudations of blood and serum excepted, this is all that is noticed. The facts point, not to inflamma- tion, but to disintegration, and what Mr. Clarke finds in six cases is substantially the same as that which is found by Dr. Dickinson in the one case recorded by him,f for the only peculiarity in this case is in the presence, in addition, of an excessive quantity of a translucent, structureless, or finely granular, carmine- absorbing material, evidently the sero-fibrinous plasma of the blood, which had escaped from the minute arteries into various parts of the substance of the cord where the nerve tissue had broken down, and which lay in pools here and there between the cord and its membranes, a state of things pointing evidently, t "Med. Chir. Trans.," vol. li, 1868. 254 DYNAMICS OF not to inflammation, but to oedema or dropsy. Nor is a contrary conclusion to be drawn from the condition of the sympathetic ganglia or of the nerves at the wound where there is a wound. In some cases, there is the preternatu rally injected state of the minute vessels supplying the sympathetic ganglia, especially the cervical and semi-lunar, met with by Mr. Swan, but these cases are few in number compared with others in which all signs of the kind are absent. In some cases, also, there may be traces of inflammation in the wound, and these cases are more numerous than those in which such traces are met with in the spinal cord or other great nerve-centre ; but here again these traces, instead of being constant, are not even common. In the great majority of cases, indeed, the wound, if there be one, is to all appearance perfectly healthy, and healing or healed. In a great number of cases, in the majority perhaps, the primary wound was completely healed and almost forgotten when the symptoms of tetanus made their appearance, and Dr. Rush, who had extensive opportunities for observation in the military hospitals of the United States, and who was unquestionably a most competent observer, remarks that there was invariably an absence of inflammation in the wounds causing the disease. John Hunter also says : " The wound producing tetanus is either considerable or slight. * * * When I have seen it from the first, it was after the inflam- matory stage, and when good suppuration had come on ; in some cases when it had nearly healed, and the patient was considered healthy. Some have had locked-jaw after the healing was completed. * * * When tetanus comes on in horses, as after docking, NERVE AND MUSCLE. 255 it is after the wound has suppurated and began to heal." Again, the history of true inflammation of the spinal cord or its membranes, would only seem to lead to the same conclusion by a different way, that is, by showing that where this inflammation is really present, the symptoms are not those of tetanus. Acute general spinal meningitis is often obscure enough in its symptoms at first, and this obscurity is generally increased by the presence of head-symptoms in one form or another, for, in the majority of cases, the spinal disease is only a part of an affection in which the cranial nerve-centres are all in some degree implicated. As symptoms of primary importance may be enumerated : fits of pain along the spine and in the extremities, produced by movement, accompanied by fits of muscular stiffness in the painful parts, intervals of comparative or complete freedom from pain and stiffness as long as movement can be avoided, absence of marked spasmodic symptoms, absence of paralysis, some exaltation of sensibility, loss of power over the bladder, partial loss of power over the bowels, and absence of spinal tenderness : as symptoms of secondary importance, these difficulty of mastication and deglutition, difficulty of breathing, no increased reflex excitability, no priapism, fits of perspiration, no active inflammatory fever, and no marked head-symptoms. The pain along the spine and in the extremities produced by movement, must, as I think, be regarded as the most prominent symptom of all. It may be confined to the region of the spine, but more generally it shoots into the extremities, into the legs especially. As a rule, it 256 DYNAMICS OF does not shoot belt-wise round the trunk. It is brought on by any movement of the trunk, and in great measure at least it may be prevented by avoid- ing such movement. It is brought on also by moving the extremities, and in this case it is very likely to begin in the limb and shoot thence to the spine. It seems to depend, in part at least, upon the same cause as the pain of pleurisy, viz., the dragging of an in- flamed and therefore exquisitely tender serous mem- brane, and its character is certainly more like that of pleurisy than of rheumatism (to which latter pain it has been likened), for it occurs in the same sharp, sudden, breath-stopping catches. Along with these fits of pain are fits of muscular stiffness in the painful parts, about which latter fits it is desirable to have very clear notions. It is usual to regard this stiffness as analogous to the spasm of tetanus ; it is necessary, I believe, to look upon it as expressing an instinctive act of muscular contraction, of which the object is to prevent pain by preventing the movements which pro- duce pain. The spine and extremities cannot be moved without causing pain: the stiffness prevents the pain by preventing the movement : this would appear to be the true view. This explanation, originally given by Dance as applying to the mus- cular stiffness in a case of acute spinal meningitis observed by him and recorded by Ollivier, would seem to apply with the same exactness to all cases of the kind. Indeed, as I believe, there can be no greater mistake than to confound the stiffness in ques- tion with the spasm of tetanus, or to regard, with Ollivier, spasm "comme indignant positivement la phlegmasie des membranes de la moelle/'for the rule is, NERVE A^ 7 D MUSCLE. 257 that as long as the patient can keep still, so long is he, comparatively at least, free, not only from fits of pain, but from fits of stiffness also, these intervals of free- dom being sometimes of considerable length, even for days a rule which is very different from that which obtains in tetanus. The differences between acute spinal meningitis and tetanus, in respect of spasm, are indeed so marked as to prevent the possibility of a mistake in diagnosis, if only a moderate degree cf attention be paid to the subject. Muscular rigidity continuing without any marked relaxation from the time of its first appearance is the most characteristic symptom of tetanus. It would seem to be the rule for this state of rigidity to begin in the muscles of the jaws, causing trismus, and to extend from thence as a centre, first to the muscles of the face and neck, then to those of the back, causing opisthotonus, then to those of the lower extremities, and, lastly, to those of the upper extremities, the progress in both extremities being from above downwards, but there are excep- tions to this rule. Thus, the tetanus caused by strychnia, if, at least, the dose of the poison be large, is not only very speedily fatal, the time varying from 15' to 20', but, according to Mr. Poland, it differs also from ordinary tetanus, in the absence of lock-jaw, and in the presence of specially strong spasms in the extremities, the arms being stretched out stiffly and the hands clenched, and the legs being widely apart and rigidly extended. Again, in ordinary tetanus there are some cases in which the muscles of the neck are affected before those of the jaws, and others in which the muscles near a wound, as in the stump after an amputation, have been the first to become rigid, S 258 DYNAMICS OF Even in the most extreme cases the hands and tongue remain limber, and it is but very rarely, except per- haps in children with " head-symptoms " in addition to the ordinary phenomena of tetanus, that a squint or a fixed stare shows that the deep muscles of the orbit are affected. Fits of spasm may seize upon the tongue, as they do frequently upon the muscles of the throat in attempts to swallow, but there is no proof that either the tongue or the muscles of the throat are ever in a state of permanent rigidity. Neither is it probable that the heart or any other involuntary muscle is in any degree permanently contracted. The affected muscles are very hard, curiously so, feeling very much as they do in rigor mortis, and not unfre- quently they are found to be somewhat tender when pressed upon or squeezed. In the great majority of cases, without question, the first effect of tetanic rigidity is to cause lock-jaw, and the next to bend the body backwards as it is bent in opisthotonus, which backward bending, by the way, is almost as constant and characteristic a phenomenon as trismus.. Now and then, it is true, instead of the body being bent backwards it may be bent sideways, causing pleuros- thotonus, or forwards, causing emprosthotonus ; but these bendings are quite exceptional, and opisthotonus may therefore be looked upon as the one position which the body always takes or tends to take in tetanus. Besides this rigidity, tetanus is also marked by fits of painful spasm in the permanently contracted muscles, which fits become more frequent as well as more violent and painful as the disease progresses, recurring, when at the worst, every ten or fifteen minutes, lasting from one to two and a half minutes, NERVE AND MUSCLE. 259 and sometimes being violent enough to crush the teeth out of their sockets, or to break the thigh bones, or to cause great muscles like the psoas and rectus femoralis to tear across. In acute spinal meningitis, on the other hand, the jaw, if it be set at all, is rather at the close of the disease, and then only to a very inconsiderable degree, and muscular rigidity and spasm are neither constant nor conspicuous phe- nomena. In acute spinal meningitis, indeed, it is plain that the muscular rigidity and the seeming spasms are in great measure voluntary or semi-voluntary acts to prevent the pain in the back and limbs which is pro- duced by movement, and that the muscles are relaxed, with the exception perhaps of those behind the neck, almost as long as the patient can keep perfectly still. /;/ a word, the true involuntary fits of spasm and the permanent muscular rigidity which are constant and characteristic phenomena in tetanus are not met ivith in acute spinal meningitis. Among the symptoms of acute general myelitis, no place is found for trismus, or convulsion, or spasm in any form. Paraplegic anaesthesia, ushered in by tingling or some similar sensation in the parts which eventually become anaesthetic ; paraplegic paralysis, ushered in by uncontrollable restlessness ; a disagree- able feeling of tightness around the waist and else- where ; absence of pain in the spine or extremities of pain produced by movement especially ; retention of urine ; involuntary stools ; absence of spinal ten- derness ; increased sensitiveness to differences of temperature, by which moderately warm or iced water gives rise to a feeling of burning over the vertebra which marks the upper limit of the myelitis ; anni- S 2 260 DYNAMICS OF hilation of reflex excitability in the paraplegic parts ; priapism ; acidity of urine ; comparative voiceless- ness ; impeded respiration ; engorgement of lungs and other viscera ; tendency to bed-sores ; loss of electro-contractility and electro-sensibility in the paralysed muscles ; absence of " head-symptoms " ; absence of fever; absence of trismus, or any other convulsive or spasmodic symptoms are, in fact, the points which call for special notice in the history of general acute "myelitis. The symptoms are very different from those of spinal meningitis so different as to make it difficult to confound them, if only moderate care be taken to realize them. In spinal meningitis, the most prominent symptom is pain in the back and extremities, produced or aggravated by movement ; in myelitis, pain of any kind has scarcely a claim to be reckoned among the symptoms, pain produced by movement certainly not. In spinal meningitis the sensibility is somewhat exalted ; in myelitis it is abolished. In spinal meningitis there is muscular weakness, and the movements are fettered by pain, but there is no true paralysis ; in myelitis paralysis is the symptom of symptoms. In spinal meningitis there is occasionally a state of muscular stiffness, half voluntary in its character, of which the object is to prevent certain movements which give rise to pain. In myelitis there is, for the most part, an utter absence of any symptom akin to spasm or tremor, or convulsion. Ollivier, it is true, speaks of continuous contraction of the limbs as being met with, " assez ordinairement," in chronic myelitis ; but the cases cited by this excellent observer do not sub- stantiate this statement. Thus, out of nineteen cases NERVE AND MUSCLE. 261 of myelitis, complicated and uncomplicated, acute and chronic, there are three only in which these contrac- tions were present, and not one of the three can be correctly cited as a case of myelitis. Thus, in one of the three (89), the sensibility was intact, and the disease of the cord confined almost exclusively to the anterior columns ; in the second (93), there was obtuse sensibility, and the disease was chiefly in the grey matter ; and in the third (94), sensibility remained, and there was no post-mortem examination to show what the disease in the cord really was. In each one of these cases, also, there were head-symptoms which do not figure in uncomplicated myelitis. Again, prolonged contraction of the extremities is not an un- frequent symptom in cases in which there is neither myelitis nor spinal meningitis cases in which the state of the cord is that which is spoken of as " spinal irritation." Nay, even in those exceptional cases of myelitis in which there is increased reflex excitability in the paralysed limbs, it is difficult to connect these spasmodic symptoms with inflammation. Dr. Brown- S^quard says " When the dorso-lumbar enlargement is inflamed, reflex movements can hardly be excited in the lower limbs, and frequently it is impossible to excite any. On the contrary, energetic reflex move- ment can always be excited, when the disease is in the middle of the dorsal region, or higher up." And again, when speaking of the reflex convulsions which may happen in the cases where the inflammation is in the middle of the cord, or higher up, he says, " con- vulsions do not take place at the beginning of the inflammation, but some time after, and they recur by fits for months and years after." And this is precisely 262 DYNAMICS OF what happens. The truth, in fact, would seem to be, that these reflex spasmodic movements must be re- ferred, not to inflammation in the lumber enlargement of the cord, nor yet to inflammation higher up in the cord, for in this latter case, to enforce what has just been said by repeating it, the "convulsions do not take place at the beginning of the inflammation, but some time after, and they recur by fits for months and years after? They happen, as it would seem, after the inflammatory disorganization has interrupted the continuity of the cord, and produced a state of things analogous to that witnessed in the guinea-pig, whose cord has been cut across experimentally a state of things in which increased reflex excitability in the paralysed parts is one of the consequences. Nor is a different conclusion to be drawn from the occasional presence in the paralysed muscles of a state which is analogous to it, not identical with the " late rigidity " of Todd. This " late rigidity " is very different from " early rigidity." In " early rigidity," the electro- motility of the muscles is increased, and the muscles relax during sleep, and to a less degree under the influence of warmth. The contraction is evidently of the nature of spasm. In " late rigidity," on the con- trary, the muscles are wasted, their electro-motility is annihilated, and sleep and warmth do not tell in causing relaxation. This form of contraction, indeed, if not identical with rigor mortis, is, as it would seem, more akin to this state than to spasm. In a word, absence of spasmodic symptoms would seem to be the rule in all cases of myelitis, acute or chronic. In children, it is true, myelitis may be ushered in by convulsions in which case the convulsion may be NERVE AND MUSCLE. 263 supposed to take the place of the rigor which may usher in the same disorder in adults, and to belong to the precursory stage of irritation, and not to the stage of actual inflammation but, even in children, unless there be some meningeal complication along with the myelitis, this preliminary convulsion would seem to be of rare occurrence. Prolonged muscular contraction, on the other hand, is one of the many symptoms belonging to the state which is known under the name of spinal irritation. The lower extremities appear to be the parts most commonly affected, one or both of them ; but the upper extremities can claim no exemption, nor yet the muscles of the jaws and neck, trismus and torti- collis being among the forms it may take. This con- traction, which is generally painless, may be prolonged for weeks or even months continuously, even during sleep, or with occasional intermissions of uncertain duration ; and the attacks, secondary as well as pri- mary, are usually found to begin and end suddenly and unexpectedly. It cannot well be confounded with tetanus ; it may in some instances be difficult to distinguish between it and the somewhat vague dis- order to which Trousseau gave the name of tetany (tetanic). In tetany as in tetanus, the contraction is painful, but the order in which the body is attacked, is different from that which is observed in tetanus, centripetal not centrifugal, first the extremities, then the trunk or head, the contraction in fact being con- fined to the extremities except in cases of unusual severity. In the way in which it affects the extremi- ties first, and often exclusively, the contraction of tetany agrees with the contraction under consideration, 264 DYNAMICS OF but in other respects it differs. It differs especially in being ushered in and accompanied by symptoms which do not seem to be part and parcel of simple spinal irritation, viz., tingling and some degree of anaesthesia, and also (so it is said) in the form of the hand being peculiar when the contraction is in this part, this form being like that which is assumed in putting on a tight glove, and also in the possibility of bringing on the contraction when it is absent by firm pressure upon the principal arteries and nerves of the part in which the contraction is about to be mani- fested. It may be questioned, however, whether there are absolutely fixed lines of division between these different forms of prolonged muscular contrac- tion, and whether the differences which exist may not be accounted for as the result of different degrees of irritation, affecting, it may be, different parts of the spinal cord. It may be questioned, also, whether a sufficient case is made out for describing tetany as a distinct disorder, and whether it is not rather a form of spinal irritation complicated with some graver spinal disease myelitis, meningitis, or congestion in varying proportions. The association of tingling and numbness with the prolonged contraction is, as it would seem, a reason for an affirmative conclusion. At any rate, be its significancy in tetany what it may, prolonged contraction in various sets of muscles must be looked upon as a not unfrequent symptom in simple spinal irritation, a state which points, not to organic, but to functional disorder, of which one most characteristic feature is the way in which one symptom or group of symptoms may change, and change suddenly, into another symptom or group of NERVE AND MUSCLE. 26$ symptoms. In spinal irritation, indeed, it is now this disease which is simulated, now that, there being scarcely any disease which may not be copied. At one time the head is affected, at another the chest, at another the abdomen or the extremities, and the only thing constant among these ever-shifting pheno- mena appears to be the presence of spinal tender- ness, of which the seat changes from one part to another as this or that set of spinal nerves is chiefly affected. The pain or disorder of any particular organ is altogether out of proportion to the constitu- tional disturbance ; and the local tenderness of the spine, in the simple fact of its sudden changeableness as to its seat, has plainly nothing to do with a cause so mechanical and fixed in its nature as inflammation. In point of fact, the subjects of spinal irritation, with few if any exceptions, may be spoken of as hysterical, hypochondriacal, or nervous. They have that nervous constitution which Whytt, following in the steps of Sydenham, showed to be the common basis of hys- teria and hypochondriasis, and of which the signs are sufficiently obvious. First in order among these signs comes that sign which Sydenham regarded as patho- gnomic of hysteria and hypochondriasis a proneness to pass, under or after strong emotion, large quantities of pale, limpid urine. Then come other signs scarcely less characteristic : proneness to tenderness, not only in some part of the spinal column, but also in the epigastrium and left hypochondrium le tripled hysterique of Briquet ; proneness to sudden and distressing flatulent distension of the stomach and bowels, with loud rumblings and explosions, and with a feeling of a ball rolling about, first in the left flank, 266 DYNAMICS OF and then mounting, or tending to mount, into the throat, where it gives rise to a sense of choking and to repeated acts of swallowing ; proneness to bursts of laughing or crying and sobbing ; proneness to yawning/ sighing, and stretching of the arms, which phenomena are rarely ever present in acute organic disease ; proneness to fits of convulsive agitation and struggling. Then come a promiscuous series of signs, namely, these : erratic pains of a neuralgic character, breathlessness, nervous cough, palpitation, throbbings in the temples, epigastrium, and elsewhere, " flushes and chills," syncope, hiccough, nausea, vomiting, aversion to or unnatural craving for food, heartburn, oppression at the praecordia, languor, debility, fidgeti- ness, tremulousness, vertigo (especially on rising hastily), ringing in the ears, " animus, nee sponte, varius et mutabilis," fancifulness and inability to discriminate between fact and fiction, undue lowness of spirits or the contrary, and other symptoms whose name is legion. Not only, indeed, is the name of these symptoms legion, but there is ever going on a process of mutual metamorphosis in the symptoms themselves ; and, in short, it is this very variability and mutability of the symptoms which must be looked upon as the great characteristic of the nervous constitution, with which, and not with any inflammation or structural change, the prolonged muscular contraction, which has to do with spinal irritation, is associated. The vagueness in the seat of the inflammation which may be developed in the course of various spasmodic disorders, would also seem to show that spasm is not to be regarded as a symptom of inflam- mation of the spinal cord, or of any other part of the NERVE AND MUSCLE. 267 nervous system. In tetanus, for example, the traces of inflammation met with after death are not in the spinal cord exclusively, but in various parts of the brain, in the nerves, and in other parts as well. And so also in hydrophobia. Thus, in 46 cases, of which the histories were carefully analysed by my brother, J. Netten Radcliffe,* " the morbid appearances after death were in the dura mater in 8, in the arachnoid membrane in 10, in the pia mater in 16, in the velum interpositum in 2, in the choroid plexus in 12, in the cerebral hemispheres in 28, in the spinal cord and membranes in 18, in the medulla oblongata and pons varolii in 4, in the tongue in 8, in the palate in 3, in the salivary glands in 2, in the pharynx in 19, in the oesophagus in 16, in the stomach in 20, in the intes- tines in 6, in the larynx, trachea, and bronchial tubes in 31, in the ultimate ramifications of the air-passages in 24, in the heart in 4. These lesions consisted of every grade of injection of the blood-vessels, from the slightest blush to the most vivid red or dark black congestion ; of alteration of the consistency of the tissues, principally softening ; of effusion of blood and certain products of perverted secretion and nutri- tion. In several of the cases the lesions were of such a character that they have been classed with those resulting from common idiopathic inflammation ; in a greater number of cases they were of that character which is found in the structural changes occurring in asthenic conditions of the system." Now, this vague- ness in the seat of these inflammatory and other structural changes, I look upon as a very curious and significant fact a fact which, perhaps, more clearly * "Lancet," Sept., 1856. 268 DYNAMICS OF than any other single fact, is calculated to show the true relation of spasm to inflammation. It is calcu- lated to show that inflammation of one particular nerve-centre cannot be essential to the existence of the spasm. It is calculated to show that the cause of the inflammation may be as general as the cause of the febrile symptoms which are developed along with the inflammation that, in fact, it is little more than an accident, which fixes the seat of the inflammation in one nerve-centre rather than in another, or in one part of the organism rather than in another. In the case of hydrophobia, indeed, it is calculated to put the inflammation which may be developed in the course of the malady in the position of a depurative process a process which, like the inflammation de- veloped in connection with the fever of small-pox, is intended to rid the system of a morbid virus. And thus, as with convulsion and tremor, there is reason to believe that spasm is connected, not with a state of inflammation in any part of the nervous system, but with a state which may or may not issue in such inflammation a state to which the name of " irrita- tion " is commonly given, and which is marked, not by relaxation of vessels and hyperaemia, but by con- traction of vessels and anaemia ; for the arguments which were of avail in the former cases hold good in this case also. III. Tlie key to the history of spasm would seem to be that which served to unlock the histories of convulsion and tremor, and which is to be found, not in the current NERVE AND MUSCLE. 269 viciv of muscular motion, but in the view of this motion ivhich is unfolded in the physiological portion of this inquiry. The preceding remarks evidently lead to the same conclusion as that already arrived at when speaking of convulsion and tremor, and by the same way. Indeed, what was said when dismissing the subject of convulsion and tremor, will equally serve for the dis- missal of the subject of spasm, if only the word spasm be inserted in the places where the word convulsion or tremor was inserted. CHAPTER IV. ON THE HISTORY OF SENSATION AS EX- HIBITED IN NEURALGIA AND OTHER FORMS OF NEURALGIC DISORDER. (A.) ON THE HISTORY OF SENSATION AS EXHIBITED IN THE CONDITION OF THE CIRCULATION AND RESPIRATION DURING NEURALGIA AND OTHER FORMS OF NEURALGIC DISORDER. I. A IN of a neuralgic character may be asso- ciated with a very depressed condition of the circulation. It is a well-established fact that neuralgia in its most excruciating form may occur again and again without either fever or inflammation. It is also a well- established fact that the majority of persons who suffer from neuralgia are of a feeble and excitable constitution, with the circulation in keeping with this state of things. Judging, also, from the pale and perspiring skin, and the miserable pulse, which are so generally met with in the actual paroxysm of neuralgia, it may be supposed that this paroxysm is associated with a state of the circulation in which the habitual depression is exaggerated. Indeed, the appearances DYNAMICS OF NERVE, ETC. 271 during such a paroxysm are often calculated to re- mind one of the cold stage of ague, especially in that form of neuralgia which is met with in aguish districts, and in which malaria seems to figure conspicuously as a cause of the malady ; for in this case the neuralgia is often obedient to the same law as ague so far as this that it is associated with rigors, that it begins and ends punctually at a given time, and that it is followed by an obscure hot fit. It would seem, indeed, as if the neuralgia and the rigors were com- panion symptoms, both belonging to a cold stage, both associated with a depressed state of the circula- tion a state of anaemia, and not a state of hyperaemia. And this view of the matter derives some additional support from the fact that in all cases of neuralgia the patient is apt to shiver and shudder during the paroxysm. There is, in fact, abundant evidence to show that pain of a neuralgic character is associated with a state of circulation which is altogether opposed to the state of inflammation and fever : at any rate there will be no lack of such evidence when what has just been said is taken in connection with what still remains to be said. II. Pain of a neuralgic character would seem to be antago- nized ratJier than favoured by an over-active condition of the circulation. In rheumatic fever the rule, I believe, will be found to be this that the pains which had been torturing the patient for days, or weeks, or months previously, preventing him from being comfortable when up, and 272 DYNAMICS OF causing him to toss about in sleepless misery at night, come to an end when the feverish reaction and local inflammation of the fully formed disorder make their appearance. After this, the joints are tender enough, but if the patient keep as still as he is very likely to do under the circumstances, he is comparatively at peace so far as pain is concerned. Or, if it be other- wise, the pain will generally be found to be in a part in which the signs of rheumatic inflammation are im- perfectly established or absent, or else at a time in which x there is a decided remission in the feverish symptoms an event which happens more frequently in this disorder than is commonly supposed. It is also difficult to look upon the local inflamma- tion of gout as essential to the existence of the racking pain of this disorder. "About two o'clock in the morning," says Sydenham, who from personal expe- rience knew full well what to say, " the patient is awakened by a severe pain in the great toe, or, more rarely, in the heel, ankle, or instep. This pain is like that of a dislocation, and yet the parts feel as if cold water were being poured over them. Then follow chills and shiverings, and a little fever. The pain, which was at first moderate, becomes more intense ; and with its intensity the chills and shivers increase." After tossing about in agony for four or five hours, often till near daybreak, the patient suddenly finds relief, and falls asleep. Before falling asleep, the only visible change in the tortured joint is some fullness in the veins : on waking in the morning, this part has become swollen, shining, red, tender in the extreme, and more or less painful, but this painfulness is as nothing when compared with the torture of the night NERVE AND MUSCLE. 273 past. It seems, indeed, as if the pain which now exists must be referred to the mere tension and stretching of the inflamed ligaments, for it may be relieved, or even removed, by judiciously applying support to the toe and to the sole of the foot. On the night following, and not unfrequently for the next three or four nights, the sharp pain in all probability returns, reappearing and disappearing suddenly, or almost suddenly, and resulting in the discovery of additional inflammatory swelling upon awaking in the morning. The pain in these relapses, like the primary pain, is accompanied by chills and shivers, and by the most distressing irritability and excitability, but until unequivocal signs of inflammation are developed in it the painful part is not tender in the true sense of the word. The inflammation is attended by no fever, or by very little ; or, if it be otherwise, as it is occasion- ally, the inflammation runs higher than usual, and the characteristic pain is less urgent than usual. Dr. Garrod points out this latter fact in his excellent work on Gout,* and says that he has seen several illustrations of it. From its history, then, it would seem as if the inflammation of gout were not essential to the pain of gout. It would seem as if the pain went hand in hand with the rigors which are preliminary to the development of the inflammation. It would seem as if the inflammation had little to do with the pain, for if it were otherwise, it is scarcely to be supposed that the pain should be least urgent in the cases of gout in which the inflammation is most marked, and that the unequivocal signs of inflammation should make their * "Gout and Rheumatic Gout." Post 8vo. London: Walton and Maberly, 1859, p. 39. T 274 DYNAMICS OF appearance during sleep without waking the patient. Nay, it would even seem as if the pain were put an end to by the establishment of the inflammation as if, in fact, the pain were antagonized rather than favoured by the inflammatory condition. Moreover, the suddenness with which it begins and ends in the majority of cases must be looked upon as a reason for referring the pain to the category of neuralgia a category in which, to say the least, it is not a little difficult to find any place for inflammation. There is also reason to believe that pain holds the same relation to fever and inflammation in other kinds of fever besides the rheumatic, and in other kinds of inflammation besides the gouty. Six or seven years ago, I had a patient in the Westminster Hospital who, when I saw him first, complained of violent pains all over the body, espe- cially in the back and loins, and also of chills and shivers. A few hours afterwards he was hot and feverish, and the pains and chills and shivers had all taken their departure. The case was one of small- pox ; and the lesson I gathered from it was that the pains and the rigors were symptoms which ought to be classed together, and considered as belonging to the cold and not to the hot stage of the fever. And this case would seem to be a fair illustration of what happens in other fevers ; for it seems to be the rule rather than the exception for the pains which attend upon the onset of these disorders to pass away or to become greatly mitigated when the cold stage gives place to the hot stage. Nay, it would even seem as if pain gave place for the time to what may be called artificial feverishness. At any rate, I have more than NERVE AND MUSCLE. 275 once felt tic-douloureux pass away as soon as I could set my blood fairly in motion by violent bodily exercise ; and on two occasions I have derived a similar benefit from a practice which is not unfre- quently adopted in the hunting field, and put an end summarily to a sudden attack of lumbago by leaning forwards in the saddle and beating the loins with the two hands until the whole body was aglow arid the perspiration dropped from the forehead. Nor is it different with inflammation. In the case of a dislocation or sprain, for example, the acute pain of the accident the pain to which Sydenham likens that of gout does not, as a rule, remain after the parts have begun to be hot and swollen and tender ; and this case is certainly no exception in the history of inflammation. It would seem, in fact, as if the proper place for the pain was among the phenomena of the preliminary cold stage the stage of " shock," and not among the phenomena of actual inflamma- tion. And it is not impossible that the efficacy of blisters in the relief of many kinds of pain may furnish another passage in a similar story ; for it is a fact, which is as well established as any fact in thera- peutics, that blisters are most effectual means of relieving pain, and that this relief is usually coincident with the blistering that is, with the inflammation set up by these agents. Nor is a contrary conclusion to be drawn from the history of certain cases in which pain continues as a permanent symptom after the full establishment of inflammation, as, for example, in deep-seated inflammation of the mamma, for in these cases it is a fact that this persistent pain is imme- diately relieved or removed by those operative mea- T 2 276 DYNAMICS OF sures which diminish the tension or stretching arising directly or indirectly from the inflammation. It is a fact, that is to say, that the persistent pain in these cases is an accidental and not an essential accompani- ment of the inflammation a consequence, as I have just said, of tension or stretching of the tender tissues, and not a necessary part of the inflammation itself. How far these inferences will be confirmed or set aside by the histories of those forms of pain in which the nervous system is more especially implicated remains to be seen ; but, so far, there seems to be good reason for believing that pain of a neuralgic character is connected with a depressed state of the circulation rather than the opposite state of febrile in inflammatory excitement. III. Pain, the result of tenderness, not pain of a neuralgic character, is associated with the state of active con- gestion or inflammation. Severe and prolonged pain may be the result of touching or otherwise interfering with an inflamed part, but this pain, which is the result of the tender- ness which accompanies the inflammation, is not to be confounded with pain of a neuralgic character. Pain, the result of tenderness, in fact, is only the sign of exalted sensibility, which exalted sensibility is the effect of the increased vascularity a phenomena to be explained in the same way as the sensation pro- duced by the prick of a pin, or by any other local means. It does not occur if the inflamed part be let alone. It is not essential, like pain of a neuralgic NERVE AND MUSCLE. 277 character ; it is only accidental. In a word, evidence is not wanting which would seem to show that there is something uncongenial between pain of a neuralgic character, and pain the result of tenderness, the former pain disappearing when the latter makes its appearance. Thus in the cases of neuralgia in which it may be presumed that neuritis is developed in the course of the disorder, the nerve changes from a state of comparative indifference to pressure into a state of exquisite tenderness, and at the same time the pre- vious torture comes to an end, and the patient is comparatively at ease if the nerve be let alone. IV. TJie condition of the respiration in neuralgia and other neuralgic disorders, like the condition of tJie circula- tion, is one of deficient activity. The condition of the respiration in neuralgia and neuralgic disorders generally presents nothing which can be spoken of as at all remarkable. A patient suffering from severe tic-douloureux will often sigh in a way which suggests the notion that he is far from happy at the time, when in reality the sighs only show that insufficient breathing has to be made up now and then by breaths which are more deeply drawn than usual ; and other signs to the same effect may be found if they are carefully looked for in this and in analogous disorders. But it is unnecessary to adduce special illustration in support of this point, for if the condition of the circulation in neuralgia and analogous disorders be what it has been stated to be, one, that is, DYNAMICS OF of wanting activity, it is plain that the accompanying condition of the respiration must also be marked by wanting activity. (B.) ON THE HISTORY OF SENSATION AS EXHIBITED IN THE CONDITION OF THE NERVOUS SYSTEM DURING NEURALGIA AND OTHER NEURALGIC DISORDERS. I. Neuralgia and pain of a neuralgic character would seem to be connected, not with a state of inflammation in any part of the nervous system, but with a state which may or may not issue in such inflammation a state to which the name of irritation is commonly given, and which is marked, not by relaxation of vessels and hypercemia > but by contraction of vessels and ancemia. Pain is no very conspicuous symptom in the com- mon form of cerebral meningitis that is, the tuber- cular form ; and in simple meningitis there is reason to believe that any severe pain in the head is the precursor of, rather than the attendant upon, the actual inflammation. Not long ago, for example, I had in the Westminster Hospital a well-marked case of acute simple cerebral meningitis in a boy aged fifteen. On my first visit, the face was pale and perspiring, the ears and head generally somewhat below the natural temperature, the pupils dilated, and the pulse con- tracted and feeble, and what was complained of was agonising pain in the head, with frequent chills and shivers. On my second visit, eight hours afterwards, the face was flushed, the head burning hot, the pupils NERVE AND MUSCLE. 279 contracted, the eyes ferrety, the skin hot and dry, the pulse quick and hard ; and now fierce delirium had taken the place of the pain. And this, so far as my experience goes, is the regular history of the pain in this disorder. It is pain ceasing, not pain beginning, as the signs of active determination of blood to the head make their appearance. It is pain in associa- tion, as it would seem, with an anaemic rather than with a hyperaemic condition of the membranes of the brain. Nor is it otherwise when the membranes of the spinal cord are the seat of the inflammation. For example, I had also in the Westminster Hospital, about the same time as the last case, another case in which, after death, was found unmistakable evidence of recent spinal meningitis of an acute character, the patient being a young man aged 23. The illness began three days before admission with sharp pain in the back and legs, shivering and retention of urine, the patient beginning to suffer in this way shortly after sleeping for some time flat on his back on the grass. Upon examination the back was found stiff, with the head drawn back, and on any attempt at movement, and now and then without such attempt, severe pain was experienced along the whole course of the spine, in the legs, in the lower part of the abdomen, and, to a lesser extent, in the head also, this pain being always accompanied by increase of stiffness. Death happened at the end of a week. During the last three days of life the bouts of pain and contraction were very occasional and of very short duration ; and in many instances even these there is reason to believe might have been avoided if the patient could have 2 8o DYNAMICS OF been kept perfectly still. The pain, in fact, obeyed the same rule as that obeyed by the contraction, of which enough has been said already, and the conclu- sion would seem to be that the pain is, not of a neuralgic character, but the result of tenderness, and that pain of a neuralgic character in this case is antagonized rather than favoured by the inflamma- tion. And certainly this is the conclusion which must be drawn from the history of those painful disorders which come under the head of spinal irritation, and which are so often met with in hysterical patients, for here severe pain of a neuralgic character is a prominent symptom, and yet the collateral symptoms and the issue of the disorder in nineteen cases out of twenty make it impossible to ascribe the pain to inflamma- tion of the substance or membranes of the cord. With respect to neuralgia in all its manifold forms one thing is certain, and this is, that neuritis is not necessary to its production. In the cases where the extreme local tenderness with some degree of swelling along the track of the sciatic nerve would seem, to show that sciatica has become complicated with neuritis, the neuralgic pains are not aggravated. On the contrary, the plain fact would seem to be rather this that these pains, which had been such prominent symptoms previously, come to an end when the local tenderness and swelling give evidence of the establishment of inflammation in the course of the sciatic nerve, if only the affected limb be kept still and all pressure upon the tender parts be avoided. It is also the rule, rather than the exception, for NERVE AND MUSCLE. 281 toothache to come to an end when the face becomes swollen and inflamed, and so likewise with the stabbing pains which so generally precede the inflammatory eruption of herpes, for these pains scarcely ever remain after the eruption is fully established. Again, I can testify to this being the true history of facial neuralgia, or tic-douloreux, in many cases : first, neuralgia without local tenderness and swelling and redness, and with frequent chills and shiverings, and a decidedly depressed condition of the circulation ; then, after an interval more or less prolonged, local tenderness, redness and swelling, with general feverish reaction, without chills and shivers, and without neuralgia, the true neuralgia for the most part coming to an end coincidently with the establishment of the local inflammation. In short, neuralgia and pain of a neuralgic character would seem to be connected, not with a state of in- flammation in any part of the nervous system, but with a state the reverse of this, which may or may not issue in such inflammation a state to which the name of irritation is given, and which is marked, not by relaxation of vessels and hypersemia, but by contrac- tion of vessels and anaemia, the case, indeed, being no other than that of convulsion, or tremor, or spasm, if only the scene of action be shifted from the parts concerned in motion to the parts concerned in sensa- tion. II. The key to the history of neuralgia and pain of a neuralgic character would seem to be that which is found, not in tJie current view of sensation, but in tJie 282 DYNAMICS, ETC. view which is unfolded in the physiological portion of this inquiry, and- which has also served to unlock the mystery of muscular motion. Neuralgia and pain of a neuralgic character, accord- ing to the current view of sensation, are associated with a state of increased vascularity in some part of the nervous system. The pain is looked upon as a sign of excited vital action, and, because the manifesta- tions of life in a part are proportionate to the supply of blood to the part, it is assumed that there is this state of increased vascularity. Neuralgia and pain of a neuralgic character, according to the view of sensa- tion set forth in the premises, is nothing more than the result of a disturbance in the electrical equilibrium in some parts of the nervous system, of which the re- sult is discharge, this disturbance being brought about, not by excess of blood in some parts of the nervous system, but by the contrary state of things. In short, the key to the history of neuralgia and pain of a neuralgic character would seem to be that which is found, not in the current view of sensation, but in the view which is unfolded in the physiological portion of this inquiry, and which has also served to unlock the mystery of muscular motion. The physiology explains the pathology, and the pathology establishes the physiology. In physiology and in pathology it is one and the same story throughout. DYNAMICS OF NERVE AND MUSCLE PART III. A FEW WORDS IN CONCLUSION. IN CONCLUSION. FEW words will serve to say all that remains to be said in conclusion. Looking back at the evidence brought forward in the previous investigations, it is impossible to accept as truth the dogma which ascribes to nerve and muscle a special life, of which action is the expression, which is fed by the blood, and which is prone to act in direct proportion to the amount of blood it has to feed upon. It is impossible to reconcile with this dogma the true history of convulsion, or spasm, or tremor, or increased mus- cular contraction in any form, or neuralgia, or any pain of a neuralgic character. These phenomena, according to this view, are signs of undue vital excitement in one or other of the parts concerned in the production of muscular motion and sensation. They point to a bloodshot or congested state in one or other of these parts, for without the additional blood, it is believed, there could not be this undue vital excitement. In fact, however, the actual case proves to be the very opposite of what in theory it ought to be. Where the state ought to be one of afflux of blood, it is one of efflux ; and, in point of 286 CONCLUSION. fact, the signs of increased action which have been indicated, convulsion and the rest, are met with under the very circumstances in which they ought not to exist if they are the signs of undue excitement in a special life of nerve or muscle which expresses itself in action. This is the conclusion arrived at when the subject is regarded from a physiological point of view, and this no less is the conclusion when the point of view is shifted from the side of physiology to that of pathology, physiology and pathology in this matter telling one and the same story. Instead of regarding the state of action in nerve and muscle as a manifestation of vitality, there is, indeed, reason to believe that it must be brought under the dominion of physical law in order to be intelligible, and that a different meaning, also based upon pure physics, must be attached to the state of rest. There is reason to believe that all kinds of electri- city act upon nerve and muscle by way of charge and discharge, the charge antagonizing, the discharge permitting, the state of action. There is reason to believe that the blood acts upon nerve and muscle, not by causing the state of action, but by antagonizing it. There is reason to believe that " nervous influence " acts upon nerve and muscle, not by causing the state of action, but by antagonizing it. The whole case is simple enough. It would seem, indeed : (i) That the sheaths of the fibres in nerve and CONCLUSION. 287 muscle are capable of being charged like Leydenjars, and that during the state of rest they are so charged. (2) That the sheaths of the fibres in muscle are highly elastic. (3) That the fibres of muscle are elongated during the state of rest by the charge with which their sheaths are charged, the mutual attraction of the two opposite electricities, disposed Leyd en- jar-wise, upon the two surfaces of the sheaths, compressing the elastic sub- stance of the sheaths and so causing elongation of the fibre in proportion to the amount of the charge. (4) That the muscular fibres contract when the state of rest changes for that of action, because the charge which caused the state of elongation during rest is then discharged, and because this discharge leaves the fibres free to return, by virtue of their elasticity simply, from the state of elongation in which they had been previously kept by the charge, and that the degree of contraction is proportional to the degree of elongation previously existing. (5) That the fibres of nerve are not affected in the same way as the fibres of muscle by the charge and dis- charge of electricity, because the sheaths of the fibres may be wanting in the requisite degree of elasticity. (6) That the blood antagonizes the state of action in nerve and muscle by helping to keep up the natural electrical charge which antagonizes action. (7) That " nervous influence " antagonizes the state of action in nerve and muscle by helping to keep up the natural electrical charge which antagonizes action. 288 CONCLUSION. (8) That diminished efflux of blood to certain nerve- centres leads to excessive action in nerve and muscle by disturbing the electric equilibrium of the nervous system which is maintained during the state of rest, this disturbance causing a partial reversal in the relative position of the two electricities with which the sheaths of the fibres are charged, and so necessitating the discharge which is the basis of the state of action ; for by this partial reversal sheaths of which the charge has become negative at the sides and positive at the ends are brought into juxta-position with sheaths of which the charge remains positive at the sides and negative at the ends are brought into a relation which necessitates discharge, for discharge must happen when opposite electricities come to- gether. These are the broad conclusions which are dedu- cible from the facts ; these are the more salient points which are made out by a retrospective glance at the subject as a whole. Everything is in opposition to the dogma which ascribes to nerve and muscle a life of which the state of action is the expression. Every- thing, indeed, points to a solution of the problem of which the effect is to bring phenomena which have been regarded as exclusively vital under the dominion of physical law. THE END. Harrison and Sons, Printers in Ordinary to Her Majesty, St. Martin's Lane. BY THE SAME AUTHOR, Will be shortly Published, SKETCHES OF CEREBRAL, SPINAL, AND OTHER DISORDERS OF THE NERVOUS SYSTEM. 14 DAY USE RETURN TO DESK FROM WHICH BORROWED LI This book is due on the last date stamped below, or on the date to which renewed. Renewed books are subject to immediate recall. x- 1 ??* 7:1 28Ap"63Xy ft m n r-L "I f\ ***~-.-~< MAR 1 1970 MAR 2 1970 1 DUE APR o 1982 Subject to Recall RnyTOW! M/*R26 198? BIOIQGY fiaoABw LD 21-50m-6,'59 (A2845slO)476 General Library University of California Berkeley