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arachnoid membranes, increase of cerebro-spinal fluid, or other obvious signs of cerebral wasting. The ventricles are not granular, but there may be a few ependymal granulations in the lateral sacs of the fourth ventricle. Microscopical examination shows some wasting of the tangential fibres and subpial glia cell proliferation and felting, but as a rule this is not marked. The fibre systems are otherwise well preserved. There is no very marked glia cell proliferation in the cortex, and when sections are stained by the Nissl method, the cells of the columns of Meynert are not distorted or poorly stained; their apical processes are not cork-screwed (vide figs. I and II). There is no lymphocyte and plasma cell infiltration around the vessels and in the membranes, consequently we should always be able to decide between the brain of a patient suffering from alcoholic dementia and general paralysis; for in the latter disease there is marked cortical wasting, granular ventricles, thickened membranes, excess of cerebro-spinal fluid, and microscopic changes, indicating great cell and fibre destruction, increased vascularity, with perivascular cell infiltration and neuroglia proliferation.

The changes in the central cortex by the microscopic study of the cell lamination and fibre systems do not, according to my experience, explain (by our present methods) the mental symptoms of alcoholic psychosis. Dupré does not consider that the mental symptoms of the disease can be correlated with its morbid anatomy, and cases were observed in Ballet's Clinique, in which no histological changes were detected in the cortex to account for the well-marked mental symptoms observed during life. But the integrative action of the nervous system depends not only upon the recognisable anatomical basis of mind, the cells and fibres, but also upon the condition of the substance which forms the physiological synapsis of the neurones. This bio-chemical substance may be a product of the Nissl substance much the same as the ferment of a gland cell is the product of the pro-ferment; it may indeed represent neuro-potential. It is pretty certain that the bio-chemical changes incidental to neuronic activity take place at the synapse, and we may accept MacDougall's hypothesis of an inter-neuronic substance which is essential for all nervous activity and especially for the processes of attention. The action of the poison in paralysing the functions of the cortical cells would serve to explain the loss of attention, of memory for recent events, and the mental confusion, all symptoms indicative of exhaustion of cortical cells with disintegration of function.

Besides the changes in the peripheral nerves with which you are doubtless familiar, there are certain very characteristic changes in the sensory and motor cells, which can be demonstrated in the posterior spinal ganglia, the anterior horn cells or their homologues in the base of the brain and medulla oblongata, and in the large psycho-motor (Betz cells) of the motor area of the cerebral cortex. The changes can be demonstrated readily by Nissl method, and are indicated in the

figures II, III, IV. The nucleus is large and clear, often dislocated to the side and sometimes extruded altogether. The Nissl granules may be almost entirely absent, or only found at the periphery; sometimes the cytoplasm is vacuolated or shows an excess of pigment. In severe cases many of these neurones must be permanently destroyed as shown by the fact that their axons with their myelin investing sheaths undergo degeneration. This can be easily demonstrated in fatal cases by Marchi method if the patient died within a month or two of the onset of the paralytic symptoms (vide figure V), and by the Weigert method if the patient has died at a later period when a substitution sclerosis has had time to develop. The degenerative changes will be found in the pyramids of the medulla, the crossed and direct pyramidal tracts and the posterior roots, posterior columns, anterior roots, and anterior root zone. Even in severe cases, only a portion, and that relatively a small portion, of the cells are completely destroyed beyond hope of recovery; and this is a matter of very considerable importance in prognosis and treatment, for if the neurones are to recover their specific energy, we must afford them the necessary stimulus, and this can only be effected by preventing contracture and atrophy of the muscles by massage and passive movements. The chromolytic changes in the cytoplasm and the alterations of the nucleus may be due to a réaction à distance, that is to say, they are similar to the changes produced when a nerve is divided. The peripheral neuritis causing death of the axons of a number of the sensory and motor neurones would produce changes of the nature of reaction of injury, and combined with the toxic condition of the blood, would lead to death of a number of cells of low specific energy.

I do not regard the changes described in the sensory and motor spinal cells, nor in the cortical motor cells, as being peculiar to alcoholic neuritis. I have found the same in the polyneuritic psychosis of lead poisoning. I have only found changes in the psychomotor cells when there has been an associated polyneuritis. In some cases cortical hæmorrhages occur (fig. VI.)

In conclusion, I would remark that a great deal has lately been written about the attitude doctors should take up in regard to alcohol. Probably the teaching of the late Dr. Parkes is the best to take up on this question:-"It produces effects which are often useful in disease, and sometimes desirable in health, but in health it certainly is not a necessity, and many persons (especially neuropathic individuals) are much better without it. As now used for mankind, it is infinitely more powerful for evil than for good, and though it can hardly be imagined that its dietetic use will cease in our time, yet a clearer view of its effects must surely lead to a lessening of the excessive use which now prevails."

Fig. I.-Section of the top of the ascending frontal convolution from the brain of a highly intelligent man who died of tetanus, stained

by Nissl method. The weight of the brain was 1,500 grams, and this may account for the greater depth of the cortex than fig. II. The cells present a normal appearance. Observe the nucleus and the Nissl granules of the giant psycho-motor Betz cell, and compare with three similar cells in fig. II.

Fig. II. Section of the top of the ascending frontal convolution from the brain of a woman who died of alcoholic polyneuritic psychosis of long standing, stained by Nissl method. Observe that there are no vascular changes as in general paralysis; the columns of Meynert are not disorganised, the pyramidal cells, with the exception of the giant Betz cells, show but little difference to the normal in appearance and numbers; yet this patient was demented. The Betz cells show the characteristic changes described in the text. Magnification 120.

Fig. III.—Photomicrograph of a group of anterior horn cells from the lower lumbar region, showing various degrees of central chromatolysis and nuclear displacement.

Fig. IV. Photomicrograph of a section of the first sacral ganglion, showing chromatolysis and eccentric nucleus. Magnification 120 Nissl's stain.

Fig. V. Diagram of sections of the spinal cord at seven levels and of the lower part of the medulla from a case of acute alcoholic polyneuritic psychosis, representing the Marchi degeneration found in the posterior columns, the anterior root zones, and the crossed and direct pyramidal tracts.

Fig. VI. (1) Shows the naked eye appearance of the cortical capillary hæmorrhages in a case of acute polyneuritic psychosis. (2) Shows a small vessel with inflammatory nuclear proliferation and fatty degeneration; a capillary branching from it terminates in a hæmorrhage, the result of the rupture of its wall. Magnification 250 x 1.

Figs. I, II, and VI are reproduced from the “Archives of Neurology," Vol. III.

Figs. III, IV, and V are reproduced from a paper by Dr. Sydney Cole on the Systematic Examination of the Central and Peripheral Nervous Systems and Muscles in a case of Acute Alcoholic Paralysis with Mental Symptoms, " Archives of Neurology," Vol. II.

Hospital Notes.

We heartily congratulate Dr. Turney on his election as a full Physician of the Hospital. The In-Patient Staff now consists of five Physicians and six Surgeons. A certain amount of rearrangement of the Medical Wards must necessarily follow. This will probably take place after the summer.

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Certain changes which have just been announced, with reference to the arrangements for some of the Hospital Prizes, seem worthy of mention. In the first place there has been a complete readjustment in the marking for the Treasurer's Gold Medal. Hitherto the marks obtained in the Sessional Examinations of the second and third years have aggregated three times the highest possible number which can be obtained in the fifth year examination. In future this will be equalised, and the full marks obtainable in the final sessionals will just about correspond to the full marks for the second and third years combined.

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In addition to this, the date of the Hospital Entrance Scholarship Examinations has been altered. Instead of being held, as heretofore, in the beginning of October, these will take place intending 'Varsity and Pre. Sci. candidates please note in the July, the revised regulations coming into effect in July, 1908. This will make it possible for men to compete just after having finished their Professional Examination in the identical subjects, and then to get a really respectable holiday before starting work at the commencement of the winter

session.

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The new catering arrangements in the Club appear at present to be working satisfactorily. The general appearance of the dining room is immeasurably superior to anything that has been seen there for some years past. The food, generally speaking, is excellent, and the table d'hote luncheon a revelation. The service is not always, perhaps, quite as prompt as we should desire, for the ladies who attend to our simple wants do not bustle to anything like the extent of the perspiring

waiters of old. But this is being gradually remedied. It is interesting to note that alcoholic beverages have practically disappeared from the tables. Mr. Parsons deserves and obtains the gratitude of all the members for the trouble he has taken in the matter: the whole reorganisation has been largely due to his own personal initiative.

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As a sequel to our performances in the last conjoint examinations, we have now to chronicle a brilliant success in the final London M.B. B.S. lists just published. Fourteen men entered from the Hospital, and of these nine obtained the degree, one passing in Group II only. The Honours list contained the names of nine men all told. No less than three of these were Thomas's men, H. G. Bennet obtaining distinction in Medicine, A. C. F. Turner in Pathology, while H. J. Nightingale was awarded the Gold Medal with distinction in every subject except Midwifery and Diseases of Women.

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As a Hospital our social functions throughout the year can hardly be described as numerous. Towards the end of January we get into our stride with the Nurses' Conversazione (the exact explanation of the terminology employed has up to the present eluded us). In May comes the now annual Students' Club Dance (which we refer to in another column), and the season closes in June with the Sports Day and the Prize Distribution Day. Of course there are others, such as the Nightingale "At Home," but here it is only the elect few who are privileged to behold our budding sisterhood in its own secure retreat.

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This year the Sports Day has been fixed for June 18th. It is a day on which all are welcomed-and on no occasion does our Chiswick athletic ground look more alluring. During the last few years the climatic conditions have been most favourable, and we must hope for a similar kindly provision in the present instance. One of the most attractive features in the programme, viz., the Donkey Race (in costume and on real skittish quadrupeds), has had for the last three years to be abandoned. A College House Race now forms a somewhat inappropriate substitute. The cream of the meeting, however, is the Staff Race, in which certain of the senior members of the staff, with their customary self-sacrifice, offering themselves upon the

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