Vol. 60, 1909 - University of North Carolina at Chapel Hill

392 THE CHARLOTTE MEDICAL JOUKNA. .
rest of the nervous system, apparently, manifest itself first in the upper extremities, j
showing no change. The development of It is the nerve centres controlling the groups |
these conditions is progressive. It is im- most commonly in use that first undergo |
possible to find any one factor or set of atrophy. A most suggestive example of i
factors to explain them unless it be sup- what may be termed general abiotrophy, •
posed that these cells have a shorter life throwing light upon these more specialized i
than have the other neurons, that they ex- abiotrophies has recently been adduced in j
hibit a premature senility leading to pre- Bardeen's studies upon the effects of X-rays »
cocious death. Such would seem to be a upon frog's spermatozoa. By subjecting
most satisfactory explanation of conditions the sperm to the rays for a few minutes it
like Thomsen's disease and other familiar is found that are capable of fertilizing the
paraplegias. In these diseases, for a time, ova; the individual life begins, but the larthe
mental and nervous conditions develop vae, growing, all die prematurely; none
in a normal manner. However, in a few survive beyond the second week. Appar- |
years one particular set of mscles under- ently there is cell axhauslion after a certain |
goes atropliy with corresponding paTalysis, early period. '.
and the motor centres governing these mus-
'
cles show localized atrophy of their cells. indig«nuri«^ its sigmificange.
Somewhat similar to these hereditary con- The presence in the urine of indican, or ij
ditions, are the nervous disorders which indoxyl sulphuric acid, has recently been i(
may follow long years after an attack of the subject of much discussion, whether or ».
syphilis, notably tobes or locomotor ataxia, not a proper significance has been ascribed 1
One method of regarding these conditions to the occurrence of this substance in hu- i
is to imagine that syphilis is a disease that man urine is as yet unproven. Investiga- i
is never wholly cured, that, once in the sys- tors, noting its association with various i,
tem, the germs continue to grow and to pathological processes, have forthwith con- I
produce their toxins, and that these toxins eluded that the indican stands in etiologic '
have, as it were, a cumulative effect until, relation. However, the possibility that the d
at last, owing to their continued irritation, indoxyl compound is nothing more than «
they bring about the death of certain groups evidence of some deeper metabolic perver- ••
of nerve cells which are more susceptible sion and not of itself necessarily of serious .-j
to their influence than are others. The import must not be forgotten. In discuss- •,
difficulty in accepting this view is that, in ing a paper on "indicanuria" by Dr. Judsuch
cases, we have no other sign of the son Doland, which appeared in the Journal
continued existence of the germs of syphi- American Medical Association recently,
lis. W^ do not find indications of gum- Dr. Heinrich Stern emphasizes his opinion
mata or other syphilomata. The Individ- that the pathologic significance of indican
ual is incapable of infecting others with has been grossly exaggerated. The fact
his disease, and, judging, by macroscopic that there occurs an increased production
and microscopic appearances, the disease of indoxyl compounds in certain conditions
is, and has been for years, arrested. It is does not justify us in ascribing to them
more satisfactory to suppose that, during toxic qualities, or that they stand at the
its active stage, there had been a certain foundation of a number of pathologic conamount
of irritation and intoxication of ditions. To cite a simple instance: They
these particular groups of cells. Or, again, have no direct relationship to so-called pyit
may be that there has been a general in- orrhea alveolaris; they are neither its cause
toxication of all the nerve elements to such nor its result. Inddxyl compounds are
an extent that, although the intoxication normal urinary constituents; they are found;
has been recovered from temporarily the in small amounts in every human urine,j
cells have, notwithstanding, been weaken- except in that of newborn and breast-fed'
ed so that now, under the normal strain, infants. Indoxyl is even contained in the
these cells, being called upon to perform secretion of infants who obtain besides liuno
more than the normal amount of work, man milk also some cow's milk and, evett
become easily exhausted and undergo pre- in these instances, it occurs in the absence
mature dissolution. This second possibili- of any digestive disturbances whatsoever.
ty is mentioned inasmuch as, while it is Increased amounts of indoxyl as found incells
in connection with the lower portion the urine allow but one interpretation,
of the cord controlling the lower limbs that, namely, that there exists some form
in general, first give out, there are cases on tryptic perversion. Some observers hold
record of those who, leading a sedentary that the trypsin of the pancreatic secresio
life, do not employ the lower limbs in induces or favors the production of indoxyUJ
walking to the normal extent, but use the Their contention is based on two facts, viz|
arms and upper extremities actively, and, the tryptic quality as regards decompositii
in these, the paralytic condition is apt to of the ingested proteid material, audi
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