THERAPEUTIC VALUE OF LOCALIZED FARADIZATION. 167 



Case XL — The foregoing has been confirmed by another case seen by 

 M. Charcot, in 1865, in a woman seventy-eight years of age, who was under 

 his care at the Saltpetriere. In this case the intervertebral ganglia and 

 intercostal nerves, corresponding to the surface attacked by the zona, pre- 

 sented precisely the same appearance as in that last described.^ 



(6). Critical examination. — The following, I think, are the 

 deductions that should be drawn from the anatomo-pathological 

 facts of Barensprmig and Charcot. 1. Inflammation of spinal 

 ganglia anatomically characterised by a well-marked vascular 

 injection, and a proliferation of the perineurine, without lesion of 

 nutrition, or with only a slight change of the nervous elements, 

 produces, in the portions of skin which receive innervation from 

 the parts affected, a special lesion of nutrition, of the nature of 

 zoster. 2. The neuralgia which accompanies the zona is the 

 result of excitation of the sensitive nerve -filaments which pass 

 through the ganglion. 3. The spinal ganglia contain the trophic 

 nerve-filaments of the skin. But the anatomo-pathological facts in 

 no way confirm the general doctrine of Samuel and Barensprung, 

 who maintain that the trophic nerves originate in the spinal ganglia. 



M. Charcot, a more strict observer, and one who ne^er goes 

 beyond his facts, has been too careful to draw any general con- 

 clusion from his own particular case. 



The clinical facts do not prove, indeed, that other parts of the 

 nervous centres may not contain trophic nerves of the skin. 

 Clinical observation shows, moreover, that, under certain circum- 

 stances, lesions of the cord will alter the nutrition of the skin and 

 of the subcutaneous cellular tissue. Of this I could cite many 

 examples from my practice. Thus, in infantile spinal paralysis, 

 the anatomical lesion of which is a wasting or destruction of the 

 cells and a fibroid metamorphosis of the anterior oornua,^ whenever 

 a muscle has been attacked in its nutrition and texture (granular 

 or fatty degeneration), I have observed that the subcutaneous 

 cellular tissue covering it was hypertrophied, and sometimes that 

 the nutrition of the skin was altered in various ways. These con- 

 ditions will be more fully described in the chapter which treats of 

 the spinal or fatty atrophic paralysis of infancy. 



I should observe, also, that inflammation of the spinal ganglia 

 produces no lesion of nutrition excepting in the skin. How, then, 

 shall we explain the alterations of nutrition of the muscular and 

 even of the osseous system, which have been observed consecutively 



^ Charcot et Cotard. Alteration (n^u- 

 rite) du "plexus cervical et des ganglions 

 correspondants des racines spinales pos- 

 terieures, Zona du ecu (^Memoires de 

 la Socie'te'de biologic, 1865, p. 47). Charcot 



' This anatomo-pathological fact, dis 



vered in 1866 by M. Prevost, interne to 

 M. Vulpian, has been confirmed by a 

 recent autopsy in a case of infantile 

 paralysis, communicated to me by M. 



