224 PHYSIC 



cervical branches of the brachial plexus at their points of 

 origin in the neck, and that the superficial or cutaneous 

 excretion at those points of the cerebro-spinal lymph was 

 transferred from the superficial afferent or sensory to the 

 deep efferent or motor roots of the involved nerves to be 

 finally disposed of ; and, thereafter, instead of being 

 excreted through the skin, as in the other parts of the 

 spinal nervature, it was reflected along the corresponding 

 motor nerves these being the nearest lines of least resist- 

 ance thence entering and traversing the muscles named, 

 with their periosteal attachments, in the order mentioned, 

 and ultimately being deposited as exostoses in the periosteal 

 layers of tissue covering the distal phalanx at the points 

 of attachment of the affected thumb muscle tendons. 



Here, we contend, is a manifestation of a disease, from 

 inception to close, along certain definite histological lines, 

 carried by obvious and definite agencies, and leaving 

 definite after-effects in a consistent and intelligible manner, 

 like any concrete pathological entity. 



It is, moreover, an illustration of the manner in which 

 earthy or ossific material is conveyed by neuro-muscular 

 agency along continuous circulatory ways from the purely 

 central nervine to the skeletal structures of the body, and 

 a collateral proof of the truth of the contention that frac- 

 tures do not properly unite when the systemic nerves are 

 severed. 



Had there been here no "concentrated and continued 

 exposure" of the limited surface of the neck between the 

 coat collar and the hair of the head, as above described, 

 there would have been no case to record. We may add 

 that there occur in like manner such pathological sequences 

 as the synchronous, consecutive and mixed, but etiologi- 

 cally connected, bacterial and other diseases, due to 

 cerebro-spinal sepsis and neuro-muscular morbid pheno- 

 mena myopathy, for instance, cold abscesses, multiple 

 exostosis, and acute and chronic osteo-arthritis, with 

 spontaneous disarticulations, become evolved in clinical 

 experience in complete and definite order, one merging 

 in the other as parts of a single morbid entity, as well as 

 all the constantly occurring associated groups of pneumo- 

 gastrically determined and distributed diseases, acute 



