A CASE OF CIRCUMSCRIBED UNILATERAL 
AND ELECTIVE SENSORY PARALYSIS 
BY 
LEWELLYS F. BARKER 
ASSOCIATE IN ANATOMY IN THE JOHNS HOPKINS UNIVERSITY, AND ASSISTANT 
PATHOLOGIST, JOHNS HOPKINS HOSPITAL 
From 
THE JOURNAL OF EXPERIMENTAL MEDICINE 
Vol. I, No. 2, 1896 A CASE OF CIRCUMSCRIBED UNILATERAL, AND 
ELECTIVE SENSORY PARALYSIS. 
By LEWELLYS F. BARKER, 
ASSOCIATE IN ANATOMY IN THE JOHNS HOPKINS UNIVERSITY, AND ASSISTANT PATHOLOGIST, 
JOHNS HOPKINS HOSPITAL. 
{From the Physiological Laboratory of the University of Leipsic.) 
By elective sensory paralysis is to be understood one in which 
certain only of the functions of the sensory nerves are abolished. 
The observations which are to be briefly reported here have been 
made upon my own left arm, and in large part by myself. The an- 
amnesis is as follows: I am at present twenty-eight years old, and, 
as far as I remember, aside from the ordinary diseases from which 
children suffer, I have always been tolerably healthy. For the past 
nine or ten years 1 have noticed at times along the inner (medial) 
side of the left arm radiating pains, which are prone to appear on 
standing for a long time or after a long walk, especially when I am 
overtired or a little run down in health. For about the same length 
of time, sensations of numbness and formication have made them- 
selves noticeable. These have been referred to the same area, 
and have affected also, in a slight degree, the little finger and 
the ulnar side of the ring finger of the left hand. The pains, 
which, as a rule, are not very severe, can be quickly stopped, 
or essentially relieved, by lying down or by elevating the left 
shoulder. Beyond these symptoms I have nothing to complain 
of, and during the past two or three years unpleasant sensations 
of any kind have rarely existed. The motility of the left arm is in 
no way diminished or interfered with. This arm is slightly weaker 
than the right, which is easily to be explained by the fact that it has 
been used less. Alterations in the muscles or the skin have never 
been perceptible. The secretion of sweat is normal, and goose 
Copyright, 1896, by D. Appleton and Company. 2 
Circumscribed Unilateral, and Elective Sensory Paralysis 
skin occurs on the left as often and to the same extent as on the 
right side. 
About a year ago the arm was examined by my friend Dr. 11. 
M. Thomas, neurologist at the Johns Hopkins Hospital, and the 
presence of a sharply circumscribed zone of anaesthesia for tempera- 
ture and pressure was demonstrated in the area mentioned. 
The last cervical vertebra shows on the left side a rigid, bony 
process apparently firmly attached to it. This process projects above 
the clavicle in front where it can be easily seen and felt. It is 
extremely little if at all movable, and it accompanies the first rib 
for a short distance, lying directly above it. This process is prob- 
ably to be looked upon as a cervical rib. 
Being in Leipsic during the spring and summer of 1895, at the 
suggestion of Prof. v. Frey, in the Physiological Laboratory there, I 
undertook an exact investigation of the conditions in the arm, in 
order to determine the extent and the kind of disturbance of sensi- 
bility qualitatively, and, as far as possible, also quantitatively. Un- 
fortunately, my time did not permit me to make the study complete 
for all parts of the arm, and the investigations were therefore limited 
to the changes in the forearm, an attempt being made to establish 
with extreme care the character of the anaesthesia in this region. 
Although the working out of the whole zone must be deferred until 
later, I am already in a position to state that the sensory changes 
in the anaesthetic areas of the upper arm and of the hand (the devi- 
ations from the normal in the latter are very slight) resemble ex- 
actly in all essential points those in the forearm. 
Methods. 
The sensation for cold, warmth, pressure, and pain was exam- 
ined, and for these four sense-qualities the limits of the anaesthetic 
areas were at first tolerably accurately established by quick methods 
of examination, and later the distribution of the different sense- 
points and their threshold-stimuli (.ReizschweUen) were carefully 
determined, with exact methods of localization and measure- 
ment. Le welly s F. Barker 
3 
I. Cold-sensation.—For quick limitation, metal rods with an end 
surface of one square centimetre or a camel’s-hair brush moistened 
with ether were used. To localize the individual cold-points there 
were employed metal rods with conical ends, as in Qoldscheider’s 
thermsesthesiometer,* and fine steel pens moistened in water at the 
room temperature; finally, for extremely exact localization, pieces 
of copper wire of 02 millimetre diameter were used. I prepared a 
large number of such bits of copper wire, varying in length from a 
half to six millimetres, mounted on little sticks of wood surrounded, 
except at one free end, by sealing-wax. By means of these the in- 
vestigator is in a position to make quantitative examinations by 
which the more or less accurate estimation of threshold-values in 
“ heat-quantities ”is rendered possible. If the temperature of the 
skin is known, through the application of water which is felt neither 
as warm nor as cold, and also the temperature of the room in which 
the wires are used, one can obtain the “ heat-quantity ” which a 
given bit of wire can yield to the skin or take from it by multi- 
plying together (1) the difference between the above temperatures; 
(2) the “ heat-capacity ”of copper; and (3) the “ mass ”of the piece 
of wire. 
11. Warmth-sensation.—The hot tube of Blix,f provided with a 
thermometer, was used almost exclusively, since either the broad sur- 
face or the fine point, as desired, can be applied to the skin. An 
attempt was also made to stimulate the warm points with known 
“heat-quantities,” the pieces of copper wire previously described 
being heated to 40° C, in an air-bath. 
111. Pressure-sensation (Druckemjofindung).—For the first ex- 
amination a soft pencil, or, still better, a little wad of absorbent cot- 
ton, was drawn over the skin, especially over the hairs. For finding 
the pressure-points, and particularly for determining their threshold- 
values, w~e used punctiform faradic stimulation as well as the test- 
hairs {Reizhaare), finely graded, according to the pressure they 
* Du Bois’ Arctiiv., Supply 1885, p. 2. 
■j- Zeitschr. f. Biologic, Bd. xx, 1884, p. 153. 4 
Circumscribed Unilateral, and Elective Sensory Paralysis 
exerted. These test-hairs were first devised and used by Prof. v. 
Frey.* 
IY. Pain-sensation.—For this purpose also test-hairs similar to 
those used in examining the pressure-sense, only of higher pressure- 
values, were employed, but an extensive use was also made of other 
mechanical as well as of electrical and thermic stimuli. 
Since an alteration of the sensory conditions during the course of 
the investigation was not to be expected, and, as a matter of fact, 
could not be demonstrated, the test was carried through in a systematic 
way for each single one of the sense-qualities under examination, after 
which the next kind of sensation was taken up for study. The ex- 
amination of each kind of sensation was divided into three stages. 
At first the limits of the anaesthetic area for the sense-quality con- 
cerned were broadly determined by one of the investigators named 
below and marked by coloured lines. After this, in numerous sit- 
tings, the sense-points were carefully sought out one by one and 
marked by myself. Finally, the results were confirmed, for the 
thermic sensations by Dr, F. Kiesow, for pressure- and pain-sensa- 
tion by Prof. v. Frey, It is a great pleasure to me to heartily 
thank once more both these gentlemen for the repeated and most 
painstaking confirmatory tests which they so cheerfully made. 
Every one who has had any experience in seeking out sense- 
points knows that the examination even of small areas of the skin, 
if it pretend to completeness, can not be terminated in one sitting. 
Estimations of the number and position of sense-points are also the 
more reliable the less the stimuli exceed the threshold-value; if one 
acts accordingly, the testing makes such claims on the attention that 
the examiner is incapable of making any one sitting very prolonged. 
Inasmuch as the examination in this case had to include tolerably 
large areas of the skin, it became necessary to establish the position 
of the sense-points which had been sought out and confirmed in some 
more permanent way than could be arrived at by any kind of colour- 
\ Beitriige zur Sinnesphysiologie der Haut, i, ii, iii, Leipzig, 1894-’95. Aus den Berich- 
ten der math.-ph.ys. Classe der K. Sachs. Gesdlsch. der Wiss., July 2 and December 3, 1894, 
and March 4, 1895. Lewellys F. Barker 
5 
ing of the point upon the skin. This problem was solved in the 
following manner: The skin was divided into a number of tields 
according to the course of the visible cutaneous veins and also with 
regard to certain irregularities, which have yet to be mentioned, in 
the lines limiting the anaesthetic zone. As soon as the determination 
of the sense-points of one quality for such a cutaneous field had been 
completed, a piece of gelatin-paper was laid upon the skin and the 
sense points and the limits of the area were accurately copied and 
transferred to a plaster-of-Paris cast of the whole arm. For each 
quality of sensation examined a special plaster cast was made. This 
method of keeping track of the topographical relations of the inves- 
tigation proved to be particularly serviceable. With the help of 
these casts it has been possible to find again very quickly any desired 
single sense-point. 
General Results 
• It appears to me desirable to state first generally the main re- 
sults of the investigation, and later to refer more in detail to the 
experiments which bear on the single sense-qualities. 
1. The disturbance is limited to the domain of the nervi cutanei 
brachii et antibrachii mediales of the left arm. 
2. In this area the sensation for warmth, cold, pressure, and touch 
(Druck und JBeruhrung) are absent. In addition, no tickling sensa- 
tion can be called forth in the cutaneous region concerned. The 
sensation for pain is apparently intact on superficial examination, 
but with accurate testing a slight diminution in the number of pain- 
points can be demonstrated. 
3. The limit of the area of sensory disturbance on the flexor sur- 
face of the forearm is sharply and regularly defined, and is situated 
almost exactly in the middle between the radial and ulnar side. On 
the extensor side the limit is not sharply defined, and indeed is very 
irregular—i. e., the anaesthetic zone invades by deep indentations the 
normal area, and the transition from regions where the three sense- 
qualities are entirely absent to areas where sense-capacity is complete 
is very gradual. These findings can also be described in the follow- 6 
Circumscribed Unilateral, and Elective Sensory Paralysis 
in g way: On the flexor surface, passing from the radial to the ulnar 
half, the sense-points for warmth, cold, and pressure, which on the 
radial side are present- in normal numbers, suddenly cease when we 
advance beyond the above-mentioned line.* In passing over the 
ulnar margin of the forearm to the extensor surface, single sense- 
points here and there again appear, increasing gradually in numbers 
toward the radial margin, but not being present in normal numbers 
until this margin is nearly reached. 
4. The limits described, although they hold in general for each 
of the sense-qualities which are disturbed, show in detail many vari- 
ations. These are in part to be accounted for by the fact that the 
distribution of the sensory points within the partially anfesthetic 
area follow the same rule as on the normal skin, namely, that of the 
three kinds of sense-points—pressure-points, cold-points, and warm- 
points—the pressure-points occur in greatest and the warm-points in 
smallest numbers. In addition to this, single sense-points or groups 
of sense-points of one kind are to be found located in places where 
none of the other sense-qualities is represented. 
5. The sense-points of the partially anaesthetic area, whether they 
are isolated or mixed with others, as well as the points on the border 
of the normal and anaesthetic skin, react to normal threshold-stimuli. 
I can assert this absolutely for the pressure- and pain-points from 
numerous determinations of threshold-stimuli. The individual cold- 
points and warm-points show considerable differences in excitability, 
but these differences do not appear to be more marked than in nor- 
mal areas. 
Some Special Observations. 
A. Regarding Temperature-sensations.—The excitability of the 
cold- and warm-points is, when fatigue is completely excluded, dis- 
tinctly dependent upon the absolute temperature of the skin ; with 
higher outside temperatures, after bodily exercise, and after meals, 
the excitability on previously clothed portions of the skin is greater, 
and the localization of the sense-points is made easier. Strong tern- 
* Compare below the results regarding the pressure-points. Lewellys F. Barker 
perature stimuli, even when they are of small area—the so-called 
puuctiform stimuli—spread out to a considerable distance beyond the 
direct spot of skin to which they are applied. In the anaesthetic 
zone single demonstrable sense-points can be excited from a distance, 
although not with equal ease from all directions. One can probably 
accept the view that the direction of the blood stream and the course 
of the blood vessels in the skin are of essential significance as regards 
this point. The response to the stimulus in such cases occurs rela- 
tively late. The smallest amount of heat, the subtraction of which 
I have found could lead to the reaction of a cold-point, was 00024 
calorie, or the same amount of heat by means of*which the tempera- 
ture of 2*4: cubic millimetres of water can be raised through 1° C. 
In this test direct mechanical excitation of the cold-points, which 
had previously been most exactly located, was excluded. Of 
twenty cold-points examined, there were eighteen threshold-values 
which lay between the amount of heat just mentioned and an amount 
twelve times as great. I have made determinations of the threshold- 
stimuli for the warm-points only in single instances. These in rela- 
tion to those of the cold-points are relatively high—a fact which may 
stand in some relation to the long latent period which is, as is well 
known, characteristic of the warm-points. The question needs and 
deserves a much more thorough than I could devote to it in 
view of the work which had to be done in connection with the main 
portion of this investigation. 
The paradoxical cold sensation (v. Frey*) was examined on some 
fifty cold-points by Dr. Kiesow ; the majority of these yielded, on the 
application of temperatures of from 40° to 50° C., exclusively the sen- 
sation of cold. In some few, cold and warmth were felt at the same 
time; in the case of some others, cold was felt at first, and after 
some time the sensation of warmth appeared. In the latter in- 
stances warm-points were always demonstrable in the immediate 
neighbourhood of the cold-points. The paradoxical excitation ap- 
peared even at temperatures which were absolutely unassociated 
* Of. y. Frey, op. cit., iii, p. 172. 8 
Circumscribed Unilateral, and Elective Sensory Paralysis 
with any painful quality, a point upon which especial emphasis 
must he laid. 
The reverse experiment—the stimulation, by the application of 
bits of ice, of isolated warm-points lying in the anaesthetic zone— 
never succeeded. If one allowed, however, a drop of ether to evap- 
orate over such a warm-point, after some time a slight feeling of 
warmth resulted. Here we had to deal probably with a reaction on 
the part of the blood vessels. I have convinced myself many times 
of the electrical and mechanical excitability of the temperature- 
points, although these modes of excitation were not made the sub- 
ject of an especial study. I have, however, confirmed the results of 
Blix and Goldscheider in this connection. 
B. Pressure-sensation.—The area of complete anaesthesia to 
pressure is smaller than that to thermic stimuli; it never reaches 
beyond the ulnar margin of the forearm on the flexor surface. As 
Prof. v. Frey* has found, the spots where the pressure-threshold is 
lowest (Orte niedrigster I)ruclcsclmelle) exhibit a very definite rela- 
tion to the hair follicles. There is no perceptible difference in the 
number or in the development of the hairs on the anaesthetic and 
the normal skin, although in the former almost all the hair follicles 
are non-responsive to stimuli of pressure or touch. Between the 
completely anaesthetic and the normal area lies a transitional zone 
in which some of the hair follicles are still sensitive. The tran- 
sitional zone is, on the flexor side, scarcely one centimetre in width, 
whereas on the ulnar side it includes the ulnar margin and the 
greater part of the extensor surface. That these more or less iso- 
lated pressure-points possess normal threshold-values has already 
been mentioned. The hair follicles which do not react to pressure 
fail to yield the characteristic oscillatory or buzzing sensation on 
faradic stimulation. (Cf. v. Frey, ii, p. 291.) As a special peculiarity 
of the isolated pressure-points I might state that with increase 
of the mechanical stimulus the sensation gains only a little in inten- 
sity. This would appear to show that the deformation of the skin 
increasing with the stimulus is recognised more by the number of the 
* Of. v. Frey, op cit., i, p. 190; ii, p. 28'7. Lewellys F. Barker 
9 
sensory points affected than by the intensity of the excitation of the 
single-points. 
While stroking the hairs of an uninjured spot of skin calls forth 
intense sensations of touch or even of tickling, within the anaesthetic 
area such a stimulus is not perceived at all. Mechanical influences 
which affect the skin itself become recognised as soon as the defor- 
mation, displacement, or pulling of the skin extends beyond the 
limiting lines into the area in which the pressure-points are sen- 
sitive. 
C. Pain-sensation.—•Pain-sensation can be called forth within 
the anaesthetic zone on very many spots. However, exact investiga- 
tion shows that the points especially set apart for this sensation, the 
pain-points, do not everywhere lie so closely together as in normal 
areas. One can find on stimulation with the very finest needles or 
by punctiform faradization painless spots of the extent of more than 
several square millimetres; areas of this size not sensitive to pain do 
not occur normally in the region under examination, Nevertheless, 
the disturbance of the pain-sense is everywhere but little marked, as 
compared with that of the other sense-qualities, so that on superficial 
testing one might arrive at the conclusion that he had to deal with 
an anaesthesia of all the qualities of sensation with the exception of 
pain. 
A series of influences which in normal regions at first evoke 
other sense-qualities and only subsequently give rise to pain-excita- 
tion, here are felt exclusively as painful. Pricks with a fine needle 
excite only a feeling of pain without calling forth previous touch- or 
pressure-sensations, and are answered by lively reflexes. A small 
piece of ice laid on the anaesthetic zone is at first not felt at all, and 
only after the lapse of a certain time excites a sensation of pain. 
Metal at the temperature of 47° C. and upward very quickly causes 
pain, though there is absolutely no accompanying sensation of 
warmth. Here the opportunity is offered of observing the so-called 
“ temperature-pain ” wholly independent of the temperature-sensa- 
tions which on the normal skin accompany it or precede it. 
As to the “heat-pain,” it was shown that the threshold-stimulus 10 
Circumscribed Unilateral, and Elective Sensory Paralysis 
for it lies at a different level in different places. On some points a 
painful response was obtained to a temperature of 46° C.; this, how- 
ever, was rare. For the most part, pain was felt first at higher tem- 
peratures, and hardly ever under one of 50° C. These experiments 
are all in favour of the view that the painful sensations which 
under similar conditions are felt on normal portions of skin have 
their origin in the stimulation of the organs directly concerned in 
pain-sensation. Under ordinary conditions the sensations of pres- 
sure, heat and cold, which are normally always previously evoked, 
act to a certain degree as protective mechanisms which very often 
suffice to enable one to avoid the pain-sensation. Within my anaes- 
thetic zone these introductory sensations are absent, and I became, 
so to speak, surprised by the unannounced appearance of pain when 
efficient stimuli, though not strong enough nor so widespread as to 
involve the area which possesses normal sensation, were applied. 
This may perhaps afford an explanation of the fact that I have 
throughout life preferably used the right arm relatively more than 
most right-handed men, since there has been a partly conscious and 
partly instinctive attempt to protect the left arm. 
The threshold-stimulus for mechanical excitation of pain I have 
found, by testing with Prof. v. Frey’s test-hairs in the anaesthetic 
area, to vary within the same limits as in normal areas. For the 
“heat-pain ” I found the region of the wrist and the ulnar border 
of the forearm more sensitive than those areas which lie toward the 
fossa cubiti. In addition, it must be remarked that exactly in the 
last-mentioned region the diminution of the pain-points is most dis- 
tinctly to be made out. 
The capacity to localize is very incomplete within the area where 
pain exclusively is felt. The exact situation of compass points is 
appreciated only very inaccurately. In applying the compass test 
of Weber the neighbourhood of the normal domain must be avoided, 
and in addition one must have made sure that the spots of skin struck 
by the two points actually possess pain-sensation. One finds then 
that pain-points which are separated from one another by as much as 
10 centimetres can often not be distinguished. Lewellys F. Barker 
11 
D. Motility.—ln conclusion I desire also to mention the results 
of an examination of the motility of both my arms which Privat- 
docent Dr. Windscheid was good enough to make for me. 
Circumference in Centimetres.—The middle of the upper arm, 
B. 25 ; L. 24. The middle of the forearm, R. 21; L. 20. 
Crude strength of left biceps and muscles of forearm weaker than 
right. In the faradic and galvanic excitability of the biceps as well 
as in conduction-resistance no distinct difference can be made out 
between the right and the left side. The contractions are never 
sluggish. Atrophy of single muscles is nowhere demonstrable. 
Epiceisis. 
In reviewing the disturbances described, they are seen to be 
essentially “phenomena of absence,” a number of nervous functions 
which are peculiar to the normal skin not being present. Irritation- 
phenomena, as far as they can be observed, are by no means promi- 
nent. With this conforms the observation that an alteration of the 
threshold-values of the retained functions in the partially anaesthetic 
area could nowhere be distinctly demonstrated. 
One will find, in considering the etiology, in the purely unilateral 
seat of the disturbance and in the definite limitation to two cutaneous 
nerves, strong ground in support of the view that the cause of the 
disturbance is peripheral, and it is probably to be sought in the cervi- 
cal rib, which is almost certainly present. Quite recently attention 
has been several times drawn to the fact that the presence of a cervi- 
cal rib through pressure on the brachial plexus can give rise to dis- 
turbances of sensibility and motility. The cases in which the symp- 
toms have disappeared after resection of the rib are most convincing 
in this connection,* Since in the case just described a loss in motor 
capacity is not demonstrable, the disturbance appearing to be much 
more of a purely sensory nature, one might be inclined to look for 
the seat of the lesion in the nerve roots or in the spinal cord. In op- 
position to this, however, it may be pointed out that at the site of 
* The literature will be found appended to the article by Tilmann in the Deutsche Zeit- 
schriftfur Chirurgie, Bd. xli, S. 380. 12 
Circumscribed Unilateral, and Elective Sensory Paralysis 
the disturbance the sensory paths must already be arranged with re- 
gard to the peripheral distribution, if one is to explain the fact that 
the two above-mentioned cutaneous nerves alone have been injured. 
Now, according to Henle, the nervi cutanei brachii et antibrachii 
mediales arise from the lower cord of the plexus brachialis which 
represents a continuation of the eighth cervical and first thoracic 
nerves, and thus it is at any rate possible that the nerves mentioned 
could be affected by a cervical rib. 
Most interesting in the case before us is the slight amount of dis- 
turbance of pain-conduction as compared with that of the other sen- 
sory functions. However, even this finding represents only one of 
the numerous variations which are possible in elective injuries of 
peripheral nerves. As regards this point, numerous experiences 
could be referred to, more particularly the newer observations of 
Cavazzani* and the younger Charcot, f In Charcot’s case, which is 
antithetic to mine, the individual, as the result of a scar in the cubi- 
tal region, suffered from a paralysis of temperature- and pain-sensa- 
tions in a large part of the hand, while the sensations of pressure 
and touch were retained. The loss of temperature- and pressure- 
sensations was unequal in the case observed by Cavazzani. These 
two cases, to which others might be added, are the more convincing 
in that after excision of the scar in the one instance and the healing 
of the wound in the other the sensory disturbances disappeared. As 
physiological experiments have shown that the nerve fibres of one 
portion of a limb—for example, those for the flexors and extensors— 
are not evenly distributed within the nerve trunk leading to it, but 
are already arranged according to their functions, so it wmiild appear 
that a similar arrangement may hold also for the sensory nerves 
with regard to the different paths which they are to follow within 
the spinal cord. Thus, whereas in the motor nerves the fibres ap- 
pear to be arranged according to the muscles to which they are to be 
distributed, for the sensory fibres we may have to consider rather 
* Archives ital. de Biologic, t. 17, p. 413. 
f Comptes rendus de la Soc. de Biologic, December 10, 1892. Lewellys F. Barker 
13 
the different paths which they have to follow on entrance into the 
spinal cord. 
In accordance with these views the case just described would 
have to be looked upon as one in which the irtajority of the pain- 
conducting fibres have been retained, while the others in great part 
have disappeared, for some areas of skin even completely. In any 
case it appears to me that this view agrees better with the facts than 
the other that the nerves are retained, but that their excitation is no 
longer felt except in giving rise to pain. When one sees that in the 
periphery certain only of the sense-points have disappeared—for ex- 
ample, the pressure-points arranged in connection with the hair fol- 
licles, while the far more numerous pain-points are present in normal 
or in only slightly diminished numbers—one can scarcely avoid the 
conclusion that there are specific nerve-endings and nerve-paths in- 
volved, which have actually disappeared. 
Further, the irregular limitation of the anaesthetic area and the 
occurrence of sense-points singly or in groups on the extensor sur- 
face of the forearm, seems to be worthy of mention. From this alone 
one might almost conjecture that, even normally, the endings of dif- 
ferent sensory nerves are associated with one another in the skin in 
the most complicated manner. It is true, however, that one might 
think also of regenerations, and more especially since such have re- 
cently been observed by Fedor Krause * in the distribution of the 
trigeminus. But the adoption for the present case of either of these 
views would be associated with difficulties, considering the relatively 
very sharp limitation of the anaesthetic area on the flexor side. 
In conclusion, I beg to tender my most sincere thanks to Prof, 
v. Frey, at whose suggestion and under whose supervision this re- 
search was carried out. Without his assistance I could hardly have 
appreciated fully the physiological bearings of the results obtained. 
* Munch, med, Woch., 1895, Nos. 25-27.