OF PRIORITY IN THE DISCOVERT AM) J^fcT J9l. 3ML "Ji". T^y" OF T1IK EXCITO-SBCKBTORV SYSTEM OF NERVES. BY HENRY FRASER CAMPBELL, M.D., MKMItKK OK THE AMERICAN MEDICAL ASSOCIATION; PROFESSOR OF COMPARATIVE ANATOMY. AC, IN THE MEDICAL COLLEGE OK GEORGIA, ETC, KTC AUGUSTA: McCAFFKRTVS OFFICE-J. MORRIS, PKINTKR, Opposite the Post-office, 1857. -MM SSfflV A. CLAIM of PRIORITY IN THE DISCOVERY AND r*r ^m_ jmvm: it ijkt OF THE EXMTO-SECRETOilUYSTKSI OF NERVES 11 -► ■rir^' BY HENRY FRA:W,R CAMPBELL, M.D., MEMBER OK THE AMERICAN MEDfCAL ASSOCIATION; PROFKSSOR OF (OMI'AP.ATIVB ANATOMY, AC, IN THE MEDICAL COLLEGE OK GEORGIA, ETC., ETC. 4^ % cc ' '■■''■ liY ■&-. v'-7 // /' ^ ,7&* * AUGUSTA, GA: MeCAFFEUTY'S OFFICE—J. MORRIS, PRINTER. Opposite the Post-office. I 8 5 V . V4U } [FOR THE LONDON LANCET.] LETTER. Augusta, Georgia, U.S.A., March 2nd, 1857. To Marshall Hall, M. D., of London, F. R. S., &c. My Dear Sir—In the number of the London Lancet republished in this country, for March, 1857, (present month,) I have just read a paper from your distinguished pen ; and in this paper you announce a system of Excito- Secretory nerves, in the following connection and in the following terms: "In a memoir read at the Royal Society in February 1837,1 announced the existence of an Exctto-motory system of nerves. " I believe I may now announce a system or sub-system of Excito- secretory Nerves, not less extensive." As the above announcement is here made in close relation with a dis- covery long admitted to be your own—viz., that of the Excito-mofort/ system of nerves, and inasmuch as in your subsequent remarks, you attri- bute the proposition to no one else, I am left to infer that it is deemed by you an original deduction from the admitted facts of Anatomical and Physiological Science, as developed by observations and experiments dtt* ring the last and the present century. Some of these last—viz., the Experi- ments of Mons. Claude Bernard, of Paris—you adduce with the apparent intention of fortifying the views you here express. Finding in none of your communications upon this interesting topic, any mention made of my name or of my records, I am, with regret, impelled, from considerations of courtesy to you and of justice to myself, to call your attention to the registration of my own labors in the same important field. I will, however, first direct you particularly, though briefly, to several portions of your own communication, in order that they may be placed in convenient juxtaposition with my own records, without giving tbe trouble of each time referring to the pages of the Lancet: " But the most remarkable proof of the doctrine which I am endeavoring to unfold is furnished by the brilliant discovery and skillful experiments of M. CI. Bernard"— 4 And you here refer to his well known experiments on the Pneumogastric nerve in its relation to the secretions of the Liver, published in his Lec- tures on Experimental Physiology, during the winter session of 1854 and 1855* In the earlier part of your communication (March, 1857) you thus an- nounce the addition of this, as you suppose, new sub-system, to what you term the "Diastaltic Nervous System," the term "henceforth" apparently being used to date the initial moment of an era : " Henceforth the Diastaltic Nervous System, must be divided into two sub-systems: I. The Excito-motory. II. The Excito-secretory. "Theformer is extended to the entire muscular system ; the latter is dif- fused over the general system as the blood is diffused over the system." Again, in reference to the Pathological Relations of the Excito-secretory system, yon remark: ^ "The Pathology of the Excito-secretory sub-system remains to be inves- tigated and traced. A partial keen current of air falling on any portion of the skin may induce inflammation in any susceptible internal organ. An extensive burn or scald is apt to produce pneumonia." And as my last quotation for the present: "But here I close this brief communication. Mv present object is only to draw the merest sketch of this vast subject which demands a most exten- sive and cautious series of experiments and observations. The efforts of many laborers, through many years, will be required fully to develop the two sub-systems of the Diastaltic nervous system. "I propose shortly to treat this important subject at greater length and with more details." ° b Now, my dear sir, hy a reference to the following series of records run- ning through a period of nearly seven years, you will at onee perceive that the Excito-secretory function of the nervous system has been the subject of earnest and diligent inquiry, and also of plain record, with me for a length of toe for anterior to that, at which either yourself or Mons! Bernard had published any thing on the subject. You will herein also perceive, that this system of nerves has been plainly recognized and set forth as considered in its relations to Pathology, through which, indeed, its Physiology has been mainly deduced by me. And last- ly, that this system of nerves, before plainly stated and amply discussed was, as early as May 5th, 1853, in th* presence of the American Medical Association, the highest tribunal in the Medical Sciences within my reach, * Lean's de Physiologie, p. 325. Paris, 1855. 5 publicly named by me the Excito-secretory : and that too in juxta position with and contradistinction to, your own discovery, viz., the Excito-motory function. Has name or verbal combination, then for the very first time printed in the English language, or, indeed, in any other language, had not, so far as 1 can learn, after continued and interested inquiry on my part, been print- ed a second time, until taken from your own recent manuscript, it appears at the heading of your paper in the March number of the London Lancet, (American edition,) and thus becomes the occasion of the present commu- nication. Below, I now present you with certain passages from an article on " The Influence of Dentition in producing Disease," read before the Medical So- ciety of Augusta, Georgia, in May, 1850, and afterwards published in this city, in the Southern Medical and Surgical Journal, a periodical circu- lating extensively and exchanging with all the medical journals in this country and with many of those of Europe. Here you will now find these several records presented to you seriatim and in that order, together with the dates and accompanying circumstances, in which they were long ago successively presented to the Profession. May 2nd, 1850. "Dr. Henry F. Campbell read an Essay on the Influ- ence of Dentition in producing Disease."—[From Minutes of a meeting of the Medical Society of Augusta, Georgia? I will not quote from or remark upon the Essay now, but fully hereafter as published below. June, 1850. Permit me now, respected sir, to refer you to the pages of the Southern Medical and Surgical Journal, (new series,) volume 6th, num- ber 6, June, 1850. Part I.—Original Communications. Article XV., page 321. You will in this place find the paper just cited, published—viz: "An Essay on the Influence of Dentition in producing Disease. By Henry F. Campbell, M. D., Demonstrator of Anatomy in the Medical College of Geor- gia." Here you will find that I have in the beginning, sketched prominently the two orders of phenomena which occur during the period of Dentition, viz., the convulsive and the secretory, explaining the first easily enough, by a reference to the principles of Excito-motory action laid down by yourself; while the other set of phenomena I presented in such a manner as that from them, the Excito-secretory function of the nervous system became an obvious and an unavoidable deduction—by this means mutually establish- ing a physiological principle before scarcely ever broached or hinted at; and in the second place, leaving no chance to escape the necessary admis- sion that this set of phenomena, before perfectly inexplicable to the Profess- ion, could only be rationally interpreted by the admission of that very 6 Physiological principle. In doing this, " the two sub-systems," as yon now term them, were, throughout, kept in close relation, but in decided contrast, the one being used, occasionally it is true, to illustrate the other, but never for a moment becoming confounded with the other—thus : " Xow let us inquire how far these phenomena are dependent upon Dentition; and analo- gy with the Excito-motory system will much assist us in our argument, We have seen that local irritation can through this system, produce con- vulsions by the reflex function of the nerves, the sensitive branches of the fifth pair becoming excitor to the motory spinal nerves; and so, may we justly infer, do these same branches, under certain circumstances, become excitor to the secretory filaments of the sympathetic, distributed so abund- antly to the intestinal canal by a transmission of this irritation through the various ganglia with which it is connected." You will also here see that the discussion is carried still farther into the pathological relations of the, then, new function, and that I have instanced nearly all those localities which you have recently adduced, and that I have considered those changes in the Blood while eliminating the secre- tions under nervous influence, which you, in your paper, designate by the word ilmethoEmatous;" as in the following: "Thus the irritation at first produces simply an exaltation of the innervation of the secretory surfaces, and secretion is more active than normal, producing simple diarrhoea. A con- tinuance of the irritation, alters the character of the secretion and we have the various morbid discharges observable during this period. This increase and change in the secretion are effected by the agency of the altered func- tion of the nerve upon the arteries from which these secretions are elimina- ted."—(Sec Southern Medical and Surgical Journal, p. 331.) "Without further remark at present, I will lay before you that portion of this Essay which embodies my first record upon the Excito-secretory func- tion of the nervous system. "The period of Dentition has ever been regarded one of peculiar interest, as well to the pathologist as to the practitioner. That certain diseases are more apt to occur during this season, few pretend to deny; but the amount of the symptoms, due to the irritation of teething, has been variously esti- mated, some attributing to this cause nearly all the ills to which infancy is liable, while others ridicule the idea, that a process in itself so purely physio- logical and natural should be regarded ever a cause of disease. "The object of our essay is to investigate impartially this important sub- ject with the view of determining, as nearly as possible, to what extent the organism is affected by the evolution of the teeth. In doing so, it appears to us most rational, as a primary step in the investigation, to review briefly the phenomena of both normal and anormal dentition, with the view of finding the foundation of the pathogenic theory, if such exists, in the physic ology of this process. " The phenomena observed during easy or normal dentition may be briefly wwwned up as follows;—The salivary secretion is increased, the gums are 7 swollen, the mouth hot, and the child evinces a disposition to press every substance within its reach upon the gums, in order to relieve the irritation it here suffers. Later, the gums become more swollen and softer, the irri- tation more distressing, and, under certain circumstances, the mouth dry and slightly inflamed. The child becomes fretful; its sleep is disturbed and feverish, its bowels become loose, which latter symptom we frequently observe accompanied by nausea and vomiting. There is also described by some authors an irritation of the schneiderian membrane, with increased secretion, marked by the child's rubbing its nose. " Cases of anormal dentition are brought more frequently under the cog- nizance of physicians, and their phenomena are hence familiar to every one. The above symptoms become exaggerated—some, which in normal denti- tion were of trivial importance, becoming so severe as to threaten the life of the patient. Thus the gently relaxed condition of the bowels, which in easy dentition was even beneficial, is now changed to diarrhoea with dis- tressing tormina and alarming emaciation. The salivary glands, which in easy dentition manifested their implication only by increased secretion, now become inflamed and swollen till finally their secretion is altogether arrested, leaving the mouth and tongue dry, parched and painful; and the nervous fretfulness of the normal process is often replaced by actual fever, sometimes attended by the most terrific convulsions. " We have here sketched hastily some of the more prominent phenomena of both easy and severe dentition, as we each daily observe in practice, and find reported by authors, and we do not adduce them at present as the direct results or consequences of the process, but only as its pretty constant con- comitants. In referring to those symptoms hereafter in the course of our essay, we will necessarily enlarge upon and develop more fully some of their characteristics. Let us now, with a little attention, enter into an analysis of these concomitants of dentition, and endeavor to ascertain whe- ther or not their origin may be found in the process itself. To this end, we will consider briefly the anatomy and physiology of the parts concerned in this important and often perilous process of evolution." * * * * * *_* * * " From the above considerations we are induced to conclude that the con- vulsions are often produced by the irritation of dentition, and can be directly referred to this as the sole cause. " We arrive now at a point in this somewhat obscure and much disputed question which perhaps affords more ground for doubt than any of the foregoing, viz., a consideration of the pathogenic influence of dentition in the cholera infantum or diarrhoea so uniformly co-existent with this pro- cess. Unlike the convulsions, the analogy between which and certain known and established phenomena of the excito-motory system, which it is only necessary to refer to, and their operation is plain and intelligible, this new set of symptoms, if we refer them to the process of dentition, re- quires us to look yet deeper into the mysteries of our nervous organization, and to venture still one step further on the terra incerta of sympathetic interpretation. " In order to apply our arguments, let us hastily review the foregoing in- vestigation, that they may bear more fully upon this part of our question ; and,"firstly, we have seen that inflammation, pain, and irritation are pro- duced locally by the process of dentition, evinced by restlessness, biting, &c. Secondly, we have seen that this local irritation can be transmitted by 8 excito-motory influence to other and distant parte of the body, manifested bv convulsions. We have also endeavored to corroborate this latter opin- ion bv a reference to the order of succession in the nerves m which tins irritation occurs, and also bv a comparison of these phenomena with other well understood and established analogous phenomena. Heretofore we have had to deal entirely with functions of the cerebrospinal system ot nerves; but to account for this second and more obscure part ot our pro- blem, we must look in vain to any direct anatomical connection between the fifth pair and the rest of this system of nerves. 117' are forced to seek out other connections, indeed somewhat more intricate and indirect, but fortunately no less legitimate and definable. We have now to consider a 'set of organs which, unlike the voluntary muscles, have no connection, or rather, we would say, emphatically, tht-y.have a connection, though indi- rectly, with the cerebro-spinal system. We mean the abdominal viscera, which we know are almost altogether supplied from the great sympathetic system of nerves. Now, in the prosecution of our inquiry it becomes ne- cessary, to the elucidation of the question to trace out the same connection between the fifth pair and the sympathetic or secretory, as we did between the fifth pair and the cerebrospinal or motory nerves, and then, should we succeed, we will briefly inquire into the bearing which this connection and its possible results may have upon our question. "The connections between the fifth pair, the rest of the cerebro-spinal system of nerves and the great sympathetic, are so abundant and universal that it is only necessary to enumerate a few of them to illustrate the fact. Firstly, we have a connection in the ophthalmic or first division, by its na- sal branch communicating with the ciliary ganglion; then in the superior maxillary, or second division, are branches of communication with Meckel's ganglion ; again, in the sub-maxillary ganglion, with the inferior maxillary or third division. So much for the fifth itself. Then we know that every one of the spinal nerves throughout the entire chord are connected to each sympathetic ganglion of the system, thus establishing communications the most abundant and intimate between these two systems of nerves. We know also that these ganglia distribute numerous branches to all the splanchnic viscera by plexuses which accompany the arterial trunks into the minute structure of these organs. '•Thus connected and distributed, this nerve presides over the important functions of nutrition and secretion, which office so characterizes it as to give it the name of the secretory system. In the physiology of the nervous system, there is no fact better established by anatomy and pathology, as well as by experiments on the lower animals, than this, that the sympa- thetic nerve, whatever else may be its functions, always forms a necessary element in the nutrient and secretory apparatus of all the splanchnic visce- ra ; and further, that upon its sanity depends the due administration of these two great functions. It is the nerve for the bloodvessels; " and " remark Todd and Bowman, "as secretion is mainly dependent onthe nor- mal nutrition of glands, it is reasonable to suppose that that function would be to a certain extent controlled by these nerves." And as early as the year 1732, Pourfour du Petit found that the division of the trunk of the sympathetic, opposite the fourth or fifth cervical vertebra in dogs was fol- lowed very rapidly by great disturbance of the circulation of the'eye-ball producing inflammation, flattening of the cornea, and finally destruction of this organ. ' 9 " The experiments of Dupuy upon the horse, wherein he severed this nerve at the superior cervical ganglion, also corroborate this statement; general emaciation here ensued, with an anasarcous condition of the limb9 and an eruption over the whole cutaneous surface. " In some experiments made by Dr. J. Reid, and reported by Todd and Bowman, in reference to the sympathetic branches supplying the eye, it was found that the effect of a section of this nerve was to produce an immediate injection of the conjunctiva. In one case, he observes, the redness of the con- junctiva took place in a few minutes after the section. It has been already stated, continue these great authors, that a section of the brandies of the fifth nerve which supply the eye, is followed by ulceration and other signs of impaired nutrition in the eye-ball. But these changes do not take place for some time after the section of the nerve—generally many days elapse—■• and they are attributable to the presence of irritating particles which, owing to the insensible state of the conjunctiva, are suffered to remain in contact with the surface of the eye, giving rise to inflammation and ulcera- tion of its textures. The effects of section of the sympathetic are imme^ diate, and are probably due to a change produced in the blood-vessels, in consequence of the withdrawal of the accustomed nervous influence. " We have now glanced sufficiently, we think, at the anatomy and physi- ology of the sympathetic system of nerves, to make the application of such points as are pertinent in the solution of our pathological problem. In its anatomy, we have seen its connections with all three of the divisions of the fifth nerve by ganglia, the connexion of these various ganglia with each other, as well as with the cerebro-spinal axis; and lastly, the distribution of branches from these ganglia, which are conducted by the arteries into every part of every one of the splanchnic viscera. In its physiology, we find it in entire charge of the important functions of nutrition and secretion, and that wherever these processes are effected, it is by the agency of this nerve alone upon the blood-vessels-. And further, we have seen that pa- thology and experiments on lower animals establish its indispensableness to the "due performance of these functions, and that whenever the supply of its innervation has been cut off from a particular part of the organism, that part immediately manifests symptoms of impaired nutrition and altered secretion. "Now we are all aware that nearly the whole of the intestinal canal, of rather that portion between the stomach and lower part of the colon, re- ceives no direct innervation from the cerebro-spinal axis, but is entirely dependent upon the sympathetic nerve for its supply of nervous-influence of whatever kind it may enjoy, whether motory, sensory, or secretory, and consequently an impairment of the function of this nerve must necessarily correspondency alter its condition so far as regards all those functions with which this nerve endows it. The alteration in these functions would, of course, depend, in a great degree, upon the amount of impairment in the source of irritation ; thus, as we have seen, if the supply is entirely cut offT the functions of the arteries seem in a great measure to cease, passive con- gestions occur, and the parts inflame and ulcerate. Now we can also very naturally conceive of a condition of these nerves somewhat analogous to the above, yet intermediate between the entire interruption caused by sec- tion, and perfect health—a condition of embarrassed or of exalted innerva- tion. Now this intermediate condition is exactly the state which, froin the developments of the foregoing investigation, we feel that we are authorized 10 deny. Now let us enqune now J tem win much assist us dentition; and anal*,,,vnth ^ X^^aTfr/tatioM can, through this in our argument. A\ e havVtLr7flPv function of the nerves, the sensi- TT ^XSfSlt^trii. motory spinal nerves; Z^S^^toZ* "same branches under certain circum- stances Wome^xcitor to the secretory filaments of the sympo>,hetic, di n- buted s'o abundantly to the intestinal canal, by transmission othi,> irri at^on throuoh the various ganglia with which it is connected. Thus the> nnta- on! first moduce§s simply an exaltation of the innervation of these retory suffices, and consequently secretion is more active than normal producing simple diarrhoea. A continuance of the irntation alters the IZeJrt the secretion, and we have the various morbid discharges ob- servable during this period. This increase and change m the secretion are effected by the^agency of the altered function of the nerve upon the arte- ries from which these 'secretions are eliminated. Now, when the innerva- tion of these arteries is still further embarrassed by the long continuance of the reflected irritation, the state of things nearly approaches that ob- served in Dupuy's, Reids's and Pourfour du Petit's experiments of actual destruction of the nerve, and we have ulceration of the intestinal mucous membrane; all these phenomena being the result of various degrees ot in- jury sustained by the sympathetic nerve. _ " It may here be asked, why should the branches supplying the intestinal mucous membrane become more implicated than any other portion of the sympathetic system ?—and why do not similar irritations of the fifth nerve produce like results in the adult ? To the first of these questions we answer, that most probably the other portions are implicated, but the manifesta- tions of such implication are greater and graver here than elsewhere, be- cause these are the sole sources of innervation to the viscus. The other organs are in all probability implicated, but receiving a certain amount of innervation from other sources, most of their functions not being entirely secretory, are still, though imperfectly, carried on. But in the intestinal canal the case is far different; the requisitions made upon it are of a nature that it has need for no other innervation than that of the sympathetic sys- tem, fts functions are secretion and nutrition for the whole animal organ' ism, and when these are impaired, its primary, indeed its only intents are altered or completely nullified. The second question is answered by the greater development of this system in the growing than in the adult indivi- dual, for the purpose of supplying the more active nutrition and secretion at that time necessary. We know that disease is more apt to occur in many parts of the body during this period ; this is the general admission. Thus, according to many authors, among whom are West, Churchill, &c, pneumonia and bronchitis are more apt to attack children during dentition, than at any previous or subsequent period. Cutaneous eruptions, and many other aberrations of secretion occurring during this period, but serve to corroborate our theory of the origin of the morbid intestinal secretion. The increased vermicular action and tormina attending this affection, find a ready explanation in the fact, now well estabhshed, that the sympathetic 11 receives both motor and sensitive filaments from the anterior and posterior roots of the spinal nerves, endowing the organs of their distribution, to a certain degree, with corresponding susceptibilities. " In conclusion, let us define the position which, at the end of our investi- gation, we feel warranted in assuming. They are the following: that in the anatomy and physiology, as well as in the dependent analogies of the process of dentition, we find ample ground for the opinion that the diseases pertaining to this period, may be dependent, and in many cases are entirely so, upon the local irritation attending the process being transmit- ted through either the cerebro-spinal system of nerves, producing con- vulsive diseases in the motory apparatus, or through the sympathetic, causing derangements in the secretory organs, particularly the alimentary canal, by the sway which it exercises over the arterial system, from which these secretions are eliminated. And the practical deductions to be drawn from these conclusions are,—that we should not be remiss in taking every measure to arrest "or lessen this local irritation, either by free and repeated incisions of the gums, or by the judicious administration of appropriate re- medies, among which we have found opiates to prove most safe and effi- cient. "It would indeed be an improving, and not an unpleasing exercise, to trace out more fully the connexions between the local irritation and the various diseases occurring during the period of dentition, to take more ex- tended views of the abundant analogies and comparisons afforded by this truly prolific subject; but time and the special object of our essay, do not warrant the indulgence in speculations so general and discursive. " Our object has been to trace the connexion between this process and diseases in general, only in so far as it has a bearing upon the establish- ment of one principal question in reference to the diarrhoea of this period. The subject lias been only glanced at, and deserves a fuller and more ex- tended treatise; wherein all the concomitant diseases of dentition, as drop- sy, eruptions, and the many infantile neuroses, should be fully and carefully discussed. Such views, we would earnestly invite from some abler and more philosophic member of the profession." The circumstances of my second published record are the following :— At the fifth annual meeting of the American Medical Association, (1852) held in Richmond, Yirginia, not being present myself, I was appointed a special committee, to prepare an essay on the subject of TvPHOin Fever, which essay was read before that body in New York, in May, 1853. In this paper, I took occasion to consider carefully, the ganglionic system, in the support of the position therein assumed, that all Typhoidal Fevers were manifestations of disease through the secretory system of nerves. While thus engaged, my attention was called to certain experiments per- formed by Mons. Claude Bernard, of Paris, and made public through the Gazette Medicale, and translated in the New Orleans Medical Register, to- gether with his deductions therefrom. On examination, finding that they contained, what at that time, appear- ed to me, the germ of a theory similar to mine, recorded in June, 1850, though he refers to them as " a set of phenomena identical with those t 12 occurring in the cerebro-spinal system of nerves, denominated Excito- ITy !y Dr. Marshall Hall," while I had deduced this Excito-secretory "tn (n 1850.) saving Analogy with, the Excito-motory system will n uch as ist us i„ Lament;» and further, inasmuch as this distmgmsh- ed gentleman s report piented itself to my mind at that time, somewhat n the form of an announcement, I deemed it advisable to appeal to our National Medical Congress, in the following brief memoir, praying permis- sion to record before them, my claim to priohitv, and also my protest against the palm of originality attaching to Mons. Claude Bernard. [Abstract from the Transactions of the American Med,oai Association : Meeting 1 HELD IN THE ClTT OF XeW YORK, MAT 3RD, I8o8.] Dr C4mpbell, of Georgia, submitted a paper, on a question of priority in reference to the discovery of the reflex relation subsisting between the cerebro-spinal and sympathetic system of nerves.—See Minutes of bixtk Annual Meeting, vol. vi., page 49. " On the Sympathetic Nerve in Reflex Phenomena. By Henry F. Camp- bell, of Georgia. "In a recent number of the Gazette Medicale appear some remarks,* by M. Cle. Bernard, on the Reflex Actions of the Nervous System. In these, he refers one order of such reflex phenomena to the sympathetic system of nerves, and illustrates, by experiments upon the frog, as well as by refer- ence to many of the acts of nutrition and secretion, that such a relation exists between the cerebro-spinal and ganglionic system of nerves, as well as between the excitor and motory portions of the .cerebro-spinal system. Or, in his own words, " two kinds of nerves are requisite for the production of these reflex phenomena of organic life : the first, transmits the impression to the nervous centres; the second, to the viscera. With one order of these nervous filaments is always connected a ganglion of the great sym- pathetic. Example : the lingual nerve transmits the impression of the taste to the nervous centres; a special nerve then conveys a corresponding ex- citation to the submaxillary gland ; on one of these nerves is situated a ganglion of the sympathetic, the submaxillary ganglion," &c. He gives several illustrations of this fact, and farther, appears to be of the opinion that this set of phenomena are identical with those occurring in the cere- bro-spinal system of nerves denominated excito-motory, by Dr. Marshall Hall; but with this latter part of his paper we have nothing to do. It is only with that portion in which he appears to claim as his own, the sug- gestion of the theory that there does exist such a reflex relation between the sympathetic and the cerebro-spinal systems, and his presentation of it as an observation entirely new. " Now, we are not aware of the exact length of time that these views have been held by physiologists; they may be old, or, on the other hand, they may be of recent suggestion ; but certainly, we cannot award to M. Bernard the merit of being the first to express such views in relation to the function of the sympathetic system of nerves; and while we are exceeding- * Translated by the New Orleans Medical Register. 13 ly reluctant to refer to our own humble labors in connection with the bril- liant discoveries of this most philosophic and able observer, a sense of duty toourself, as a member of this National Association, prompts us not to al- low this assertion to pass unchallenged. " A reference to a paper presented by us to the Medical Society of Au- gusta, Georgia, and published in the Southern Medical and Surgical Journal, on the Influence of Dentition in producing Disease, will show that this subject was fully discussed by us as early as June, 1850, and that the whole argument upon which our theory of the mode in which denti- tion does produce certain morbid results (diarrhoea, for instance) is based upon the supposed existence of such a reflex relation between the cerebro- spinal and ganglionic systems of nerves, as will be seen by the following: After referring the occurrence of convulsions, during dentition, to the reflex relations existing between certain nerves of the cerebro-spinal sys- tem, viz., the fifth pair as excitor, and the muscular branches of the spinal system as motory, we then endeavor to account for the occurrence of diarrhoea by establishing the existence of a similar relation between the cerebrospinal and branches of the ganglionic system supplying the intes- tinal canal; which suggestions will be found embodied in the following extract from our essay in the June number of the Southern Medical and Surgical Journal, volume for 1850, p. 329: ' We have now glanced suffi- ciently, we think, at the anatomy and physiology of the sympathetic system of nerves, to make the application of such points as are pertinent, in the solution of our pathological problem. In its anatomy, we have seen its connections with all three of the divisions of the fifth nerve by ganglia, the connection of these various ganglia with each other, as well as with the cerebro-spinal axis, and lastly, the distribution of branches from these gan- glia, which are conducted by the arteries into every part of every one of the splanchnic vise-era. In its physiology, we find it in entire charge of the important functions of nutrition and secretion, and that wherever these processes are effected, it is by the agency of this nerve alone upon the bloodvessels. And farther, we have seen that pathology, and experiments upon the lower animals, establish its indispensableuess to the due perform- ance of these functions, and that whenever the supply of its innervation has been cut off from any particular part of the organism, that part immedi- ately manifests symptoms of impaired nutrition and altered secretion. ""' Now, we are all aware that nearly the whole of the intestinal canal, or rather that portion between the stomach and lower part of the colon, receives no direct innervation from the cerebro-spinal axis, but is entirely dependent upon the sympathetic nerve for its supply of nervous influence, of whatever kind it may enjoy, whether motory, sensory, or secretory, and consequently an impairment in the function of this nerve must, necessarily, correspondently, alter its condition, so far as regards all those functions with which this nerve endows it. The alteration in these functions would, of course, depend in a great degree upon the amount of impairment in the source'of irritation ; thus, as we have seen, if the supply be entirely cut off, the functions of the arteries seem in a great measure to cease, passive con- gestions occur, and the parts inflame and ulcerate. Now, we can also very naturally conceive of a condition of these nerves somewhat analogous to the above, yet intermediate between the entire interruption caused by sec- tion and perfect health ; a condition of embarrassed, or perhaps of exalted innervation. Now, this intermediate condition is exactly the state which, 11 from the developments of the foregoing investigation, ^^^t^n authorized to affirm is that which occurs as the result of eveie lenttion, and that upon it is dependent the whole train ot intestinal moibid pheno- mena observable during this process. ... "' That this so tar is legitimately inferable, we do not think any one will deny. Now let us inquire how far these phenomena are dependent upon dentition ; and analogy with the excito-motory system will much assist us in our argument. We have seen that local irritations can, through this sys- tem, produce convulsions by the reflex function of the nerves, the sensitive branches of the fifth pair becoming excitor to the motory spinal nerves; and so, we may justly infer, do these same branches (of the fifth pair), under certain, circumstances, become excitor to the secretory filaments of the sympathetic, distributed so abundantly to the intestinal canal, by a trans- mission of this irritation through the various ganglia with which it is con- nected. Thus, the irritation at first produces simply an exaltation of the innervation of these secretory surfaces, and consequently secretion is more active than normal, producing simple diarrhoea. A continuance of the ir- ritation alters the character of the secretion, and we have the various morbid discharges observable during this period. This increase and change in the secretion are effected by the agency of the altered function of the nerve upon the arteries from which these secretions are eliminated. Now, when the innervation of these arteries is still farther embarrassed by the long continuance of the reflected irritation, the state of things nearly ap- proaches what was observed in Dupuy's, Reid's, and Pourfour du Petit's experiments, of actual destruction of the nerve, and we have ulceration of the intestinal mucous membrane; all these phenomena being the result of various degrees of injury sustained by the sympathetic nerve. It may here be asked, Why should the branches supplying the intestinal mucous mem- brane become more implicated than any other portion of the sympathetic system ? And why do not similar irritations of the fifth nerve produce like results in the adult? To the first of these questions we answer, that most probably the other portions are implicated ; but the manifestations of such implication are greater and graver here than elsewhere, because these sympathetic branches are the sole sources of innervation to the viscus. Other organs are in all probability affected ; but, receiving a certain amount of innervation from other sources, most of their functions not being entirely secretory, are still, though imperfectly, carried on. But in the intestinal canal the case is far different; the requisitions made upon it are of such a nature that it has need for no other innervation than that of the sympathe- tic system. Its functions are secretion and nutrition for the whole animal organism ; and when these are impaired, its primary, indeed its only intents are altered, or completely nullified. The second question is answered by the greater development of this system in the growing, than in the adult individual, for the purpose of supplying the more active nutrition and secre- tion, at that time, necessary. We'know that disease is more apt to occur in many parts of the body during this period than at other times; this is the general admission. Thus, according to many authors, among whom are \\ est, Churchill, &c, pneumonia and bronchitis are more apt to attack children during dentition than at any previous or subsequent period. Cu- taneous eruptions, and many other aberrations of secretion occurring durincr this period, serve to corroborate our theory of the origin of the morbid in- testinal secretion. The increased vermicular action and tormina attending 15 this affection find a ready explanation in the fact, now well established, that the sympathetic receives both motor and sensitive filaments from the ante- rior and posterior roots of the spinal nerves, endowing the organs of their distribution, 10 a certain degree, with corresponding susceptibilities. " ' fn conclusion, let us define the position 'which, at the end of our inves- tigation, we feel warranted in assuming, ft is the following: That in the anatomy and physiology, as well as in the dependent analogies of the pro- cess of dentition, we find ample ground for the opinion that the diseases per- taining to this period may be dependent, and in many instances, are entirely SO, UPON THE LOCAL IRRITATION ATTENDING THE PROCESS, BEING TRANSMITTED through the cerebrospinal system of nerves, producing convulsive diseases in the motory apparatus, or through the sympathetic, causing derange- ments OF the secretory organs, particularly of the alimentary canal, by the sway which it exercises over the arterial system from which these secre- tions are eliminated'.'" " In the above brief quotation, it will be observed that the doctrine of the reflex function between the cerebro-spinal and sympathetic systems is plainly enunciated, and not only is the physiological fact noted, but we there also have surmised the transmission of permanent irritation, or of pa- ralysis from the cerebro-spinal to the sympathetic system, giving rise to various aberrations in nutrition and secretion. This opinion we have held for several years, teaching to our classes that there existed between the cerebro-spinal and the ganglionic system of nerves, a relation similar to that between the sensitive and motor branches of the cerebro-spinal, and which Marshall Hall terms excito-motory; while we have termed that be- tween the cerebro-spinal and sympathetic systems excito-secretory. " As we have before indicated in this report, we do not feel authorized to lay full claim to the above theory without farther investigation of the sub- ject; but with all due courtesy to that highly distinguished gentleman, we can say that we feel assured that these views are not original with M. Ber- nard, unless he entertained them previous to June, 1850. There may haye been other similar observations; but until the publication of M. Bernard's, we had not noticed them elsewhere than in our paper on Dentition." You will perceive that in the above memoir, I have introduced enough from the first record to constitute a pretty complete resume of my original announcement and process of induction. But being apprehensive that the doctrine of a new function so clearly and publicly defined, would suggest its appropriate name to some one, before I was prepared to take up the subject a»-ain, I, on this occasion, condensed into a short paragraph, as you will see, near the end of the paper, a comprehensive re-statement of my doctrine, and placing it in juxta-position with your own distinguished name, and also, in contra-distinction to your own great, analogous discovery of the Excito- motory system, after emphasizing the word "similar," to indicate that I did not consider them " identical,'" I applied to it, the expressive designation (now used by yourself) of Excito-secretory—a word, never before that moment, (as f believe and have above stated,) written by any other person in any language, except by me, in my private notes. As an evidence of the importance attached to this brief communication 10 bv the publishing committee of the association, I call your attention to the fact that it is rendered conspicuous bv not less than four references in the short index at the end of this volume of the Transactions. On the appear- ance of the volume, (vol. vi., 1853) several of the prominent scientific peri- odicals made special reference to my claim of priority preferred against Mons. Cle. Bernard, during their review of the Transactions. I send you two of these, the most prominent, perhaps, now at hand : From American Journal of Medical Sciences, January, 1854. No. LIU, new series, p. 135. Edited by Isaac Hays, M.D., Philadelphia, Pa. "The next article is a short paper by Dr. Henry F. Campbell, of Geor- gia, in which that gentleman lavs claim to priority in the enunciation of the doctrine that there exists a reflex relationship between the sympathetic and the cerebro-spinal systems of nerves, which has been recently claimed by Dr. Bernard, of Paris, as an observation entirely new and original with him. Dr. Campbell has shown that, at least, priority of publication is with him." The next is from the New York Journal of Medicine, new series, Vol. XII., No. 2, March, 1854. Edited by S. S. Purple, M.D., and Stephen Smith, M.D. Page 254. " On the Sympathetic Nerve in Reflex Phenomena, by Henry F. Camp- bell, M.D., of Ga.—The design of this short article is to establish the pre- cedence of the writer's enunciation of the doctrine of a reflex relation ex- isting between the cerebro-spinal and ganglionic system of nerves, recently put forth by M. Bernard. The views of Dr. Campbell are contained in a paper on the Influence of Dentition in Producing Disease, published in the Southern Medical and Surgical Journal, in 1850. The author certainly establishes his claim to priority of publication, as far as regards Bernard's article referred to in the Gazette Medicale; but, if we are not mistaken, similar views have been advanced at a still earlier date. As he does not, however, pretend to priority over all others, but only so far as his informa- tion extends, we will not be to the trouble of examining the subject farther." You will here perceive that the above claim of Priority over Mons. Claude Bernard, in 1854, is distinctly referred to, and recognized, by two of the leading medical periodicals of this country, both of which have ex- changes in Europe, and the first especially circulating and being read, in your country, more, probably, than any other American medical journal. On the printing of the sixth volume of the Transactions of the American Me.Ileal Association, for 1853, I engaged with the publishers to strike off extra copies, for distribution, of the "Report on Typhoid Fever,'"' in which memoir, the principle of the Reflex Phenomena between the cerebro-spinal and ganglionic or secretory system of nerves is recognized, though not made a prominent feature of the essay. The pamphlet made up from these extra sheets was sent to yourself, as well as to your distinguished cotemporaries 17 Drs. W. B. Carpenter, R. B. Todd, Mr. W. Bowman, and Dr. W. Jenner ; and more recently, to Dr. T. B. Peacock, of St. Thomas's Hospital. JNear the close of last year, I was solicited to become senior editor of the Southern Medical and Surgical Journal, and with this subject ever upper- most mjny thoughts you will observe, that my first editorial work consist- ed m certain strictures upon a lecture on "The Effects of Dentition, in Nursing Children," delivered at Hotel Dieu, by Mons. Trousseau, of Paris, wherein I enter into a restatement of my views published in June, 1850, again bringing the two great facts of tlte nervous system into emphatic contra-distinction and analogy, the Excito-motory being indicated by the " convulsive Phenomena,''1 while the Excito-secretory is instanced, by the " diarrhoea" succeeding the local irritation in the sensitive branches of the fifth pair. From this I quote the following: " Here, it will be observed that we have unmistakable evidences of local irritation of the gums, which we know are supplied by branches of that most exquisitely sensitive of all sensitive nerves, the fifth pair; if we admit the principle of reflex action, we must recognize here a competent cause, considering the impressible character of the infant's nervous system, for the convulsive phenomena. On the other hand, we may trace a con- nection between the local irritation and the diarrhoea succeeding it, in an analogous manner, taking into view the intimate connections between the fifth pair and the nerves of the ganglionic nervous system, from which the intestinal mucous surfaces receive their secretory endowments. " We have been thus careful (I here continue.) in pointing out the man- ner in which we think this local irritation may produce the convulsive symptoms and, also, even the increased secretion from the mucous surface of the bowels and the diarrhoea, in order to give it what we consider its proper amount of importance, and to direct attention to this, as the chief source of those difficulties, calling for early and continued care."* This is my latest printed record, published in this country, as you will perceive, three months previously to your first; but this important and ex- tensive subject has never ceased to possess and stir my thoughts—suggested to my mind in the first instance, by an accidental and trivial circumstance, occurring years ago, in the earliest days of my pupilage, it became inwoven with the tissue of my thoughts, first, as an unpromising and tantalizing problem, it is true, but soon, as a broken seal—a revealed fact; and finally, as the familiar, self-evident truth of reflex nervous action. And now, dear sir, I have completed the chain of evidence which I find in my published records upon this, to me, momentous subject. While it has been acknowledged on all hands, that there is an unity in the truths of nature, it is a pleasing reflection that there is also an universality in the principles of science—nature's humble interpreter—which makes them the property of no one clime, or particular race of men, but parts of that vast * Southern Medical and Surgical Journal, VoL XIII., pp. 20 and 21. 18 and common treasury, for the benefit of all mankind. To this rapidly ac- cumulating store, your own genius and unremitting energy have contributed more, much more, than often falls to the lot of one member, of this great commonwealth, to gather. Your name must ever be associated with the his- tory of doctrines in the physiology of the nervous system, acknowledged and made the basis of induction in every portion of the scientific world.—Ob- serving you, admiring you, and studying you closely, can you censure me, if I have wished, in some degree, to emulate you, and place my humble name one day, near your own, on the scroll of science. That day is now, I hope, about to arrive; you have intimated that this Excito-secretory function of the nervous system, which, as I think, I have herein shown has been de- veloped and named by me in 1850 and 1853, is a principle not less exten- sive than the excito-motory function developed and named by you in 1837. You have said, most truly, that it is " a vast subject requiring many labor- ers and many years, fully to develop that and the other sub-system." I here ask permission to express the wish, that as long and as usefully as you have already lived, you may still be spared, to add much to the fuller de- velopment of the Excito-secretory system, much more than I could ever hope alone to accomplish. Mingled with other feelings, all of which are at this moment those of sincere kindness, is the regret, that my repeated publications on this subject have never reached your eye. I feel that I am not chargeable with having omitted to give publicity to my records, as the annals of the American Medical Association will plainly reveal. As you intend publishing shortly more in detail upon these subjects, I here earnestly and respectfully ask the honor of having my records meet due acknowledgment at your distin- guished hands. And now, respected sir, I will close this already too prolonged commu- nication : as courtesy to you, and justice to myself, were professedly the instigating causes of its inditement, I do most sincerely hope, that in the too earnest establishment of the latter, I have not at any moment even ap- peared to have forgotten the former. I am, Sir, with feelings of great respect, Your obedient servant, HENRY F. CAMPBELL. ' -- J;..- t8--.il u&je&v^:.:. NATIONAL LIBRARY OF MEDICINE NLM Qm3TD20 E