results, while we leave the other as it was—we completely arrest the secretion, but we allow the vessels to dilate as before. If, on the other hand, we employ physostigma, we contract the vessels, but cause great secretion, such secretion as is usually accompanied by dilated vessels and the free flow of blood through the gland. It is evident, then, that vascular changes, although usually associated with alterations in nutrition, do not necessarily cause them; and that, in the gland we have just mentioned, changes in the tissues composing it will occur without the caliber of the vessels or the flow of blood through them undergoing any material alteration.
We will now say a word about the transference of impressions. Just as we may imagine the farther side of the cord passed over the pulley to be divided into different strands, while the nearer side is single, and as we imagine different results obtained by pulling upon the single string by reason of those subdivisions at its farther end, so we may have the nearer end of the cord subdivided into strands, while the farther end is single, and thus we can obtain a similar result by pulling any one of the strands on the nearer end. This simile may serve to illustrate the way in which we may obtain a similar result by irritation of various efferent nerves, the stimulation being conveyed to the nerve-center and reflected down the same efferent nerve in each case. For example, a small grain of sand in the eye will cause a person to wink violently and involuntarily. In this case the impression made upon the sensory nerves of the conjunctiva is transmitted up to the brain, and reflected down the motor nerves of the orbicularis palpebrarum. But some time ago, after the extraction of a tooth, and while the wound in the gum was healing, I observed a twitching in the corresponding eyelid somewhat resembling that which would have been caused by a grain of sand in the eye. Here, also, we have the motor nerves of the orbicularis reflexly excited, but the strand, if we may so term it, through which the stimulus was sent up the nerve-center was not the same, for in this case it was a dental and in the other case an ophthalmic branch of the fifth. With these general remarks on reflex action and transference of impressions, we will now proceed to consider some cases in which reflex action is a cause of disease. I have just mentioned one instance in which intermittent spasm of a voluntary muscle, the orbicularis palpebrarum, was caused by irritation of a sensory nerve. This leads me to remark that a very important condition to be borne in mind is that constant stimulation of a sensory nerve will often produce clonic or intermittent, and not tonic or continuous, contraction of the muscles which it may set in action. It was observed by Nothnagel that if the sciatic nerve of a frog's leg was subjected to constant stimulation under certain conditions, the contractions which it induced reflexly in the other leg were intermittent or spasmodic, but not continuous or tetanic. Another instance in which voluntary muscles are reflexly affected is seen in the acts of coughing and vomiting.
