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Microbiome, Immunity, Digestive Health and
Nutrition
Epidemiology, Pathophysiology, Prevention and Treatment
This page intentionally left blank
Microbiome, Immunity,
Digestive Health and
Nutrition
Epidemiology, Pathophysiology, Prevention
and Treatment

Edited by
Debasis Bagchi
College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, United States;
Department of Biology, Adelphi University, Garden City, NY, United States; Department of R&D,
Victory Nutrition International, Inc., Bonita Springs, FL, United States

Bernard William Downs

Division of Precision Nutrition, Victory Nutrition International, Inc.,
Bonita Springs, FL, United States
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 Dedication

Dedicated this legendary book to Mr. Tapan Kumar Pain, my beloved and
respected guide, philosopher, and friend for his esteemed contribution,
encouragement, and inspiration in my life.

Debasis Bagchi

This book is dedicated with love and awe-struck admiration to Kim, my wife.
She is the most amazing woman I know and a source of constant inspiration
to me. She achieves extraordinary accomplishments and makes them seem
simply like routine occurrences.

Bernard William Downs
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Contents

List of contributors xix Author disclosure statement 21

Preface xxv References 21

3. Impact of the gut microbiome on

Section I human health and diseases 25
Microbiome and human health: Samudra Prosad Banik, Shalini Sehgal,
Rituparna Banik Ghosh and Ahana Das
an introduction
3.1 Introduction 25
1. Oral microbiome: a gateway to your 3.1.1 Definition of microbiome 25
health 3 3.1.2 Uneven distribution of microbiota
across various sites and organs of the
Na-Young Song, Se-Young Park, body: reasons and implications 25
Won-Yoon Chung, Young-Joon Surh, 3.2 The gut as the most significant niche of
Kyung-Soo Chun and Kwang-Kyun Park the human microbiome 26
1.1 Introduction 3 3.2.1 Establishment of the gut microbiome:
1.2 Oral microbiome and oral disease 3 journey from womb to adulthood 26
1.2.1 Caries 3 3.2.2 Heritable component of the gut
1.2.2 Periodontal disease 4 microbiome 26
1.2.3 Oral cancer 4 3.2.3 Role of diet and other environmental
1.3 Oral microbiome and systemic disease 5 factors in shaping the gut
1.3.1 Alzheimer’s disease 5 microbiome 27
1.3.2 Cardiovascular disease 6 3.3 Physiological roles of the gut microbiome 27
1.3.3 Diabetes 6 3.3.1 Gut Microbiota in metabolism 27
1.4 Concluding remarks 7 3.3.2 Gut microbiota in boosting immune
Acknowledgments 8 response: role of short-chain fatty
References 8 acids and cross-talk with diet 28
3.3.3 The role of the gut microbiome in
the development of gut-associated
2. Influence of microbiome in shaping lymphoid tissue 29
the newborn immune system: 3.3.4 Gut microbes as a defense
an overview 11 mechanism against pathogens 30
3.3.5 Role in cognitive development:
Manoj Kumar Kingsley and B. Vishnu Bhat
the gut-brain axis 30
2.1 Introduction 11 3.3.6 The gut microbiome as a human
2.2 How the microbiota shapes the organ 32
development of immunity in early life 11 3.4 Dysbiosis of normal flora: implications in
2.3 Influence of the microbiota on the human diseases and intervention strategies 32
development and function of specific 3.4.1 Gut microbiome in human ailments 32
immune cell subsets in early life 13 3.4.2 How to keep the gut happy: prebiotics,
2.3.1 Myeloid cells 13 probiotics, postbiotics, and synbiotics 34
2.3.2 Lymphoid cells 14 3.5 Concluding remarks 35
2.3.3 Epithelial cells 20 Acknowledgments 36
2.4 Conclusion 21 References 36

vii
viii Contents

4. The gut microbiome, human 5.1.4 Microbiome formation and early

nutrition, and immunity: colonization 54
visualizing the future 41 5.1.5 The endocannabinoid axis: the
microbiome as a mechanism by
Soching Luikham and Jhimli Bhattacharyya which lifestyle affects various
4.1 Introduction 41 aspects of metabolism, which in
4.2 Studying the gut microbiome and its turn can lead to metabolic
importance 42 syndrome and metabolic disorders 54
4.3 The role of the microbiome in nutrition 44 5.2 Brief methodology overview 55
4.3.1 Digestion of breast milk 45 5.3 Biomarker validation: metabolic
4.3.2 Digestion of Fiber 45 syndrome and cardiovascular diseases 55
4.3.3 Enhancement of immune 5.3.1 Limited clinical trial: person-oriented
competence 45 treatment of type 2 diabetes 55
4.3.4 Promotion of brain health 45 5.4 Results and discussion 55
4.3.5 Boosting of cardiovascular health 45 5.4.1 Patterns of clinically validated
4.3.6 Potentiation of insulin sensitization biomarkers in the gastrointestinal
and decrease in the risk of diabetes 45 microbiome for patients with
4.3.7 Prebiotic foods and dietary fiber 45 metabolic syndrome, obesity, type 2
4.3.8 Probiotic foods 46 diabetes, and cardiovascular diseases 55
4.4 The role of the microbiome in immune 5.4.2 Data from human trials: treatment
system development 46 by individual nutrition and
4.5 Various ways to improve our gut biopreparation with pharmabiotics 56
microbiome 47 5.4.3 IT tools for implementation of 3P
4.5.1 Eat a diverse diet 47 medicine and individual nutrition 58
4.5.2 Consider fermented foods 47 5.4.4 Databases 58
4.5.3 Avoid artificial sweeteners 47 5.4.5 IT tools 59
4.5.4 Consume prebiotic foods 47 5.4.6 Mechanisms involved and
4.5.5 Breastfeed for six months 47 prospective research 59
4.5.6 Include whole grains 48 5.4.7 Biological active compounds as
4.5.7 Include plant-based foods 48 potential modern prebiotics 59
4.5.8 Consume polyphenol-containing 5.4.8 Early health programming 62
food 48 5.5 Conclusion 65
4.5.9 Take antibiotics when required 48 References 66
4.6 Future areas of research 48
4.7 Conclusion 48
Acknowledgments 48
References 49 Section II
Microbiome and digestive health
5. Individual microbiota correction and
human health: programming and 6. The etiology of gut dysbiosis and
reprogramming of systemic and its role in chronic disease 71
local immune response 53 Alvin H. Danenberg
Tamara Meleshko, Oleksandra Pallah and
6.1 Introduction 71
Nadiya Boyko
6.2 First things first 71
5.1 Introduction 53 6.3 Diet and the gut 72
5.1.1 What is known and what is new? 6.4 Short-chain fatty acids 72
Beneficial microbes: a new concept? 53 6.5 Fasting and the gut 72
5.1.2 The concept of a healthy human 6.6 The effect of unhealthy diets on the gut 72
microbiome 53 6.7 The benefit of healthy diets for the gut 73
5.1.3 The basic concept of a healthy 6.7.1 Mediterranean diet 74
normal microbiota and concepts of 6.7.2 Low-carbohydrate diets 74
early formation of the microbiome 54 6.7.3 Ketogenic diets 74
 Contents ix

6.7.4 Paleolithic diet 74 7.5 Contribution of human intestinal

6.8 Inflammation 74 microbes in causing diseases 96
6.8.1 Acute inflammation 75 7.5.1 Clostridium difficile infection 97
6.8.2 Chronic inflammation 75 7.5.2 Inflammatory bowel disease 97
6.9 Gluten 75 7.5.3 Colorectal cancer 97
6.10 Gliadin 75 7.5.4 Rheumatoid arthritis 98
6.11 Leaky gut 76 7.5.5 Obesity 98
6.12 Other irritants to the gut 76 7.5.6 Esophageal cancer 98
6.13 A closer look into the inner tube of 7.6 Microorganism that can prevent human
the gut 77 disease 99
6.13.1 The gut microbiome and 7.6.1 Colorectal cancer 99
infections 78 7.6.2 Gastric cancer 99
6.13.2 Cross-talk between microbes 78 7.6.3 Inflammatory bowel diseases 100
6.14 Chronic inflammatory and autoimmune 7.6.4 Obesity 100
diseases 79 7.6.5 Hepatic encephalopathy 100
6.14.1 Type 1 diabetes 79 7.7 Dietary modulation of the gut
6.14.2 Rheumatoid arthritis 79 microbiota 100
6.14.3 Celiac disease 79 7.8 Conclusion 102
6.14.4 Inflammatory bowel disease 80 References 102
6.14.5 Allergic diseases 80
6.14.6 Systemic lupus erythematosus 80
6.14.7 Skin-related autoimmune
pathologies 80 Section III
6.14.8 Neurological inflammatory Microbiome and metabolic syndrome
diseases 80
6.14.9 Periodontal disease 80 8. The beneficial role of healthy
6.14.10 Cancer 81 microbiome in metabolic syndrome
6.15 Unraveling the mystery of treatment 82 and cardiovascular health 109
6.15.1 Treatment for active infections 82
6.15.2 Understanding periodontal Smriti Arora, Nitika Bhambri, Samikshha Puri,
disease 82 Anamika, Nandini Dasgupta, Shradha Khater
6.15.3 Repairing and restoring the gut 82 and Gautam Das
6.15.4 Spore-based bacillus probiotics 83 8.1 Introduction 109
6.15.5 Prebiotics 83 8.2 Gut microbiota and metabolic syndrome 110
6.15.6 The mucosal layer 83 8.2.1 Obesity 111
6.15.7 The importance of the mouth 84 8.2.2 Gut microbiota and hyperglycemia
6.15.8 Personal oral hygiene protocol 84 and diabetes 112
6.16 Concluding remarks 85 8.2.3 Gut microbiota and dyslipidemia 112
References 85 8.2.4 Gut microbiota and hypertension 113
8.2.5 Gut microbiota and cardiovascular
7. Role of the microbiome in the disease 113
function and diseases of the 8.2.6 Early gut microbiota and MetS 114
digestive system 93 8.3 Mechanism at the molecular level 114
8.3.1 The gut barrier 114
F A Dain Md Opo, Addisu Demeke Teklemariam,
8.3.2 Energy metabolites 115
Rokeya Pervin and Md. Akil Hossain
8.4 Metabolic syndrome therapy by
7.1 Introduction 93 managing gut microbiota 117
7.2 Microbes in gastrointestinal tract 93 8.4.1 Influence of diet 117
7.3 Development of the gut flora 94 8.4.2 Influence of prebiotics 118
7.4 Physiological functions of gut microbes 95 8.4.3 Influence of probiotics 118
7.4.1 Metabolism 95 8.4.4 Influence of exercise 119
7.4.2 Immune system development 96 8.5 Conclusion 119
7.4.3 Central nervous system development 96 References 119
x Contents

9. The role of the intestinal microbiota 11.4.4 Intestinal microbiota in

in weight loss in overweight and cardiovascular diseases:
obese humans 125 the heart-gut axis 156
11.5 Influence of dietary components in
Isabel Sospedra López, Gema Alfonso Sigüenza, boosting a healthy microbiome and
Estela González Rodrı́guez, Mar Lozano Casanova reducing the risk of metabolic
and José Miguel Martı́nez-Sanz syndrome 157
9.1 Causes of overweight and obesity 125 11.5.1 Carbohydrates 158
9.2 The microbiota and obesity 125 11.5.2 Proteins 158
9.3 The bacterial composition of the 11.5.3 Fats 159
microbiota according to weight status 126 11.5.4 Fatty acids 159
9.4 Effect of dietary interventions on the 11.5.5 Polyphenols 160
microbiota 127 11.5.6 Spices 160
9.5 Conclusions 133 11.5.7 Prebiotics 160
References 133 11.5.8 Probiotics 161
11.5.9 Selective diets 161
11.6 Conclusion 162
10. Role of microbial metabolites in
References 162
cardiovascular and human health 137 Further reading 165
Abhilasha Singh
Abbreviations 137 12. Restoring gut biome balance for
10.1 Introduction 137 weight loss: clinical applications 167
10.2 Gut microbial metabolites and
cardiovascular disease 138 Naras Bhat, Jyoti Bhat, Kusum Bhat,
10.2.1 Short-chain fatty acids 139 Imran Junaid, Anita Bhat and Joy Bhat
10.2.2 Other metabolites of clinical 12.1 Introduction 167
significance 143 12.2 Gut microbiome resiliency 167
10.3 Conclusions 145 12.3 Obesogenic features of the gut
References 145 microbiome 168
12.3.1 Obesogenic gut microbiome is
11. Beneficial role of gut microbiome in transferrable 168
metabolic syndrome, obesity, and 12.3.2 Mother-to-child transmission of
cardiovascular diseases 149 obesity 168
12.4 Dysbiosis as obesogenic signature 168
Pradipta Banerjee, Sriya Choudhury, Komal Jalan,
12.4.1 Decreased diversity 168
Amitava Das, Nandini Ghosh and Debasis Bagchi
12.4.2 Firmicutes/bacteroidetes ratio 168
11.1 Introduction 149 12.4.3 Keystone bacteria 168
11.1.1 Gut microbiome 149 12.4.4 Gut barrier permeability 169
11.1.2 Dietary intake for reducing the risk 12.4.5 Concept of prebiotics,
factor of metabolic syndrome, probiotics, and postbiotics 169
obesity, and cardiovascular 12.5 Obesogenic metabolic endotoxemia
disease 149 and insulin resistance 170
11.2 Metabolic syndrome 150 12.5.1 Diet-induced lipopolysaccharide
11.3 Composition of a healthy gut endotoxemia 170
microbiome 150 12.5.2 Insulin resistance and
11.4 Beneficial role of a healthy microbiome inflammation 172
in preventing metabolic syndrome 154 12.5.3 Stress and metabolic
11.4.1 How the microbiome is related endotoxemia 172
to health and diseases 154 12.5.4 Immune activation 172
11.4.2 Gut microbiome and metabolic 12.6 Effect of dietary components on
syndrome 154 metabolic endotoxemia 172
11.4.3 Gut microbiome: a new strategy 12.6.1 Effect of fasting on metabolic
to treat obesity 155 endotoxemia 172
 Contents xi

12.6.2 Exercise and metabolic 13.4 Dysbiosis 187

endotoxemia 172 13.5 Gut microbiome and inflammation 188
12.6.3 How long does it take to 13.6 Future: harnessing the gut microbiota
change the gut biome? 172 to treat metabolic disorders 188
12.7 Microbial regulation of host energy 13.7 Intestinal transplantation 188
balance 173 13.8 Oral butyrate 189
12.7.1 Microbiota-associated energy 13.8.1 Probiotics 189
harvest 173 13.9 Heat-killed probiotics 190
12.7.2 Cross-talk between the gut 13.10 Prebiotics 190
microbiota and the host 13.11 Synbiotics 190
metabolism 173 13.12 Postbiotics 190
12.7.3 Gut-brain axis of eating behavior 173 13.13 Summary and concluding remarks 190
12.7.4 Gut-muscle axis and energy References 191
output 173
12.7.5 Gut-adipose-liver axis and 14. The effect of resveratrol-mediated
energy storage 173 gut microbiota remodeling on
12.7.6 Gut biome and circadian rhythm 174 metabolic disorders 193
12.7.7 Fasting and autophagy 174
12.8 Western lifestyle as a menace to the Marzena Wojcik and Lucyna Wozniak
gut biome 174 14.1 Introduction 193
12.9 Pragmatic mitigation of western 14.2 Gut microbiota and obesity 194
lifestyle effects on the gut biome 176 14.2.1 Resveratrol, the gut microbiota,
12.10 Eating and fasting 176 and obesity 196
12.10.1 What to eat? 176 14.3 Gut microbiota and type 2 diabetes
12.10.2 Clinical protocol for mellitus 199
microbiome-centered eating 178 14.3.1 Resveratrol, the gut microbiota,
12.10.3 When to eat? Intermittent and type 2 diabetes mellitus 200
fasting 178 Acknowledgments 200
12.10.4 Clinical protocol for fasting- References 200
mimicking time-restricted
eating 179
12.11 Physical activity versus physical
inactivity 179 Section IV
12.11.1 Exercise versus nonexercise 179
12.11.2 Sedentary versus sitting disease 179
Microbiome and immune health
12.11.3 Clinical protocol for physical
activity 180
15. The microbiome, immunity,
12.12 Wake-sleep circadian rhythm 180 anaerobism, and inflammatory
12.12.1 Clinical protocol for circadian conditions: a multifaceted systems
rhythm balance 180 biology intervention 205
12.13 Conclusion 181 Bernard William Downs, Samudra Prosad Banik,
References 181 Manashi Bagchi, Rituparna Banik Ghosh,
Further reading 184 Steve Kushner and Debasis Bagchi
13. Harnessing gut friendly microbiomes 15.1 Introduction 205
to combat metabolic syndrome 185 15.2 Restoring the ideal biological
environment and optimal
Chitra Selvan and Satinath Mukhopadhyay
homeostatic equilibrium 205
13.1 Introduction 185 15.3 Digestion: the first step in metabolism 206
13.2 Gut microbiome 185 15.4 Antioxidant therapy: firing at the
13.3 Gut microbiota and metabolic wrong target 206
disorders: mechanisms 187 15.5 Role of the microbiome 207
13.3.1 Gut microbiome and energy 15.6 Epigenetic influences 209
homeostasis 187 15.7 Microbiome functional competence 209
xii Contents

15.8 Inflammatory events 210 17.4 Gut-hypothalamic homeostatic energy

15.9 Multifaceted systems biology regulation 234
intervention: conceptual overview 210 17.4.1 The set point dilemma 235
15.10 Microbial dysbiosis 211 17.4.2 Homeostatic systems 235
15.11 Functions of microbial strains 212 17.4.3 Feeding behavior regulation by
15.12 Microbial restoration 212 dopaminergic systems 235
15.13 Butyric acid 213 17.4.4 Food and drug addiction
15.14 Conclusion 213 identification of common
References 214 neurobiological mechanisms 236
Further reading 216 17.5 Summary 237
17.6 Conclusion 239
16. Preclinical data support the strong References 239
specificity and advertising ability to
control the immune reactions at 18. Influence of gut microbial flora in
mucosal sites 217 body’s serotonin turnover and
associated diseases 245
Tamara Meleshko, Oleksandra Pallah and
Nadiya Boyko Sabyasachi Choudhuri, Jyotirmoy Panda and
Sayantan Maitra
16.1 Introduction 217
16.2 Microbiota detection tools 218 List of abbreviation 245
16.2.1 Technological approaches 218 18.1 Introduction 245
16.2.2 Mice models 218 18.2 The gut microbiota 246
16.2.3 Schaedler’s E. coli induces 18.3 Role of the gut microbiota in
diminished translocation of maintaining the body’s normal
Lactobacillus salivarius into the physiological homeostasis 249
lung: the role of surfactant 18.4 Influence of neurotransmitters on
protein D 221 the gut microbiome population
16.3 Conclusion 225 through the gut-brain axis 251
References 225 18.4.1 Role of biogenic amines in the
gut microbiota 252
18.4.2 Role of esters in the gut
microbiota 256
Section V 18.4.3 Role of miscellaneous
neurotransmitters in the gut
Microbiome and cognitive health microbiota 257
18.5 Association between the microbiome-
17. Achieving dopamine homeostasis to gut-brain axis and serotonin
combat brain-gut functional turnover 257
impairment: behavioral and 18.6 Dysregulation in the occurrence of gut
neurogenetic correlates of reward microbiota and its implications in
deficiency syndrome 229 diverse pathological conditions 259
18.7 Conclusion 262
Kenneth Blum, Bernard William Downs,
References 262
Debasis Bagchi, Gene-Jack Wang,
Panyotis K. Thanos, Igor Elman, Rehan Jalali,
19. The connection between diet, gut
Abdalla Bowirrat, David Baron, Diwanshu Soni,
Rajendra D. Badgaiyan and Mark S. Gold
microbes, and cognitive decline 265
Abhai Kumar, Smita Singh and
17.1 Introduction 229
Rameshwar Nath Chaurasia
17.2 Understanding endorphin deficiency
syndrome and opioid deficiency 19.1 Introduction 265
syndrome 232 19.2 Microbiome composition and
17.3 Understanding obesity as a evolution 265
hypodopaminergia 233 19.3 Microbiota and brain functioning 266
 Contents xiii

19.4 Microbiome-gut-brain axis 267 20.5 Summary 290

19.5 Microbiome and cognitive decline 268 References 291
19.6 Diet and cognition 268
19.7 Conclusion 269 Section VI
References 269
Microbiome, dermal health and
wound healing
20. Role of the gut microbiome in Rett
syndrome 273 21. Skin microbiota and its role in health
and disease with an emphasis on
Carly Albright, Amanda Friend, Benjamin Peters,
Miranda Reed, Vishnu Suppiramaniam and
wound healing and chronic wound
Subhrajit Bhattacharya
development 297
J.H. Kim, A. Ahamed, K. Chen, E.G. Lebig,
20.1 Introduction to the gut microbiome 273
B. Petros, S. Saeed and M. Martins-Green
20.1.1 Digestion and the gut microbiome 273
20.1.2 Absorption, distribution, 21.1 Introduction 297
metabolism and excretion 274 21.2 Skin structure and function 298
20.1.3 Gut microbiome altering 21.3 Skin microbiome diversity in
medication efficacy 274 different parts of the body 299
20.1.4 Medication-induced gut 21.4 Microbial dysbiosis in skin-related
microbiome dysbiosis 276 diseases 300
20.2 Diseases of the gut 276 21.4.1 Atopic dermatitis 300
20.2.1 Diseases central to the gut 276 21.4.2 Acne vulgaris 300
20.2.2 Diseases distant from the gut: 21.4.3 Rosacea 301
psychiatric and neurological 21.4.4 Psoriasis 301
disorders 277 21.4.5 Skin cancers 302
20.3 The gut microbiome and Rett syndrome 280 21.5 The microbiome and cutaneous
20.3.1 Background and history of Rett wound healing 302
syndrome 280 21.5.1 The microbiome and cutaneous
20.3.2 Pathology, symptoms, and chronic wound development 303
progression 281 21.5.2 Specific chronic wounds and
20.3.3 Genetic links 281 their wound microbiome 304
20.3.4 DNA methylation in Rett 21.6 Common techniques for surveying
syndrome 282 the skin microbiota 306
20.3.5 Biogenic amine systems in Rett 21.7 Manipulation of the skin microbiota to
syndrome 282 prevent or treat skin-associated
20.3.6 Rett syndrome in males 282 ailments 307
20.3.7 Role of different excitatory and 21.7.1 Probiotics 307
inhibitory receptor systems: 21.7.2 Skin microbiota transplant 307
GABA, NMDAR, and AMPAR 283 21.7.3 Prebiotics 307
20.3.8 Treatment paradigm 283 21.8 Perspectives 308
20.4 Relationship between gut microbiome References 308
and Rett syndrome 284
20.4.1 Effect on gut microbiome
diversity and dysbiosis 285
Section VII
20.4.2 Recent and past studies 286 Microbiome and cancer
20.4.3 Rett syndrome and other
neurological and psychiatric 22. Healthy gut microbiome in the
disorders that share gut prevention of colorectal cancer 315
microbiome alterations 287
Marufa Rumman, Misako Nagasaka,
20.4.4 Intestinal inflammation in Rett
Bayan Al-Share, Asfar S. Azmi and
syndrome 289
Md. Hafiz Uddin
20.4.5 Rett syndrome therapeutics and
the gut microbiome 289 22.1 Introduction 315
xiv Contents

22.2 The gut microbiome in the Section IX

progression
of colorectal cancer 315
Environmental pollutants and
22.3 Factors affecting the gut microbiome 317 gut microbiome
22.3.1 Dietary fats 317
22.3.2 Red and processed meats 317 24. Microplastic toxicity and the gut
22.3.3 Alcohol consumption 318 microbiome 345
22.3.4 Smoking 318
Muhammad Manjurul Karim, Pooja Shivappa,
22.3.5 Obesity 318
Nadiya Dileep, Tania Akter Jhuma and
22.3.6 Physical activity 319
Ashfaque Hossain
22.4 The gut microbiome in the protection
against colorectal cancer 319 24.1 Introduction 345
22.5 Prevention of colorectal cancer by 24.2 History of microplastics 345
enhancing healthy gut flora 320 24.3 Microplastics pollution and the
22.5.1 Prebiotics 320 threat to habitats 346
22.5.2 Probiotics 321 24.4 Gut microbiome 347
22.5.3 Synbiotics 322 24.4.1 Dysbiosis and eubiosis 348
22.6 Conclusion and future perspectives 322 24.4.2 Short-chain fatty acids and
Conflict of interest 322 branched-chain fatty acids 349
References 322 24.4.3 Virome and microplastics 349
24.4.4 Akkermansia muciniphila 351
24.5 Toxic effects of microplastics on human
systems 351
Section VIII 24.5.1 Microplastic modulation of
cellular pathways 352
Microbiome, arthritis and 24.5.2 Microplastics-induced reactive
multiple sclerosis oxygen species 352
24.5.3 Accumulation of microplastic
23. Regulatory roles of the microbiome particles in different tissues 353
in arthritis, fibromyalgia, and 24.6 Plastisphere: biofilm on microplastics 353
multiple sclerosis 331 24.7 Microplastics as pathogen carriers 354
24.8 Conclusion and perspectives 354
Liz J. Vázquez-Chinea, Savannah N. Johnson
References 354
and Elizabeth A. Lipski
23.1 Introduction 331
23.2 Rheumatoid arthritis 331 Section X
23.2.1 Microbiome profile of individuals Molecular and immunological
with rheumatoid arthritis 332
23.2.2 Probiotic supplementation in
mechanisms associated with
individuals with rheumatoid healthy gut microbiome functions
arthritis 332
23.3 Fibromyalgia 334 25. Role of the gut microbiome and
23.3.1 Pain and fibromyalgia 334 probiotics for prevention and
23.3.2 Gut microbiota and management of tuberculosis 361
fibromyalgia 334
Tejaswini Baral, Shilia Jacob Kurian, Sonal Sekhar M.,
23.4 Multiple sclerosis 335
Murali Munisamy, Chandrashekar Udyavara Kudru,
23.4.1 Gut microbiota and multiple
Bidita Khandelwal, Mithu Banerjee, Chiranjay
sclerosis 335
Mukhopadhyay, Kavitha Saravu, Jitendra Singh,
23.4.2 Multiple sclerosis and
Sarman Singh and Mahadev Rao
modifiable factors 336
23.5 Discussion 338 25.1 Introduction 361
23.6 Conclusion 340 25.2 Gut-lung axis 362
References 340 25.3 Gut-liver axis 362
 Contents xv

25.4 Gut
immune system axis 363 27. Prospective role of prebiotics and
25.5 Role of the human gut microbiome in probiotics in gut immunity 387
tuberculosis 363
25.6 Role of probiotics in tuberculosis 363 Saptadip Samanta
25.6.1 Probiotics as immunomodulator 365 27.1 Introduction 387
25.6.2 Probiotics as an antiinfective 27.2 The gut microbiota and its beneficial
mediator 366 effects 388
25.6.3 Preclinical and clinical evidence 27.2.1 Shape of the gut microbiota 388
of the effects of probiotics in 27.2.2 Role of the microbiota in the
managing tuberculosis 366 synthesis of essential metabolites
25.7 Role of probiotics in preventing and bioactive components 388
anti-TB drug-induced adverse effects 367 27.3 Impacts of dysbiosis 390
25.7.1 Amelioration of adverse 27.3.1 Inflammatory bowel diseases 391
gastrointestinal effects 367 27.3.2 Clostridium difficile infection 391
25.7.2 Amelioration of drug-induced 27.3.3 Metabolic disorders 391
hepatotoxicity 367 27.3.4 Role in cancer progression 391
25.8 Probiotics in the improvement of 27.3.5 Gastric cancer 392
nutritional status in tuberculosis 368 27.3.6 Colorectal cancer 392
25.9 Dose and dosage of probiotic 27.3.7 Hepatocellular carcinoma 392
formulations for dietary supplements 368 27.3.8 Other cancers 392
25.10 Conclusion 369 27.4 Prebiotics 393
References 369 27.5 Probiotics 394
27.6 Role of prebiotics and probiotics in
26. Lactic acid bacteria
based immunomodulation 394
beverages in the promotion of 27.6.1 Prebiotics and immune-boosting
gastrointestinal tract health 373 effects 394
27.6.2 Production of short-chain fatty
Luı́s Cláudio Lima de Jesus, Tales Fernando da acids and their
Silva, Rafael de Assis Glória, Andria dos Santos immunomodulatory effects 394
Freitas, Monique Ferrary Américo, Lucas Jorge da 27.6.3 Protective role against
Silva Fernandes, Gabriela Munis Campos, inflammation 396
Gabriel Camargos Gomes, Rhayane Cristina Viegas 27.6.4 Role of bile acids 396
Santos, Rodrigo Dias de Oliveira Carvalho, 27.6.5 Effect on development of gut-
Debmalya Barh and Vasco Azevedo associated lymphoid tissue and
26.1 Introduction 373 expansion of gut immunity 396
26.2 Lactic Acid Bacteria 373 27.6.6 Protective role of probiotic
26.3 LAB-derived bioactive compounds 374 organisms against pathogenesis 397
26.4 The LAB fermentation process 375 27.6.7 Role in innate immunity 398
26.5 Organoleptic characteristics of 27.6.8 Probiotic bacteria and
LAB-fermented foods 375 modulation of cytokine profile 398
26.6 Commercial products from LAB 27.6.9 Role in enhanced secretion of
fermented foods 376 IgA 398
26.7 Application of LAB-fermented 27.6.10 Role in immunosurveillance-
beverages in gastrointestinal mediated cancer prevention 399
tract
related diseases 376 27.7 Additional benefits of probiotics 399
26.7.1 Antibiotic-associated diarrhea 378 27.8 Concluding remarks 399
26.7.2 Constipation 378 References 399
26.7.3 Inflammatory Bowel Diseases 380
26.7.4 Intestinal mucositis 381 28. Gut
brain communication: a novel
26.7.5 Colorectal cancer 382 application of probiotics 405
26.7.6 Enteric infections 382
Sujit Das, Trupti J. Undhad and Subrota Hati
26.8 Final considerations 383
References 383 28.1 Introduction 405
xvi Contents

28.2 The gut-brain axis: a concept 405 steroid hormone
microbiota-

28.3 Factors regulating the microbiota- inflammation axis 424
gut-brain axis 407 References 427
28.3.1 Genetics and epigenetics 407
28.3.2 Mode of delivery at birth 407
28.3.3 Fats 407
28.3.4 Medications and the 30. Role of mushroom polysaccharides
microbiome 407 in improving gut health and
28.4 Interactions within the gut-brain axis 407 associated diseases 431
28.4.1 Neuronal pathway 408 Divya Yadav and Pradeep Singh Negi
28.4.2 Endocrine pathway 408
28.4.3 Humoral/metabolic pathway 408 30.1 Introduction 431
28.4.4 Immune pathway 409 30.2 The gut microbiome 432
28.5 Function of the microbiota in the 30.3 Mushroom polysaccharides 432
gut-brain-axis 409 30.3.1 D-glucan 433
28.5.1 From the gut microbiota to the 30.4 Proteoglycan 437
brain 409 30.4.1 Glycoprotein 438
28.5.2 From the brain to the gut 30.5 Prebiotic efficiency of mushroom
microbiota 410 polysaccharides 438
28.6 The gut-brain axis in the regulation 30.6 Hydrolysis of mushroom
of food intake 411 polysaccharides by intestinal
28.7 Behavior and the microbiota bacterial enzymes 439
gut-brain axis 411 30.7 Impact of mushroom polysaccharides
28.7.1 Animal studies 411 on the gut microbiome 439
28.7.2 Human studies 413 30.8 Prevention of various diseases by
28.8 Conclusions and future perspectives 413 prebiotic mushroom polysaccharides
References 413 through modulation of the gut
microbiota 440
30.8.1 Inflammatory bowel disease 440
30.8.2 Antitumor effect 444
29. Flaxseed has a pronounced effect
30.8.3 Immunomodulatory effect 445
on gut microbiota 417 30.9 Conclusion and future perspectives 445
M.N. Sharath Kumar and S. Devaraja References 445
29.1 Introduction 417
29.2 Flaxseed oil prevents alcoholic liver
disease by modulating the gut
microbiota through its antiinflammatory Section XI
property 418
29.3 Flaxseed oil reduces the severity
Microbiome and immunomodulatory
of type 2 diabetes mellitus by peptides
modulating the gut microbiota via its
antiinflammation effect 419 31. The role of the microbiome in
29.4 By altering the composition of the sports nutrition 451
gut microbiota, flaxseed oil has
Estela González-Rodrı́guez, Laura Albero Montava,
beneficial immunological and
Isabel Sospedra López and José Miguel
metabolic effects 421
Martı́nez-Sanz
29.5 Flaxseed polysaccharide modulates the
composition and structure of the gut 31.1 Introduction 451
microbiota by altering the firmicutes- 31.2 The microbiome and sport 451
bacteroidetes ratio 423 31.3 Research related to the microbiome
29.6 Flaxseed oil ameliorated polycystic and athletic performance 452
ovary syndrome through the sex 31.4 Conclusion 457
References 457
 Contents xvii

Section XII 33.3 Outcome measure 482

33.4 Sample data: hydroxycitric acid study 482
Study design and statistical 33.5 Method for analyzing the intervention
interpretation effect without adjusting for the
pre-value effect 482
32. Food-derived immunomodulatory 33.6 Method for analyzing an intervention
peptides: science to applications 461 effect, adjusting for the effect of the
pre-value: analysis of covariance 485
Chopada Kevalkumar Dineshbhai,
33.7 Change point regression model 489
Pratik Shukla, Amar Sakure, Brij Pal Singh,
References 492
Sujit Das, Sreeja V. and Subrota Hati
32.1 Introduction 461
32.2 Immunomodulation and
immunomodulatory peptides 462
Commentary from the Editor’s
32.3 Mechanism of immunomodulatory Desk 495
peptide 463
32.4 Sources of some immunomodulatory A treatise on a healthy microbiome:
peptides 463 contribution to human health and
32.4.1 Milk and milk products 464 disease prevention 497
32.4.2 Fish 467
Debasis Bagchi, Samudra Prosad Banik and
32.4.3 Marine organisms 468
Bernard William Downs
32.4.4 Eggs 468
32.4.5 Plants 468 A.1 Microbiome terminology: the origin 497
32.5 Bioavailability of bioactive peptides in A.2 Microbiota, microorganisms, and
foods 470 microbiome 497
32.5.1 Absorption 471 A.3 Microbiome: human health and disease
32.5.2 Distribution 471 pathology 498
32.5.3 Metabolism 472 A.4 Microbiome and metabolic syndrome 499
32.5.4 Elimination 472 A.5 Microbiome and obesity 500
32.6 Methods used to assay A.6 Microbiome and diabetes 500
immunomodulatory activity 472 A.7 Microbiome and cancer 500
32.7 Clinical studies 474 A.8 Microbiome, brain health, and
32.7.1 Related to COVID-19 474 advancing age 500
32.7.2 Impact of probiotics strains on A.9 Summary and conclusions 501
T cell response 474 References 501
32.8 Applications 474
32.9 Conclusion 475 Index 503
References 475

33. Clinical intervention, study design,

and statistical methodology:
statistical approaches for
pre-post studies 481
Kohsuke Hayamizu
33.1 Introduction 481
33.2 Pre-post design 481
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 The Project Gutenberg eBook of A system of
practical medicine. By American authors. Vol. 5
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Title: A system of practical medicine. By American authors. Vol. 5

Diseases of the nervous system

Editor: William Pepper

Louis Starr

Release date: October 16, 2023 [eBook #71892]

Language: English

Original publication: Philadelphia: Lea Brothers & Co, 1886

Credits: Ron Swanson

*** START OF THE PROJECT GUTENBERG EBOOK A SYSTEM

OF PRACTICAL MEDICINE. BY AMERICAN AUTHORS. VOL. 5 ***
 A

SYSTEM
OF

PRACTICAL MEDICINE.

BY

AMERICAN AUTHORS.

EDITED BY

WILLIAM PEPPER, M.D., LL.D.,

PROVOST AND PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE AND
OF
CLINICAL MEDICINE IN THE UNIVERSITY OF PENNSYLVANIA.

ASSISTED BY

LOUIS STARR, M.D.,

 CLINICAL PROFESSOR OF DISEASES OF CHILDREN
IN THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA.

VOLUME V.
DISEASES OF THE NERVOUS
SYSTEM.

PHILADELPHIA:
LEA BROTHERS & CO.
1886.
 Entered according to Act of Congress, in the year 1886, by

LEA BROTHERS & CO.,

in the Office of the Librarian of Congress at Washington. All rights reserved.

WESTCOTT & THOMSON,

Stereotypers and Electrotypers, Philada.

WILLIAM J. DORNAN,
Printer, Philada.
 VALEDICTORY.

In presenting to the profession the fifth and concluding volume of the

“SYSTEM OF PRACTICAL MEDICINE BY AMERICAN AUTHORS,” the Editor
may be permitted to refer briefly to labors which for years have
called forth his strenuous endeavors. The original prospectus of the
work was issued in 1881. The first volume was published in January,
1885; the second, in May, 1885; the third, in September, 1885; and
the fourth, in February, 1886. In view of the delays inevitable in large
and complicated literary enterprises, such unusual punctuality
reflects credit alike on the zeal of the contributors and the energy
and resources of the publishers. The duties of the Editor have been
lightened and rendered agreeable by the unvarying courtesy and
cordial co-operation of all connected with him in the undertaking; and
he has been amply rewarded by the realization of his hopes in the
favorable reception accorded to the successive volumes by the
profession on both sides of the Atlantic. The plan of the work has
been strictly adhered to, and the articles promised have been
furnished without exception, although in a very few cases
circumstances required a change in the authorship. Special mention
is due to Dr. Louis Starr and to Dr. Judson Daland for the very
valuable assistance they have rendered.

The only alloy to the pleasure which the Editor has had in the
progress of the work has been the removal by death of so many of
his distinguished collaborators: such men as Flint, Van Buren, Armor,
Bemiss, and Elsberg will long be mourned by the profession.

The number of articles is 185, written by 99 authors, covering, with

indexes, about 5600 pages, and throughout its whole extent the
original purpose has been kept constantly in view, that the practical
character of the work should adapt it specially to the needs of the
general practitioner. In conclusion, the Editor feels that it is a subject
of congratulation that through the combination of so many leading
members of the profession it has been rendered possible to present
in this work, for the first time, the entire subject of practical medicine
treated in a manner truly representative of the American School.

PHILADELPHIA, JUNE, 1886.

 CONTENTS OF VOLUME V.

DISEASES OF THE NERVOUS SYSTEM.

GENERAL SEMEIOLOGY OF DISEASES OF THE NERVOUS

SYSTEM; DATA OF DIAGNOSIS. By E. C. SEGUIN, M.D.

THE LOCALIZATION OF LESIONS IN THE NERVOUS SYSTEM.

By E. C. SEGUIN, M.D.

MENTAL DISEASES. By CHARLES F. FOLSOM, M.D.

HYSTERIA. By CHARLES K. MILLS, A.M., M.D.

HYSTERO-EPILEPSY. By CHARLES K. MILLS, A.M., M.D.

CATALEPSY. By CHARLES K. MILLS, A.M., M.D.

ECSTASY. By CHARLES K. MILLS, A.M., M.D.

NEURASTHENIA. By H. C. WOOD, M.D., LL.D.

SLEEP, AND ITS DISORDERS. By HENRY M. LYMAN, A.M., M.D.

ACUTE AFFECTIONS PRODUCED BY EXPOSURE TO HEAT. By

H. C. WOOD, M.D., LL.D.

HEADACHE. By WHARTON SINKLER, M.D.

VERTIGO. By S. WEIR MITCHELL, M.D.

TREMOR. By WHARTON SINKLER, M.D.

PARALYSIS AGITANS. By WHARTON SINKLER, M.D.

CHOREA. By WHARTON SINKLER, M.D.

ATHETOSIS. By WHARTON SINKLER, M.D.

LOCAL CONVULSIVE DISORDERS. By ALLAN MCLANE HAMILTON,

M.D.

EPILEPSY. By ALLAN MCLANE HAMILTON, M.D.

THE NEURAL DISORDERS OF WRITERS AND ARTISANS. By

MORRIS J. LEWIS, M.D.

TETANUS. By P. S. CONNER, M.D.

DISORDERS OF SPEECH. By EDWARD P. DAVIS, A.M., M.D.

ALCOHOLISM. By JAMES C. WILSON, A.M., M.D.

THE OPIUM HABIT AND KINDRED AFFECTIONS. By JAMES C.

WILSON, A.M., M.D.

CHRONIC LEAD-POISONING. By JAMES C. WILSON, A.M., M.D.

PROGRESSIVE UNILATERAL FACIAL ATROPHY. By CHARLES K.

MILLS, A.M., M.D.

DISEASES OF THE MEMBRANES OF THE BRAIN AND SPINAL

CORD. By FRANCIS MINOT, M.D.

TUBERCULAR MENINGITIS. By FRANCIS MINOT, M.D.

CHRONIC HYDROCEPHALUS. By FRANCIS MINOT, M.D.

CONGESTION, INFLAMMATION, AND HEMORRHAGE OF THE

MEMBRANES OF THE SPINAL CORD. By FRANCIS MINOT, M.D.

SPINA BIFIDA. By JOHN ASHHURST, JR., M.D.

ANÆMIA AND HYPERÆMIA OF THE BRAIN AND SPINAL CORD.
By E. C. SPITZKA, M.D.

THE CHRONIC INFLAMMATORY AND DEGENERATIVE

AFFECTIONS OF THE SPINAL CORD. By E. C. SPITZKA, M.D.

CONCUSSION OF THE BRAIN AND SPINAL CORD. By WILLIAM

HUNT, M.D.

INTRACRANIAL HEMORRHAGE AND OCCLUSION OF THE

CEREBRAL VESSELS, APOPLEXY, SOFTENING OF THE BRAIN,
CEREBRAL PARALYSIS. By ROBERT T. EDES, M.D.

ATROPHY AND HYPERTROPHY OF THE BRAIN. By H. D.

SCHMIDT, M.D.

SYPHILITIC AFFECTIONS OF THE NERVE-CENTRES. By H. C.

WOOD, M.D., LL.D.

TUMORS OF THE BRAIN AND ITS ENVELOPES. By CHARLES K.

MILLS, A.M., M.D., and JAMES HENDRIE LLOYD, A.M., M.D.

TUMORS OF THE SPINAL CORD AND ITS ENVELOPES. By

CHARLES K. MILLS, A.M., M.D., and JAMES HENDRIE LLOYD, A.M., M.D.

INFANTILE SPINAL PARALYSIS. By MARY PUTNAM JACOBI, M.D.

DISEASE OF ONE LATERAL HALF OF THE SPINAL CORD. By H.

D. SCHMIDT, M.D.

PROGRESSIVE LABIO-GLOSSO-LARYNGEAL PARALYSIS. By H.

D. SCHMIDT, M.D.

DISEASES OF THE PERIPHERAL NERVES. By FRANCIS T. MILES,

M.D.

NEURALGIA. By JAMES J. PUTNAM, M.D.

VASO-MOTOR AND TROPHIC NEUROSES. By M. ALLEN STARR,
M.D., PH.D.

INDEX
 CONTRIBUTORS TO VOLUME V.

ASHHURST, JOHN, JR., M.D.,

Professor of Clinical Surgery in the University of Pennsylvania.

CONNER, P. S., M.D.,

Professor of Anatomy and Clinical Surgery in the Medical

College of Ohio; Professor of Surgery, Dartmouth Medical
College; Surgeon to Cincinnati and Good Samaritan Hospitals,
Cincinnati.

DAVIS, EDWARD P., A.M., M.D.,

Lecturer on Physiology, Rush Medical College, Chicago, and

lately Medical Superintendent of the Presbyterian Hospital,
Chicago.

EDES, ROBERT T., M.D.,

Jackson Professor of Clinical Medicine in Harvard University,

Boston, Mass.

FOLSOM, CHARLES F., M.D.,

Visiting Physician for Nervous and Renal Diseases, Boston City

Hospital; formerly Assistant Professor of Mental Diseases in
Harvard University, Boston.

HAMILTON, ALLAN MCLANE, M.D.,

 Consulting Physician to the New York City Male and Female
Insane Asylums; Hudson River State Asylum for the Insane;
Consulting Neurologist to Hospital for Ruptured and Crippled;
Attending Physician to Hospital for Nervous Diseases; Member
of the New York Neurological Society.

HUNT, WILLIAM, M.D.,

Surgeon to the Pennsylvania Hospital, and to the Philadelphia

Orthopædic Hospital and Infirmary for Nervous Diseases.

JACOBI, MARY PUTNAM, M.D.,

Professor of Therapeutics at the Women's Medical College,

New York.

LEWIS, MORRIS J., M.D.,

Physician to the Episcopal Hospital and to the Children's

Hospital; Assistant Physician to the Orthopædic Hospital and
Infirmary for Nervous Diseases, Philada.

LLOYD, JAMES HENDRIE, A.M., M.D.,

Instructor in Electro-Therapeutics in the University of

Pennsylvania.

LYMAN, HENRY M., A.M., M.D.,

Professor of Physiology and of Diseases of the Nervous System

in Rush Medical College, Chicago; Professor of Theory and
Practice of Medicine in the Woman's Hospital Medical College,
Chicago; one of the Attending Physicians to the Presbyterian
Hospital, Chicago, Ill.

MILES, FRANCIS T., M.D.,

Professor of Physiology and Clinical Professor of Diseases of

the Nervous System, University of Maryland, Baltimore.
MILLS, CHARLES K., A.M., M.D.,

Professor of Diseases of the Mind and Nervous System in the

Philadelphia Polyclinic and College for Graduates in Medicine;
Lecturer on Mental Diseases in the University of Pennsylvania;
Neurologist to the Philadelphia Hospital.

MINOT, FRANCIS, M.D.,

Hersey Professor of the Theory and Practice of Physic in

Harvard University; Physician to Massachusetts General
Hospital.

MITCHELL, S. WEIR, M.D.,

Member of the National Academy of Sciences; President of the

College of Physicians of Philadelphia.

PUTNAM, JAMES J., A.B. (Harv.), M.D. (Harv.),

Physician to Out-patients at the Massachusetts General

Hospital; Clinical Instructor at Harvard Medical College.

SCHMIDT, H. D., M.D.,

Pathologist to the Charity Hospital of New Orleans.

SEGUIN, EDWARD C., M.D.,

Clinical Professor of Diseases of the Mind and Nervous System

in the College of Physicians and Surgeons, New York City.

SINKLER, WHARTON, M.D.,

Physician to the Philadelphia Orthopædic Hospital, and

Infirmary for Nervous Diseases.

SPITZKA, E. C., M.D.,

 Consulting Neurologist to the North-eastern Dispensary, and
Physician to the Department for Nervous Diseases of the
German Poliklinik.

STARR, M. ALLEN, M.D., PH.D.,

Professor of Diseases of the Mind and Nervous System, New

York Polyclinic; Attending Physician to Department of Nervous
Diseases, Demilt Dispensary.

WILSON, JAMES C., A.M., M.D.,

Physician to the Philadelphia Hospital, and to the Hospital of the

Jefferson College; President of the Pathological Society of
Philadelphia.

WOOD, HORATIO C., M.D., LL.D.,

Clinical Professor of Diseases of the Nervous System and

Professor of Materia Medica and Therapeutics in the University
of Pennsylvania; Neurologist to the Philadelphia Hospital;
Member of the National Academy of Sciences.
 ILLUSTRATIONS.

FIGURE
1.DIAGRAM SHOWING THE ARC FOR REFLEX ACTION
2.DIAGRAM AND TABLE SHOWING THE APPROXIMATE RELATION TO THE
SPINAL NERVES OF THE VARIOUS SENSORY AND REFLEX FUNCTIONS OF
THE SPINAL CORD
3.CONTRACTION OF NORMAL ABDUCTOR INDICIS WITH STRONG CURRENT
(AMIDON)
4.CONTRACTION OF PARALYED MUSCLE ON THIRTY-FIRST DAY OF BELL'S
PALSY OF THE FACE (AMIDON)
5.DIAGRAM OF A TRANSVERSE SECTION OF THE SPINAL CORD THROUGH
THE CERVICAL ENLARGEMENT
6.DIAGRAM OF A TRANSVERSE SECTION OF THE SPINAL CORD THROUGH
THE LUMBAR ENLARGEMENT
7.HORIZONTAL SECTION THROUGH THE CENTRE OF THE RIGHT CEREBRAL
HEMISPHERE
8.DIAGRAM OF VISUAL PATHS, DESIGNED TO ILLUSTRATE SPECIALLY LEFT
LATERAL HEMIANOPSIA FROM ANY LESION
9.LONGITUDINAL (SAGITTAL) SECTION THROUGH THE BRAIN, TO SHOW THE
DISTRIBUTION OF THE FASCICULI OF THE INTERNAL CAPSULE
10.DIAGRAM OF THE LATERAL ASPECT OF THE CEREBRAL HEMISPHERE
11.DIAGRAM OF THE MESAL ASPECT OF THE CEREBRAL HEMISPHERE
12.TOPOGRAPHICAL LINES APPLIED TO THE EXTERNAL CONTOUR OF THE
HEAD
13.TOPOGRAPHICAL LINES APPLIED TO HENLE'S FIGURE OF THE SKULL
14.THE SAME TOPOGRAPHICAL LINES APPLIED TO THE LEFT CEREBRAL
HEMISPHERE IN HENLE'S SKULL
15.SPECIMENS OF HANDWRITING IN TWO CASES OF GENERAL PARALYSIS
 OF THE INSANE
16.FEET OF A PATIENT WITH ACUTE MYELITIS
17.FEET OF A PATIENT WITH HYSTERICAL PARAPLEGIA
18.POSITION ASSUMED BY A HYSTERO-EPILEPTIC
19.POSITION OF CRUCIFIXION ASSUMED BY A HYSTERO-EPILEPTIC (SAME
CASE AS FIG. 18)
20.POSITION ASSUMED BY A HYSTERO-EPILEPTIC (SAME CASE AS FIG. 18)
21.EXTREME OPISTHOTONOS IN A HYSTERO-EPILEPTIC (SAME CASE AS FIG.
18)
22.PRINCIPAL HYSTEROGENIC ZONES, ANTERIOR SURFACE OF THE BODY
(AFTER RICHER)
23.PRINCIPAL HYSTEROGENIC ZONES, POSTERIOR SURFACE OF THE BODY
(AFTER RICHER)
24.POSITION ASSUMED BY A HYSTERO-EPILEPTIC
25.OPISTHOTONOS OF TETANUS
26.CASE OF ATHETOSIS
27.LOWER FACE OF RIGHT HEMISPHERE
28.MOVEMENTS OF WRIST IN TELEGRAPHING)
29.METHOD OF WRITING ADOPTED BY A PATIENT WHO HAS MARKED SPASM
OF FLEXORS OF FINGERS AND THUMB
30.TEMPERATURE CHART OF A CASE OF TUBERCULAR MENINGITIS IN A
BOY EIGHT YEARS OLD
31.TRANS-SECTION OF UPPER LUMBAR CORD OF A PATIENT MODERATELY
ADVANCED IN TABES DORSALIS
32.CHANGES IN THE CORD IN A CASE OF DIFFUSE SPINAL SCLEROSIS
33.CHANGES IN THE CELLS OF THE ANTERIOR HORN IN DIFFUSE SPINAL
SCLEROSIS (SAME CASE AS FIG. 32)
34.SECONDARY DEGENERATION OF INTEROLIVARY LAYER
35.SECONDARY DEGENERATION OF INTEROLIVARY LAYER, CAUDAL OR
DESCENDING PORTION
36.DECUSSATING DEGENERATION OF INTEROLIVARY LAYER
37.TEMPERATURE CHART OF A CASE OF CEREBRAL HEMORRHAGE
38.TEMPERATURE CHART OF A RAPID CASE OF CEREBRAL HEMORRHAGE
39.CHART SHOWING THE EXCESS OF TEMPERATURE IN A CASE OF
MENINGEAL HEMORRHAGE