1st. Paralysis of the voluntary motor conductors on the same side. 2nd. A paralysis also of the vaso-motor conductors on the same side, and, as a consequence, a greater afflux of blood and a higher temperature. 3rd. Hyperæsthesia--i.e., increased sensibility in the paralysed parts, owing, in great measure at least, to the vaso-motor paralysis.

4th. The well-known effects of division of the cervical sympathetic nerve in the eye and face on the side of that section, owing to the paralysis of the nerve-fibres which the spinal cord gives to that nerve through the first and second dorsal nerves. 5th. There is anesthesia of all kinds of sensibility, excepting the muscular sense, in the side opposite to that of the lesion in the spinal cord, owing to the fact that the conductors of sensitive impressions from the trunk and limbs decussate in the spinal cord, so that an injury in the cervical region of that organ in the right side, for instance, alters or destroys the conductors from the left side of the body.

6th. There is some degree of anesthesia also on the side of the lesion, in a very limited zone, above the hyperæsthetic parts, and indicating the level of the lesion in the cord. This anesthesia is due to the fact that the conductors of sensitive impressions reaching the cord through the posterior roots, at the level or a little below the seat of the alteration, have to pass through the altered part to reach the other side of the cord.

Some differences in the symptoms will of course exist, according to the extent and seat of the lesion in the spinal cord, and to its duration at the time we examine the patients. I intend to confine myself in this lecture to the properly called spinal hemiplegia-i.e., a paralysis of both limbs on one side, caused by a lesion in the cervical part of the cord; leaving for the next lecture the history of hemi-paraplegia-i.e., a paralysis of only one of the lower limbs, and caused by lesion in the dorsal or lumbar parts of the cord.

The following table shows at a glance what are the symptoms observed in the two sides of the body, when the disease of, or injury to, the spinal cord exists high up in one of the lateral halves of the cervico-brachial enlargement:

These symptoms may be summed up thus:-On the side of the lesion in the cord there is— Paralysis of voluntary movement, of the muscular sense, and of blood vessels; Increased sensibility in the trunk and limbs, except, sometimes, in a part of the arm, chest, or neck, where there may be some anæsthesia; and

Symptoms of vaso-motor paralysis in the limbs, the face, and the eye. While on the other side there isAnæsthesia in both limbs; and No paralysis.

To sum up still more, I will say that spinal hemiplegia (when complete) is characterised by loss of voluntary movements in one side of the body, and loss of sensibility in the other.

It is not necessary, I believe, to point out the differences between the complete spinal hemiplegia and cerebral spinal hemiplegia. Those differences are sufficiently striking; but in speaking of incomplete spinal hemiplegia I will revert to this diagnosis.

I will now give a number of cases, beginning with several observed by myself.

CASE 1. Wound of the spinal cord: paralysis of voluntary movement in the right limbs; hyperaesthesia of the four kinds of sensibility in the right lower limb, with anesthesia of the same kinds of feeling in the left limbs, and signs of vaso-motor paralysis in the face and eye on the right side.— Mr. F aged thirty-five, captain of a merchant vessel, was stabbed in the neck, in the harbor of San Francisco, California, on the 19th of October, 1853. He lost his senses instantly, and fell. He bled profusely, but someone soon succeeded in stopping the hæmorrhage by pressing on the wound. He remained unconscious from the time

he received the stab (about 8 P.M.) until the next morning. During the night he was a little delirous and feverish, but since then he has had no fever or cerebral symptoms. On recovering his senses he found that he was completely paralysed in both limbs on the right side, and that the left side was also partly paralysed. Sensibility, instead of being lost in the completely paraly sed side, was so much increased that he could not lie on that side (the right) owing to the pain caused by the pressure on the bed. The sight, hearing, and other senses were unaffected; his speech was not impaired, he could swallow without any difficulty, and move freely all the muscles of the eyes and face. His breathing was not disturbed, but his pulse was weak and slow. He had no vomiting, and no decided incontinence of fæces or urine, but he had to hasten to pass his water when the need was felt. He remained several days in this condition, being all the time very weak, and often alınost in a syncopal state, yet always perfectly conscious, except on one occasion, when, having been much moved at seeing a friend, he completely fainted away for a few minutes. For two or three months he was absolutely unable to turn in bed, and it was only at the end of four months that he began to stand, for a few moments, on his left leg. The wound did not give him much pain, and soon healed, and the movements of the head and neck became quite free after this healing. Symptoms of slight inflammation, or at least great congestion, of a part of the right half of the spinal cord -such as twitchings, jerkings, and tremblings, with a feeling of pricking and other painful sensations in the paralysed limbs-soon appeared after the injury, and still occur now. Gradually, but very slowly, he improved, and was in the following condition when I first saw him.

In August, 1862, he came to me, recommended by Mr. Jabez Hogg. His general health was pretty good. There was nothing abnormal in the head and face except what will be hereafter mentioned. The wound has left a scar a little more than one inch in length, longitudinal and almost parallel to the middle line of the spine, to the left of it at a distance of about three inches from it, and distant from the front middle line about five inches, having its top part about an inch and a half behind the lower part of the left ear. Hle had become able to walk with the help of a cane, although the right limbs were still notably paralysed and stiff. The left limbs had for a long while recovered completely the power of motion. Comparing the two lower extremities one with the other, I found that the right (the paralysed one) had a morbidly increased sensibility (hyperesthesia), while the left had a considerable degree of anesthesia. Studying the various kinds of sensibility, I ascertained the following facts:

1st. The tactile sensibility was increased in most parts of the paralysed limb, and considerably decreased in every part of the other, as proved by these observations.

Left, or non-paralysed Right, or paralysed leg. Left, or non-paralysed leg.

The application of the æsthesiometer gives

the sensation of the two points when at a distance of 2 or 3 milli

This application only gives the sensation of one point, on the big toe, even when the points are, as far as they

metres on the dorsal surface of the big toe.

On the dorsum of the foot the two points are felt at a distance of from 23 to 2 centimetres.

On the sole of the foot the two points are felt at a distance of 4 centimetres.

On the front part of the leg both points were felt when separated by from 12 to 13 millimetres.

On the posterior aspect of the leg both points were felt at a distance of 14 to 16 millimetres.

can be, one from the other.

On that part, even at the distance of 7 centimetres, the two points only give the sensation of one.

Only one point felt, even when the two are 12 centimetres one from the other.

Here only one point felt, even when the interval between the two was 13 centimetres.

Here always but one point, even when the two were 12 or 13 centimetres one from the other.

For his feeling one point on the left leg it was neeessary to press very hard, while he was able to distinguish the two points even when they touched but very slightly the paralysed leg. The faculty of recognising the shape of bodies applied on the legs was quite lost in the left leg, and perfect, on the contrary, in the right or the paralysed leg.

2nd. The feeling of tickling was considerably increased in the right or paralysed lower extremity, while it was completely lost in the nonparalysed one.

3rd. The sense of temperature (the power of feeling heat and cold) was considerably increased in the right or paralysed lower limb, and lost in the left, which has accidentally been burnt sometimes without his feeling the burn.

4th. There was considerable hyperesthesia as regards the painful sensations of pricking and pinching in the right or paralysed lower extremity while there was almost a complete analgesia in the left or non-paralysed leg.

5th The faculty of recognising the place on which was made a sensitive impression of any kind was perfect in the right or paralysed leg, while it was lost in the whole length of the left lower limb.

6th. The power of directing movements, which depends on the muscular sense, was markedly altered in the paralysed lower limb, while it was perfect in the non-paralysed one.

With regard to the condition of nutrition and of animal heat in the two lower extremities, I found: (1) that, although the paralysis had existed for nine years, the atrophy of the right lim. b was not very great-the calf of the leg on that side had a circumference of 31 centimetres, while that of the non-paralysed leg was 35 centimetres; (2) that, notwithstanding its atrophy, the paralysed leg was apparently warmer than the other (between the toes the thermometer marked 10 cent. (1-80 Falır.) more in the paralysed than in the other side); (3) that the blood vessels were larger and more numerous in the paralysed leg than in the other; (4) that the cutaneous perspiration was more abundant in the paralysed leg than in the other; (5) that the nails were normal in the paralysed lower extremity, while in the other one (the anesthetic) they were extremely thick, and presented many parallel longitudinal splits, besides being very loosely attached to the skin.

Passing now to the upper limbs, I found that they offered the following differences:

1st. The right limb was still notably paralysed and contracted;* while the left was strong and perfectly normal as regards voluntary movements. 2nd. The tactile sensibility was altered in both limbs. On the right side the back of the hand gave the sensation of the two points of the æsthesiometer when at a distance of 2 centimetres, while on the left it was only at 9 centimetres that they were both felt. In the palm of the hand the two points were recognised at the distance of 6 or 7 millimetres on the right side, and 10 to 12 millimetres on the left. On the forearm, in its front part, the limit of recognition of two points was 23 centim. in the right side, and 2 in the left. In the back part of the forearm the limit was 1 centin. in both sides. Both arms, from the elbow to the shoulder, were so anæsthetic that it was necessary to press hard to make the points be felt at all, and it was only when they were at 12 centim. that the two were felt. The faculty of recognising the shape of bodies was diminished in both hands, and especially in the index and thumb of the right and in the other fingers of the left hand. In the fingers of both hands he did not recognise the two points of the æsthesiometer even at a distance of 4 centim. The knowledge of the place touched was diminished in both arms, but much more in the left one.

3rd. As regards the feeling of tickling, several parts of the upper limb on the right side were endowed with it to a greater degree than usual. Not so with the left arm, which was almost entirely deprived of that kind of feeling.

4th. The sense of temperature was increased in the right arm, and almost completely lost in the left upper limb-so much so that he has sometimes been burnt without feeling it at all.

5th. The sensibility to pricking and pinching was increased in the right limb, while in the left the anaesthesia to painful sensations is such that he once accidentally had nails stuck into his fingers without being aware of it till he felt a resistance when he tried to withdraw his hand.

6th. The muscular sense was very much altered in the right limb (the paralysed one), and perfect in the left.

7th. There was some atrophy of the muscles of the right limb, the forearm there measuring 24 centimetres, while the left forearın had a circumference of 25 centimetres.

8th. There was more blood in the right limb than in the other, and its temperature was also superior by from 10 to 20 cent. (108 to 30-6 Fahr.) Besides, the right arm perspired more freely than the left. The nails of the left hand were altered, but less than those of the left foot.

Examining the eyes and face, I found the following differences between the two sides:

1st. The eyelids were less opened on the right

side than on the left.

2nd. Both pupils were constricted; but his sight was not so good with the right as with the left eye.

3rd. The lachrymal secretion was more abundant in the right side than in the other.

4th. He had frequent headaches, limited to the right side.

5th. Several muscles cf the face were slightly contracted on the right side; so that the angle of

A few years before I first saw him there was such a spasmodic contraction of the calf of the right leg that Mr. Lonsdale divided the tendo Achillis.

the mouth was nearer the ear and the eye on that side than on the other.

6th. The sensibility of the face was very slightly increased on both sides, but more on the right than the left.

He has very often been seized with a peculiar kind of convulsive attacks, which have occurred sometimes spontaneously; but by far more frequently when he stretched himself in bed. The first of these attacks he had a few weeks after the injury. It began with a spasmodic closure of the jaws, and a tetanic stiffness in the trunk and four limbs; and, after a few seconds, epileptiform convulsions took place in the right limbs, and lasted half a minute. For several years he has had three or four convulsive attacks a week; but the frequency gradually became less, and lately he has had but five or six seizures a month. The violence has become usually very much less also, the attacks consisting only of a cramp, followed by some shaking of the right leg. In stronger attacks, the left limbs still become rigid; while the right ones, and particularly the arm, are seized with clonic convulsions. His attacks only last half a minute.

The muscles of the vertebral column on the right side are weak and somewhat contracted.

Among the referred sensations which are so common in affections of the spinal cord one only has been very troublesome: it is a feeling of burning heat, apparently arising from the index finger of the left hand, which was quite anæsthetic, especially to cold and heat.

He has not had spontaneous pain in the spine, but when I pressed on the fourth and fifth cervical vertebrae 1 found them very tender. The skin, however, was much benumbed over these bones, and there was almost complete anesthesia on the right side, extending a few inches from the middle line at the level of the fourth and fifth cervical vertebræ. Behind the ears there was hyperæsthesia in both sides: he felt the two points of the æsthesiometer when only at 4 millimetres one from the other.

Since I last saw the patient, my able friend, Dr. Hughling Jackson, has had the kindness to examine him again, in September, 1865, and has made out a few facts which deserve to be mentioned: 1st. The right (paralysed) lower limb moves vigorously when the sole of the foot is tickled, but very much less than the other. 2d. Although the muscles of the left (anesthetic) lower limb contract much more than those of the right (paralytic) one, he felt pain when this last limb was galvanised, but not when the other was submitted to the same irritation.* 3rd. The temperature of the right leg, which previously was higher, was found inferior to that of the left. 4th. The patient married in 1864, and he states that his sexual power is not much diminished. The faculty of retaining his water is still some what weak.

Before I examine what took place in this case, I will say that M. F―, the patient, was shown by me to many members of the British Medical Association, at their meeting in London in 1862; and also that he was often shown to the physicians and students attending my clinical lectures at the National Hospital for the Paralysed and Epileptic.

* In these researches Dr. Jackson has had the valuable assistance of Mr. J. N. Radcliffe.

(Fig. 1), which I owe to Dr. J. Hughlings Jackson, representing that knife nearly in its full length. The blade was about six inches long, and has been shortened a few lines by being sharpened. There was blood upon it in all its length except about 1 inch.

It is, of course, impossible to know exactly what was the greatest injury to the spinal cord in this case. The patient is, I believe, still alive, and if an autopsy were made at this late day (the wound was inflicted in October, 1853-i.e., fifteen years ago), it would not reveal what was the lesion which existed at first. But in the actual state of our knowledge, as regards the physiology and pathology of the spinal cord, it is easy to explain inost, if not all, the details of that case. If something must remain doubtful, it is, at any rate, certain that the nervous centre was wounded in the cervical region, and that its two lateral halves were injured, but the right one very much more than the left.

Judging, on the one hand, from the symptoms and on the other hand from the shape of the blade of the knife, from the location of the scar and from the very small angle that would be formed by the line of the scar and a line parallel to the longitudinal axis of the spinal cord the knife must have followed an oblique course from above downwards, from the left to the right, and from behind forwards. It must have divided, or otherwise injured, at least a part of the left side of the spinal cord (the posterior column), and a very large portion of its right half (its grey watter chiefly, but other parts also). Blood effused in the right side of the cord, in the part where the number and size of blood vessels are the greatest-i.e., the grey matter-has produced a pressure which most likely was the cause of the paralysis of the four limbs which existed for some time after the stabbing.

The study of this case leads to the following remarks:

1st. There was fever only for a short time. It is so usually in cases of incised or punctured wounds of the spinal cord.

2nd. As usually also in such cases, there have been only a few symptoms of inflammation of the spinal cord.

3rd. The patient fainted away twice: at first when he was stabbed, and again nine days after. His pulse remained very weak for a long time. A syncopal state (or at least a weak pulse) is not rare after an injury to the spinal cord, in the cervical region, especially in cases in which that nervous centre has been completely or almost completely crushed by a broken piece of bone. In experiments on animals, I have ascertained that crushing or dividing suddenly a good part of the cord, in the cervical region, acts on the heart in the same way as similar injuries to the medulla oblongata. This influence ceases to exist when the experiments are made after the division of the par vagum.

4th. A convulsive affection, resembling that which I produce in certain animals by the section of a lateral half of the spinal cord, soon appeared in the patient after his wound. This must be a very rare effect of an injury to the cord in our species, as I have vainly looked for it in all the cases I know of a punctured or incised wound of that organ, and I have only found one other case of injury to the cord in which there were neral convul

1st. The right limb was still notably paralysed and contracted;* while the left was strong and perfectly normal as regards voluntary movements. 2nd. The tactile sensibility was altered in both limbs. On the right side the back of the hand gave the sensation of the two points of the æsthesiometer when at a distance of 2 centimetres, while on the left it was only at 9 centimetres that they were both felt. In the palm of the hand the two points were recognised at the distance of 6 or 7 millimetres on the right side, and 10 to 12 millimetres on the left. On the forearm, in its front part, the limit of recognition of two points was 2 centim. in the right side, and 24 in the left. In the back part of the forearm the limit was 1 centin. in both sides. Both arms, from the elbow to the shoulder, were so anæsthetic that it was necessary to press hard to make the points be felt at all, and it was only when they were at 12 centim. that the two were felt. The faculty of recognising the shape of bodies was diminished in both hands, and especially in the index and thumb of the right and in the other fingers of the left hand. In the fingers of both hands he did not recognise the two points of the æsthesiometer even at a distance of 4 centim. The knowledge of the place touched was diminished in both arms, but much more in the left one.

3rd. As regards the feeling of tickling, several parts of the upper limb on the right side were endowed with it to a greater degree than usual. Not so with the left arm, which was almost entirely deprived of that kind of feeling.

4th. The sense of temperature was increased in the right arm, and almost completely lost in the left upper limb-so much so that he has sometimes been burnt without feeling it at all.

the mouth was nearer the ear and the eye on that side than on the other.

6th. The sensibility of the face was very slightly increased on both sides, but more on the right than the left.

He has very often been seized with a peculiar kind of convulsive attacks, which have occurred sometimes spontaneously; but by far more frequently when he stretched himself in bed. The first of these attacks he had a few weeks after the injury. It began with a spasinodic closure of the jaws, and a tetanic stiffness in the trunk and four limbs; and, after a few seconds, epileptiform convulsions took place in the right limbs, and lasted half a minute. For several years he has had three or four convulsive attacks a week; but the frequency gradually became less, and lately he has had but five or six seizures a month. The violence has become usually very much less also, the attacks consisting only of a cramp, followed by some shaking of the right leg. In stronger attacks, the left limbs still become rigid; while the right ones, and particularly the arm, are seized with clonic convulsions. Hie attacks only last half a minute.

The muscles of the vertebral column on the right side are weak and somewhat contracted.

Among the referred sensations which are so common in affections of the spinal cord one only has been very troublesome: it is a feeling of burning heat, apparently arising from the index finger of the left hand, which was quite anæsthetic, especially to cold and heat.

6th. The muscular sense was very much altered in the right limb (the paralysed one), and perfect in the left.

7th. There was some atrophy of the muscles of the right limb, the forearm there measuring 24 centimetres, while the left forearm had a circumference of 25 centimetres.

8th. There was more blood in the right limb than in the other, and its temperature was also superior by from 10 to 20 cent. (10-8 to 30-6 Fahr.) Besides, the right arm perspired more freely than the left. The nails of the left hand were altered, but less than those of the left foot.

Examining the eyes and face, I found the following differences between the two sides:

1st. The eyelids were less opened on the right

side than on the left.

2nd. Both pupils were constricted; but his sight was not so good with the right as with the left eye.

points of the æsthesiometer when only at 4 millimetres one from the other.

Since I last saw the patient, my able friend, Dr. Hughling Jackson, has had the kindness to examine him again, in September, 1865, and has made out a few facts which deserve to le mentioned: 1st. The right (paralysed) lower limb moves vigorously when the sole of the foot is tickled, but very much less than the other. 2d. Although the muscles of the left (anesthetic) lower limb contract much more than those of the right (paralytic) one, he felt pain when this last limb was galvanised, but not when the other was submitted to the same irritation.* 3rd. The temperature of the right leg, which previously was higher, was found inferior to that of the left. 4th. The patient married in 1864, and he states that his sexual power is not much diminished. The faculty of retaining his water is still some what weak.

Before I examine what took place in this case, will say that M. F, the patient, was shown by me to many members of the British Medical Association, at their meeting in London in 1862; and also that he was often shown to the physicians and students attending my clinical lectures at the National Hospital for the Paralysed and Epileptic.

In these researches Dr. Jackson has had the valuable assistance of Mr. J. N. Radcliffe.