The disease has also to the writer's knowledge been mistaken for hysteria, but in none of the cases was any spasmodic condition of the muscles observed which could be attributed to hysteria.

March 28th, 1866, with
The legs were also para-

'CASE 1.—A man, æt. 41, was seen paralysis of the extensors of the hands. lysed. He was a large corpulent man and had been of intemperate habits. Two months before admission into the hospital he had suffered from pains in the limbs attributed to rheumatism. There was no evidence of rheumatism nor of lead poison.

He improved slightly, but for a short time, under the bichloride of mercury. He was sent out incurable.

CASE 2.-A woman, æt. 46, was admitted with a history of four weeks' illness. She suffered from paralysis of the extensors of the hands and from paralysis of the legs: it was not then discovered whether the extensors only were affected. This woman had been lately very intemperate; various remedies were tried, but she was sent out in four months incurable.

CASE 3.- A woman, æt. 38, was admitted in a very nervous condition from delirium tremens. After she had been in the hospital three weeks, it was observed that she was losing the power of grasping; subsequently the hands dropped and the feet became affected in the same way.

No lead hue could be detected about the gums.

This patient was also sent out incurable. In this case there was considerable hyperesthesia, and the patient would cry out when touched.

CASE 4.-A woman, æt. 40, was admitted in 1846, with paralysis of the extensors of the hands; no history of lead poison, nor was there any hue round the gums. She was subsequently seized with a succession of epileptic fits, in which condition she died. The brain was found to be anæmic and wet.

The spinal cord was (apparently) not examined.

CASE 5.-A woman, æt. 32, was admitted with paralysis of the extensors of the feet of seven weeks' duration. The woman had

for three months been drinking intemperately through grief at the loss of a child. There was in this case commencing paralysis of the extensors of the hands. No signs of lead detected. She improved slightly under treatment.

CASE 6. A girl, æt. 19, of very intemperate habits, was admitted with well-marked paralysis of the extensors of the hands and feet. The extensors of the hands had been paralysed five months, those of the feet for a much shorter period.

She was seized with epileptic convulsions three days after admission and died.

At the necropsy, the abdominal viscera were found perfectly healthy. The brain was anæmic and wet; the spinal cord was softened in two places; the softening might have been covered in each instance with a threepenny piece, and was found opposite the sixth cervical and twelfth dorsal vertebræ.

The posterior columns were the parts diseased. The musculospiral and peroneal nerves were much attenuated.

The extensor muscles were in a very early stage of fatty degeneration.

VIII. Description of the Spinal Cord in a case of Traumatic Tetanus. By WILLIAM HOWSHIP DICKINSON, M.D., F.R.C.P., Assistant-Physician to St. George's Hospital, and to the Hospital for Sick Children. (Received June 9th, 1868.)

(Abstract.)

A man, æt. 25, died in St. George's Hospital of tetanus, the result of a spike wound in the left hand. The tetanic symptoms were very violent, and produced death in eighteen hours and a half.

At the post-mortem examination there was nothing requiring especial remark excepting the condition of the spinal cord. This

structure was intensely injected throughout, and presented three remarkable swellings upon its surface. An oval swelling about the size and shape of a split bean lay on the right side of the cervical enlargement between the roots of the nerves. A much larger tumefaction lay upon the posterior aspect of the cord in the lumbar region, causing the width of the cord in this situation to be nearly double what it ought. This swelling was about an inch in length and involved both sides of the cord. About half way between this enlargement and the lower end of the cord was a small hemispherical prominence which lay on the left posterior column. These swellings all presented the same colour and texture as the adjoining part of the cord.

A microscopic examination showed profound alterations which corresponded with the superficial tumefactions. The morbid changes were, first, a general intense injection of the cord, with dilatation of the blood-vessels, in the grey matter more than the white, and in the left posterior horn more than in the rest of the grey matter. Secondly, a structurėless transparent exudation had been poured out around the blood-vessels in many situations, and by its forcible intrusion into the tissue had torn the cord in many situations, and had been the chief cause of the extended swellings by the displacement it occasioned. Thirdly, there were certain circumscribed changes in the white columns. The cord was described in detail, following the changes from above downwards, and showing that the swellings in the cervical and upper lumbar regions were chiefly due to exudations in the grey matter; in the lower lumbar region to an exudation of the same sort in the left posterior column. It was surmised, in conclusion, that a change in the innervation of the blood-vessels had led to their distension, and formed the first tangible departure from the natural state, while the exudations described had resulted from a consequent forcible extrusion of the fluid portion of their contents. Further changes in the nervous elements were attributed to a solvent or disintegrating action resulting from the contact of the effused material. It was shown that the morbid changes were developed almost equally along the whole length of the cord, and that they were manifested in the anterior and central parts of the grey matter on the side opposite to the original injury, in the

postero-lateral white columns chiefly on the side from which the irritation has originated.

The changes described were illustrated by drawings.

At the conclusion of the meeting Mr. John D. Hill exhibited two patients, one a man, æt. 34, on whom excision of the knee-joint, for inflammation of the head of the tibia and rectangular ankylosis of the joint, had been successfully performed; and the other, a successful case of excision of the greater part of the ankle-joint for disease in a lad aged five years.

PROCEEDINGS

OF

THE ROYAL

MEDICAL AND CHIRURGICAL SOCIETY

OF LONDON.

November 10, 1868.

SAMUEL SOLLY, F.R.S., President, in the Chair.

Present-66 Fellows and 14 visitors.

Books were presented to the Library by Dr. Anstie, Dr. Billing, Dr. Wilson Fox, Sir Duncan Gibb, the late Dr. Hillier, Dr. Murchison, Dr. Hyde Salter, and Dr. Sieveking; Dr. H. W. Acland, Dr. Philipson, and Dr. Radford; Mr. White Cooper, Mr. Erichsen, Mr. Gay, Mr. Christopher Heath, and Mr. Francis Mason; Mr. Lockhart Clarke, Mr. Oakley Coles, and the literary Executors of the late Mr. J. P. Catlow; Mons. Ducellier, Dr. Gesellius, Dr. Hannover, Professor Polli, and Dr. E. Reich; from the Royal Society, the Linnean Society, the Clinical Society, and the Zoological Society, the Royal College of Surgeons, the Hospital Staff of St. Bartholomew's, the Secretary of State for India,

VOL. VI.NO. III.

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