PLATE I.

FIG. 1.-A vascular fibro-nuclear tumour growing from the inner surface of the dura mater on the anterior part of the cord in the upper part of the dorsal region: the cord pushed backwards and compressed (Case 2, p. 170).

FIG. 2.-A vascular fibro-plastic tumour, situate on the posterior surface of the cord in the lower part of the dorsal region under the close arachnoid (Case 3, p. 172).

FIGS. 3-6.-Sections of the cord in Case 15, p. 199, showing the enlargement (6) in the cervical region from the development of a soft vascular nuclear growth in the grey matter. The sections 5, 4, 3, are intended to show the same in a less degree in the other parts of the cord lower down.

CASES OF PARAPLEGIA.1

(SECOND SERIES.)

THE following cases of paraplegia, with those in the Reports for 1856, though a miscellaneous contribution, may perhaps serve for reference in the absence of a more systematic treatise on the subject.

The labours of Lockhart Clarke and Lenhossék, on the minute structure of the nervous centres in health, cannot fail to give a new impulse to a more exact knowledge of the pathological changes to which they are subject. Something in this direction has been attempted. Those who are acquainted with the results of minute anatomy, as applied to the cord, will admit that we may now hope for an exhaustive morbid anatomy of it, exhaustive, at least, so far as to enable us to determine the state of the ultimate tissue.

Case 17 goes far to establish an important point in the pathology of paraplegia, namely, that the spinal centres may be paralysed without anatomical change of their structure. If this were certain it could not fail to give a new direction to our inquiries, and lead us with more earnestness to investigate the nervous substance by other means than the microscope. Dr. Sankey's observation on the variable specific gravity of the brain, lets in some light in this direcIt is from an increased knowledge of "atomical," as distinguished from "anatomical" conditions, that we may hope for future advances in nervous pathology.

tion.

Case 18 presents a not uncommon history of chronic inflammatory degeneration of the columns of the cord almost Reprinted from the 'Guy's Hospital Reports,' 1858, p. 169.

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latent up to a certain point, and then accompanied by a sudden aggravation of the symptoms. It may offer an occasion to remark that in diseases of the nerve-substance, acuteness of effects is no evidence of acuteness of the lesion

producing them. In the brain this is notoriously true, for every one knows that a sudden hemiplegia may result from local changes of the slowest and most passive kind. The same occasionally occurs in the cord. The bearing of this on diagnosis and treatment is obvious.

Case 19 is a remarkable instance of the limitation of disease to the posterior columns. The lesion was of the same character as in the preceding case. The symptoms confirm the theory of Dr. Todd that the posterior columns are the channels through which the voluntary movements are co-ordinated. In this case there was not paralysis, but a want of controlling power. There was only a slight affection of sensation, proving also that the posterior columns are not mainly subservient to the sensory function.

Case 20 presented at the bedside a rare symptom in paraplegia, namely, paralysis of both seventh nerves. This prevented the pronunciation of the labial parts of speech, and led to a suspicion of brain disease until the kind of defect was pointed out. This accident was explained by the

condition of the medulla oblongata.

As it has been just remarked, on the one hand, that the character of a lesion of the nervous substance is not to be inferred from the acuteness of the symptoms in respect to their development in time, so it may be added, on the other, that the amount of the lesion is not necessarily in proportion to the gravity of the symptoms. A very small amount of anatomical disease, or, as we seem to have proved in Case 17, not enough to be recognised, may produce fatal effects. The degree of positive lesion was appreciable in this case, but it was in amount trifling. It was its seat which gave it its importance. It is in the treatment that we need to bear these truths in mind, as no doubt there is a proneness in the mind, as before said, to estimate the activity and violence of a disease by the rapid development and danger of the symptoms, and, consequently, to aggravate it by too heroical interference.