THE

LONDON LANCET.

A JOURNAL OF

BRITISH AND FOREIGN MEDICAL,

SURGICAL AND CHEMICAL SCIENCE,

CRITICISM, LITERATURE AND NEWS.

FOR THE YEAR 1869.

EDITED BY

JAMES G. WAKLEY, M.D., M. R. C. S.

New York:

1869.

THE LANCET.

3 Journal of British and Foreign Medicine, Physiology, Surgery, Chemistry, Criticism, Literature, and News.

J. HENRY BENNET, M.D., T. WAKLEY, JR., M.R.C.S.E. EDITORS.

PUBLISHED MONTHLY.

NEW YORK, JANUARY, 1869.

No. 1.

Lectures

ON THE

complete hemiplegia from disease of the spinal cord, although existing in those cases, have attracted no attention. On the other hand, some cases of genuine and complete spinal hemiplegia have been published by writers who have not un

PHYSIOLOGY AND PATHOLOGY OF derstood what was the signification and impor

THE NERVOUS SYSTEM.

AND ON THE

TREATMENT OF ORGANIC NERVOUS
AFFECTIONS.

BY C. E. BROWN-SEQUARD, M.D., F.R.S.,
Fellow of the Royal College of Physicians of London;
Member of the National Academy of Science (U. 8.) Etc.

LECTURE I.

ON SPINAL HEMIPLEGIA.

Characteristic symptoms of spinal hemiplegia.Cases of wound and other kinds of lesion of the spinal cord having produced in the limbs, the face, and the eye the paralytic, anæsthetic, hyperaesthetic, and the principal vaso-motor symptoms of spinal hemiplegia.-Cases of incomplete spinal hemiplegia. Comparison of spinal with cerebral hemiplegia.-Treatment of spinal hemiplegia.

GENTLEMEN,-It is my intention to give in this first lecture a full history of a very interesting, but very little known, kind of paralysis. You would vainly look for an account of the curious and peculiar symptoms of this affection in the works of even the best writers on the physiology and disease of the nervous system. I must say, however, that Dr. R. Bright* and Dr. Todd† have spoken of spinal hemiplegia, but no mention is made by them of the peculiar features of that affection, either because the cases they have seen were of the kind which I will describe hereafter under the name of incomplete spinal hemiplegia, or because the characteristic symptoms of the

Reports of Medical Cases, vol. ii., part i.

+ Clinical Lectures on Paralysis, &c., by Dr. R. B. Todd, 1851, p. 321 et seq. Two cases are given, but one of them, as I will show in another lecture, was a case of reflex hemiplegia, followed by paraplegia.

tance of the symptoms they have described. Such is a remarkable case published by Dr. Dundas, and to which I shall revert by-and-by.

Experiments on animals have led me to the discovery of the very striking and curious features of the complete spinal hemiplegia. I gave for the first time a description of these symptoms in the lectures I delivered, in 1858, at St. Bartholomew's Hospital and at the College of Surgeons.* At that time, however, I had only observed them in animals; but since then I have seen no less than twenty cases of complete spinal hemiplegia, or of a similar affection, which I will describe under the name of hemi-paraplegia. Both these affections are certainly rare, and I owe the good chance I have had of observing many cases to my efforts in hunting for them, and to the kind assistance of medical friends and pupils.†

I hardly need to say that spinal hemiplegia is the effect of a disease of, or an injury to, a lateral half of the spinal cord. The principal symptoms are, paralysis of voluntary movements and hyperæsthesia on one side (the side of the lesion), and anesthesia on the other side. But, besides these characteristic features, others are also observed, which are perhaps no less remarkable, amongst which I will only point out now symptoms of paralysis of the vaso-motor nerves in the limbs, the face and the eye.

The explanation of the symptoms of spinal hemiplegia is extremely simple and easy. Experiments on animals and a great many clinical facts show that an injury, destroying a small zone, or dividing the whole lateral half, of the spinal cord in the cervical region, produces the following symptoms:

See my Course of Lectures on the Physiology and Pathology of the Central Nervous System. 1860. Lectures III., VII., and XII.

+ Some interesting cases in support of my views have been reported by friends of mine, amongst whom I will name Dr. C. B. Radcliffe, Dr. J. Hughlings Jackson, and Dr. Victor Bazire. In one of his valuable lectures on Hemiplegia, Dr. Hughlings Jackson has called attention to this subject. (See the London Hospital Reports, vol ii. 1865, p. 299.)