Series of clinical cases (with observations) illustrating the views recently put forward by Dr. Brown-Séquard, as regards certain points connected with the physiology of the nervous system / by John W. Ogle, M.D.

  • Ogle, John W. (John William), 1824-1905.
Date:
[©1859?]
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Licence: Public Domain Mark

Credit: Series of clinical cases (with observations) illustrating the views recently put forward by Dr. Brown-Séquard, as regards certain points connected with the physiology of the nervous system / by John W. Ogle, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    from the trunk or limbs along the entire length of the cord, their number must be very inconsiderable. (c) That the fibres conveying sensitive impressions to the brain do not at any rate decussate at a point higher up in the cerebro-spinal axis than the pons Varolii. (cl) That the decussation of fibres conveying sensitive impressions must be of necessity not only at a part below the level of the upper margin or central part of the pons Varolii, but even for the most part, if not entirely, below the medulla oblongata itself. That is to say, this crossing or interlacement of sensory nerves must take place in the spinal cord itself, and that not in any particular spot, but in every portion of the cord almost immediately after the entrance therein of the afferent fibres. (e) That all the motor or efferent fibres decussate at a distinct point immediately below the pons Varolii—that is to say, at the anterior pyramids and the neighbouring parts, contrary to the views of Valentin, Cruveilhier, Longet, Foville, &c. Having thus enumerated in a succinct manner the various physiolo- gical positions which I purpose to illustrate and strengthen in this pathological communication, I will, without further circumstance or digression, proceed to narrate my cases, the true interpretation of which at the time of their occurrence, and upon the old theories then com- monly in acceptance, could obviously not have been apparent. Case I.—Dislocation of some of the vertebra, and projection of lone into the anterior surface of the spinal cord, the posterior columns remaining entire; perfect loss of sensibility and power of movement in the lower limbs. History.—P. S , aged sixty-two, was brought into St. George's Hos- pital, having fallen a height of eleven feet, and received a scalp wound. He was for ten minutes stunned by the fall, but after admission walked into the ward, complaining only of pain at the neck. He had a slight cough. Nothing fresh was complained of until three days afterwards, when he felt numbness in the legs and tottered in walking. Sensibility of the skin to pinching and pricking was everywhere perfect. Seven days after the accident he had to such a degree lost power in the legs, that he scarcely was able to move them; still, sensibility of the skiu remained as before. The bowels were con- stipated, and the catheter had to be used, the urine, too, becoming purulent. Stiffness also of the aras came on, and nine days after the accident lie could with difficulty move them; they were also much flexed. All power also of voluntary movement below the diaphragm had disappeared. Eleven days after the accident the soft parts over the larger trochanter of the right femur began •to slough, and two days later his cough was attended by dyspnoea. On the thirty-second day after the accident all sensibility of the skin, as well as all power of movement in the legs, was found to be lost: the respiration was chiefly abdominal. After some difficulty in swallowing, the patienl died. Post-mortem examination.—Dislocation forwards of the sixth cervical verte- bra was found to exist, so that the body of the seventh vertebra projected for at least half an incli into the spinal canal behind. The dura mater opposite the sixth and seventh cervical vertebra: was thickened, and a slight amount of recently-formed soft fibrin existed at this spot between the bone and the theca