Cases of paraplegia / by T. Grainger Stewart.

  • Stewart Thomas Grainger, Sir, 1837-1900.
Date:
1876
Catalogue details

Licence: Public Domain Mark

Credit: Cases of paraplegia / by T. Grainger Stewart. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    localized as to involve only a single column or a lateral half of the organ; and that when this is the case corresponding varieties of symptoms are manifested. Now, during the first period of his residence in the Infirmary, our patient had, as has been shown, merely pressure upon the cord. This was made evident by his comparative freedom from palsy when lying down, the rapid increase of the palsy when he assumed the upright position, and the relief experienced whenever the weight of the shoulders and head was taken off the spine; and the gradual advance of the symptoms indicated that neither the bursting of an abscess nor partial dislocation, rendered possible by destruction of bone, could be regarded as the cause; while all the facts corre- sponded with the phenomena which should result from the pres- sure of a sort of bag of disintegrated tissue, representing the bodies of the vertebrte. The result of treatment was arrest of the progress of disease of the bone, anchylosis of the affected vertebrae, and complete relief from pressure on the cord. But during the second period of his residence in the Infirmary, it was no longer possible to ascribe the symptoms to simple pressure. It is admitted, indeed, that such a paralysis may arise from mere pressure ; but, considering, on the one hand, that change of attitude made no difference, the patient being as completely paralyzed in the recumbent as in the erect position, and, on the other, the long duration and intensity of the paralysis, we are warranted in believ- ing that chronic inflammatory changes had occurred in the sub- stance of the cord itself; whilst the distribution of the symptoms, paralysis of motion on one side, with loss of sensibility on the other, indicated an affection of one half of the cord, involving both the antero-lateral and posterior columns. Assuming the correctness of this view, there are three points of considerable physiological interest to which I would direct attention, viz.:— 1. The confirmation which the case afforded of the discovery of Brown-S<$quard,' that while the motor fibres decussate in the upper part of the spinal cord, the sensory fibres decussate near their point of entrance into tlie cord, so that section of one lateral half of tlie cord induces motor paralysis on that side, sensory on the other. 2. The confirmation of Brown-Sdquard's statement, that while the fibres for touch, temperature, tickling, and pain, decussate near their point of entrance, tliose for the muscular sense do so at the upper part of the cord. The muscular sense, it will be remembered, was lost on the side which had tlie motor paralysis—not the sensory. 3. The confirmation of Brown-Se'quard's observation, that section or injury of one lateral half of the cord at the level of the tenth dorsal vertebra leads to hypergesthesia on the side on which motor ' Brown-S6quard, Journal de la Physiologie de rHomme et des Aiiimaux, Jan., Apr., and Oct. 1863. Radcliff, Lancet, 27tli May 1865.