452 as has been said, upon the effort made in moving the paralysed parts by the non-paralysed muscles just above them. Another objection to this explanation is, that the same feeling which exists around the body exists also, sometimes, around the lower limbs, in myelitis. The most probable mode of production of this strange feeling is, that it is due to some irritation of sensitive nerve-fibres in the spinal canal producing a sensation refeired to the periphery of the body (abdomen, chest, or

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... mbs). 4th. Alterations in the N ut1'ition of Paralysed Pa1.t,. --These alterations chiefly depend upon an irritation of the spinal cord or its nerves. It is principally in myelitis that they are observed. A rapid wasting of the paralysed muscles, the production of bullae or sloughs over the sacrum, the nates, &c., are the most frequent results of an irritation of the vaso-motor or of the other nerves that have an influence upon the nutrition of the lower half of the body. These alterations are not observed in cases of reflex paraplegia, or of non-inflammatory softening of the spinal cord ; neither do they exist in cases of haemorrhage, or of a tumour in the grey matter, unless an inflammation is produced. 5th. Erection of the Penis.-This is another symptom showing an irritation of the spinal cord or its nerves. It exists frequently at night, and sometimes in the daytime, in cases of myelitis or congestion of the spinal meninges. It is also observed, but less frequently, in cases of meningitis, of tumour upon the spinal cord, of haemorrhage in the spinal canal (outside of the cord), and sometimes even in the reflex paraplegia, but then only on the introduction of a catheter or in consequence of some peripheric irritation. This symptom does not exist in cases of non-inflammatory softening, or of haemorrhage or a tumour in the grey matter of the spinal cord. 6th. Temperatue of the Paralysed Lower Limbs.-In those affections in which there is an irritation of the spinal cord or I its membranes (congestion, myelitis, meningitis, pressure on the cord by effused blood, a tumour, or a displaced bone, &c.), the lower limbs, and especially the feet, are almost constantly very cold. This symptom is the consequence of the irritation of the vaso-motor nerves, which produces a contraction of the muscular fibres of bloodvessels, just as the irritation of the nerves of the muscles of the legs, feet, so., produces cramps, twitchings, &c. In the reflex paraplegia the feet are also sometimes very cold, in consequence of a reflex contraction of their bloodvessels. In cases of non-inflammatory softening of the lumbar enlargement of the spinal cord, with a complete destruction of the vital properties of this part, the lower limbs are almost constantly very warm, as a result of the paralysis of the vaso-motor nerves. 7th. Degree and Extent of Paralysis of the Lower Limbs, the Bladder, and the Rectum.-Of course great differences exist as regards the degree and extent of the paralysis, according to the degree and extent of the alterations in the spinal cord. We do not intend entering into any details on this subject. We wish only to say here that-1st, as regards the 1node of appeararace of the paraplegia, if it be sudden it is almost always due to a haemorrhage either in the cord or outside of it; 2nd, as regards the degree of the paralysis, it is equal in all the muscles of the lower limbs if the alteration occupies the whole of the lumbar enlargement or is above it, except in cases of reflex paraplegia, where some muscles may be much more affected than others; 3rd, as regards the changes in the degree and extent of the paralysis, they are rapid and frequent in cases of reflex paraplegia, of chronic meningitis with effnsion, and of spinal congestion, while, on the contrary, they are slow and rare in cases of myelitis, tumours, and non-inflammatory softening; 4th, as regards the paralysis of the bladder and of the rectum, they exist more frequently in cases of myelitis, of non-inflammatory softening or of haemorrhage in the grey matter, than in the reflex paraplegia or in cases of tumour, of congestion, or even meningitis. 8th. Anaesthesia and Hype2-(est7besia. -Myelitis existing most frequently in the grey matter, anxsthesia (the different kinds of it, with the loss of the power of guiding the voluntary movements) is one of the ordinary symptoms of this affection. This symptom is less frequent or less intense in most other cases of paraplegia, except, of course, a haemorrhage in the grey matter. As regards hyperaesthesia— i. e., a morbidly increased insensibility, it is frequent in cases of incomplete paraplegia, when the posterior columns of the spinal cord, in a small part of their length, are destroyed, either by a tumour or by a softening (inflammatory or not). 9th. Reflex Power.-In all cases of paraplegia in which the lumbar enlargement of the spinal cord remains uninjured, the reflex power of that enlargement increases notably. On the contrary, the reverse is observed in cases of alteration of thi! enlargement.