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that of the right side; the antero-lateral columns seem to have been also the seat of the softening process to a less degree, but I do not find that they have suffered any loss of substance. In examining the softened parts by the microscope, I detected very few of the proper nerve-tubes; and those which I did observe, were much altered from their natural appearance; they had become opaque, and had assumed an indistinctly fibrous aspect. I was unable to find any trace of grey matter. The posterior horns must have shared in the great destruction of the posterior columns, and probably the anterior ones experienced a similar fate. It is right, however, to observe, that the specimen had been preserved some time in spirits, before it came into my hands. I found throughout the diseased part, numerous small scales, (cholesterine ?) such as are very commonly met with in portions of the nervous centres preserved in spirits."
Dr. Todd then makes the subsequent very important remarks :—" I consider this case of the greatest physiological interest, as affording unequivocal proof, that the posterior columns cannot perform the office assigned to them by some physiologists, namely, that of conducting sensitive impressions to the brain, or at least, that they are not the only channels of this communication. It is also important in an anatomical point of view, as showing that the posterior roots of the nerves are independent of the posterior columns of the spinal cord; for although the latter were destroyed to so great an extent, the former did not appear to have suffered in any degree."
Observations.—This instructive and interesting example of disease of the nervous system excited, as it well might, much attention in all those who witnessed its progress; and they, along with myself, confidently hoped, that the pathological appearances met with on dissection would be such as to explain satisfactorily the rationale of the peculiar symptoms, which the malady exhibited during the patient's protracted and severe sufferings; more especially, in regard to those remarkable features characterising the case, namely, that whilst sensation remained unimpaired, voluntary motion was totally suspended. Because, should these anticipations be realized by the post mortem examination, some important pathological facts, worthy of being recorded, would thereby be added to the points already established, as well regarding the actual seat, as likewise the courses of transmission of those functions. The autopsy, with the microscopical inspection of the diseased part of the medullary cord now given, although they sufficiently account for the loss of motion, do not explain why the patient's sensations remained not only unimpaired, but even appeared to be more acute than natural.
Physiologists might undoubtedly urge, since there appeared more indications of inflammation having existed in the anterior than in the posterior columns of the cord, as shown by the firmer adhesions of the membranes to them and to each other, at the diseased part of the cervical medulla, such circumstances may be thought by some, sufficient to explain most of the phenomena observed during the patient's life. Nevertheless, in these difficult and often disputed questions respecting the functions and diseases of the nervous system, other physiologists may conclude, and with considerable show of reason, that the loss of motion, so remarkable in this instance, was solely owing to the generally softened condition of the anterior part of the cord, which change in all probability arose from the previous inflammation already mentioned.
Besides these considerations, it is also deserving of notice, that the reddened state of the cord, above the softened portion of that organ, indicated such a degree of irritation in the spinal medulla, as would sufficiently account for the occurrence of those spasmodic actions of the lower extremities noticed in the case, and from which the patient latterly suffered so severely; whilst it is also probable, that had he lived for a longer period of time, the extent of disease in the cervical medulla would have been materially augmented.
As these, with some other interesting points, respecting the nature and seat of affections implicating the nerves, and exhibiting symptoms similar to the case above described, are still surrounded by considerable difficulty, more extensive experience, supported by dissections, is necessary to enable physicians to explain some of the discrepancies in
Vol. xxvi. c s opinion yet prevalent among physiologists on these important subjects; I therefore submit this case to the notice of the Society, as an instructive and somewhat rare example of disease of the nervous system, which in my opinion appears worthy of attentive consideration.
WITH OBSERVATIONS ON DISEASE OF THE
By JOHN CHARLES GRAHAM TICE, M.D.,
ASSISTANT SURGEON 8TH (king's) REGT. OF FOOT.
Communicated By Sir JAMES M'GRIGOR, Bart.
READ JANUARY 10th, 1843.
Mr. Job Aldridge, quarter-master, 8th (King's) Regiment, quartered in the Royal Barracks, Dublin, aetat. 48, plethoric and of nervous temperament, began, about the 7th September 1842, to complain of pain in the right side, affecting, to a trifling extent, the freedom of respiration.
Pressure over the liver caused great uneasiness. The pulse was natural, tongue furred, bowels constipated, and heat of surface moderate.
He states, that for some time past he has been annoyed, particularly in the morning, with a most disagreeable taste, resembling fried onions.
Suspecting the biliary secretion to be in a vitiated state, and the organ somewhat gorged, calomel, with cathartic extract, was given, followed by infusion of senna and salts. Several dark, offensive stools succeeded; the pain and difficulty of breath