Volume 1

A clinical treatise on the diseases of the nervous system / by M. Rosenthal ; with a preface by Professor Charcot ; translated from the author's revised and enlarged edition by L. Putzel.

  • Rosenthal, Moriz, 1833-1889.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: A clinical treatise on the diseases of the nervous system / by M. Rosenthal ; with a preface by Professor Charcot ; translated from the author's revised and enlarged edition by L. Putzel. Source: Wellcome Collection.

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    CLINICAL TßEATISE ON According as the lesions involve a part or the whole of a lateral half ot the cord, and according to their height and depth, the Symptoms will present some vanations, although always manifesting certain fundamental charactenstics. In severe lesions of the cervical or lumbar regions, paral- ysis ol motion occurs in one leg, and paralysis of Sensation in the other, i e hemiplegia with crossed hemiamesthesia. If the lesion does not penetrate so deeply as to involve the central organ of sensory conduction, motor pa- ralysis oi one side may alone develop. r^'^ie e^P®rimental investigations, which we have mentioned, throwcon- siderable light upon the pathology of spinal lesions. If the affection in- volves the entire lateral half of the lower Segment of the medulla oblon- gata (at the decussation in the pyramids), voluntary motion will be par- tially preserved upon both sides of the body, with complete abolition of Sensation upon the side opposite to the lesion. If the morbid foyer occu- pies the entire thickness of the lateral half of the cord at a certain height all parts of the body situated below the lesion, and upon the same side* will be deprived of voluntary motion, but not of Sensation, while, on the opposite side, abolition of Sensation will occur, with preservation of mo- tion. We may also add that different portions of the two halves of the body may be affected with paralysis of Sensation, even in unilateral affec- tions of the cord. If, for exanqile, the lesion is sufficiently extensive to involve, at the same time, the origins of the nerves which supply one limb or a portion of the trunk upon the same side, these nerves will lose their power of conduction. as well as the sensory nerves of all portions of the body situated below the lesion and upon the opposite side. If anmsthesia limited to the same side follows a unilateral lesion of the cord, it is due to irritation of the posterior nerve roots. Brown-Sequard reports twenty-four clinical observations in confirma- tion of the results of liis experimental investigations upon the lesions of a lateral half of the cord. Other cases of a similar character have been since published by Radcliffe (Lancet, May 27, 1865), Bazire (Lancet, Yol. H., 5, 1865), by myself, by Charcot (Arch. de physiol., 1869, and 1873), Cantani (II Morgagni, 1870), W. Mueller (Beitr. z. Anat. u. Physiol. des Rueckenmarks, Leipzig, 1870), Joffroy and Salmon (Gaz. med., 1872), Riegel (Berl. klin. Wschr., 1873), and Troisier (Arch. de physiol., 1873). Pathological Anatomy.—In Monod’s case, published by Ollivier (in- complete motor paralysis of the right leg and complete insensibility of the left side, from the thorax to the toes), a hremorrhagic extravasation was found in the lower portion of the right half of the cord; a brownish hrem- orrhagic infiltration also extended to half of the gray substance, and the left horns and most external portions of the white substance alone re- mained intact. Or6 has recorded two observations (Mem. de la Soc. de Biol., 1853); in one (paralysis of Sensation on the right, and of motion on the left side), a blood clot was found in the left half of the cervical cord; in the other case (abolition of motion on the right, and of Sensation on the left side), the cervical cord was compressed from right to left by a spongy excrescence growing from the dura mater. In the two cases re- ported by Charcot, the unilateral lesion was caused, in one instance, by an intra-meningeal spinal tumor, and, in the other, by an intra-medullary syphiloma. In W. Mueller’s case, the cord was cut transversely below the third pair of dorsal nerves, from behind forwards, and from right to left (the point of a dagger was left in the wound). The left half of the cord was compiecely divided, and the surface of the section was swollen, of a reddish-brown color, and covered with pus; the meninges were adhereni