Royal Infirmary cliniques . t power overthese viscera had been due to shock rather than to directinjury to their centres and connexions in the cord. It is almost certain, further, that as the result of theinjury directly, or of a myelitis which is apt to follow suchan injury, some sclerotic changes have occurred, and thequestion now is as to where these will be. Are they in the grey matter ? I do not think so to anyextent. The bladder, rectal, and genito-spinal centres areintact, and the centres for the ankle-jerk and plantar reflexesare so also. Further, there is no muscle degeneration nor 12
Royal Infirmary cliniques . t power overthese viscera had been due to shock rather than to directinjury to their centres and connexions in the cord. It is almost certain, further, that as the result of theinjury directly, or of a myelitis which is apt to follow suchan injury, some sclerotic changes have occurred, and thequestion now is as to where these will be. Are they in the grey matter ? I do not think so to anyextent. The bladder, rectal, and genito-spinal centres areintact, and the centres for the ankle-jerk and plantar reflexesare so also. Further, there is no muscle degeneration nor 124 A CASE OF SPINAL INJUKY. tendency to bed-sores. Are they in the white matter, theconnecting part of the cord ? I think so certainly. Looking at the subject theoretically, it is evident that wehave to deal with a lesion which interferes with both motionand sensation, and probably the best way to explain thiscondition will be to invite your attention to the accompany-ing Diagram. This is intended to represent a longitudinal. section of the spinal cord. In it A A represent the tractsto the muscles of the thigh, with b b as the muscle sensorynerves corresponding, whilst c c represent the motor tractsto the muscles of the leg, with d d as their correspondingmuscle sensory nerves. It is clear that a lesion in theregion of the shaded area L would cause the motor andreflex phenomena which our patient presents, for it wouldleave his voluntary motor power over the muscles of thethigh unimpaired, and deprive him of voluntary motorpower over the muscles of his leg; whilst it would at thesame time explain the increased ankle-jerk and ankle clonus,and the absence of knee-jerk and knee clonus. Similarly with sensation. To represent this diagrammati-cally a somewhat complicated diagram would be required; A CASE OF SPINAL INJURY. 125 but remembering that the skin sensory fibres do not remainlong in the white matter, but having entered the greymatter pass from it back again into the white, and
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