7'2 IT 



PHYSIOLOGY OF THE NERVOUS SYSTEM. 



urine from the bladder by the catheter; this he 

 found to be acid, a sufficient proof that the 

 urine was not alkaline when secreted, but un- 

 derwent the change during its stay in the 

 bladder. 



In those affections of the spine which are 

 not attended by a paralysed state of the blad- 

 der, the urine is not alkaline; let, however, the 

 power of the bladder be impaired, even to a 

 slight degree, and the quality of the urine will 

 soon suffer. And it is well known that in cases 

 where impediment to the flow of urine from 

 the bladder occurs independently of any para- 

 lysis of the organ, as from stricture of the 

 urethra, a similar derangement in the quality 

 of the urine is apt to take place. 



It must not, however, be forgotten that 

 chronic disease of the brain or spinal cord is 

 frequently accompanied by phospliatic urine, 

 even when the power of the bladder is unim- 

 paired, and that in such urine the addition of a 

 little liquor ammonise or potassae will cause a 

 more or less copious precipitate of triple phos- 

 phate. There can, therefore, be no doubt that 

 the cerebral or spinal lesion affects in some way 

 or other the renal secretion so as to favour the 

 developement of alkaline phosphates in it, and 

 thus to create a tendency to its becoming 

 alkaline. This, however, may arise not from 

 any special influence upon the kidney, but 

 from an undue waste of nervous matter, which 

 would furnish the material for the formation of 

 the phosphatic salt. 



A very striking connection between the 

 spinal cord and the kidneys, whereby a dis- 

 eased state of the latter organs induces a func- 

 tional derangement of the former, is shown by 

 the history of those cases to which the attention 

 of medical men was first called by Mr. Stanley. 

 The patients are more or less completely para- 

 plegic, and all the symptoms of disease of 

 the spinal cord exist : but at the same time 

 there exists irritation or actual organic lesion of 

 the kidneys, which, however, may be over- 

 looked or attributed to the spinal disease. 

 When the renal disease has been completely 

 removed and the kidneys restored to theirnormal 

 condition, the paralysis gets well ; but more 

 frequently botli the renal disease and the pa- 

 raplegia resist all remedial means, and the 

 patients die. On examination, both the brain 

 and spinal cord are found perfectly free from 

 any organic lesion; but distinct evidence of in- 

 flammatory or other irritant disease of the 

 kidneys exists.* 



In a case of this kind which came under my 

 own observation, there was, along with com- 

 plete paralysis of sensation and motion in the 

 lower half of the body, excessive hsematuria, 

 which had all the characters indicative of renal 

 hemorrhage. From the man's habits and history 

 I suspected that the affection of the kidney had 

 something to do with suppressed gout, and 

 accordingly I used every means to attract gout 

 to the feet. These means were successful, for, 

 no sooner was my patient attacked with an 

 active paroxysm of gout in one great toe than 



* M"d. Chir. Trans, vol. xviii. 



the renal disease began to subside, and the pa- 

 ralytic affection disappeared simultaneously. 



Kayer, in his valuable work on diseases of 

 the kidneys, relates several cases, which, in 

 addition to those put on record by Mr. Stanley, 

 leave no room to doubt that renal irritation may 

 be propagated to the cord, and may occasion 

 such an amount of disturbance of the functions 

 of that organ as to give rise to paralysis of the 

 lower extremities. 



There seems no other mode of explaining 

 these cases than by ascribing them to irritation 

 of the cord excited by irritation of the kidneys, 

 the nerves of the latter organ being the medium 

 through which the renal affection excites the 

 spinal. Yet there is no special connection be- 

 tween the nervous system of the kidney and 

 the spinal cord, excepting probably through such 

 tubular fibres as may be found in the renal 

 plexus. These probably run a short course, 

 and their origin in the cord is in close proximity 

 to their distribution in the kidney; and on this 

 account they may be more obnoxious to the 

 influence of irritant disease of the latter 

 organ. 



The power which irritation of the cord has 

 to develope erection of the penis may be here 

 noticed as a remarkable instance of the influ- 

 ence of that organ over a local circulation. 

 For it is only by assigning it to a temporary 

 turgescence of the complex vascular system of 

 the penis that we can explain this erect state. 

 Even in ordinary erection, excited by a stimu- 

 lus applied to the glans, as already pointed 

 out, the influence of the cord is called into 

 action, and the phenomenon is produced by a 

 reflex, or what Dr. M. Hall would call an 

 excito-motor act. Yet, (and here we may no- 

 tice how ill-chosen has this term " excito- 

 motor" been,) there is in reality no excitation 

 of muscular action, but the influence of the 

 stimulus propagated to the spinal cord is 

 extended by a reflex act to the nerves which 

 are distributed to the vessels of the penis, and 

 they, instead of being excited to any contrac- 

 tion, become rather relaxed, and are thus pre- 

 pared to receive a larger supply of blood ; or 

 by the extension of this excited influence of 

 the cord, the attractive force (vis a fronte) of 

 the capillaries is increased, and thus a larger 

 quantity of blood is attracted to the organ, and 

 erection takes place. The influence of the 

 nervous system on this act is shown by the 

 most convincing evidence by the highly sen- 

 sitive state of the organ, especially of the gkms ; 

 by the large size of its nerves; by the effects of 

 injury or disease affecting the cord imme- 

 diately, or by extension from some part of the 

 encephalon ; and lastly, by the experiment of 

 Giinther, who divided the nerves on the dor- 

 sum of the penis in a stallion, and thereby 

 destroyed the power of erection, although the 

 vessels were uninjured. 



On the mechanism of the, functions of the 

 cord. Having shown that the spinal cord is 

 concerned in voluntary motions and in sensa- 

 tion, (mental nervous actions,) and in certain 

 reflex actions, as well as in certain organic 

 functions, (physical nervous actions,) it is im- 



