18 S. E. Henschen, 



terîor grey substance; and this case might in this respect be of spe- 

 cial interest as shownig that the grey substance is without feeh'ng, so 

 long as hemorrhage has not developed slowly, (see Leyden, p. 227). 



As regards the symptoms one can well ask: what rôle has this 

 hemorrhage played? On this subject it may firstly be noted that even 

 in Eelicki's and Rybalkin's case where there was no trace of hemorrhage 

 in the cord, paralysis developed in exactly the same way, first with sen- 

 sory and then with motor phenomena; but paralysis appeared in it more 

 gradually, or on the 9"" day. 



This may possibly depend upon a less dose of arsenic having 

 been taken and the other symptoms confirm this in the case in question. 



Further no diff'erence was observed in my case in the degree 

 of the paralysis in the two legs nor was first one then the other leg 

 paralysed, which could have been expected if hemorrhage had caused 

 paralysis. Although it may now be difficult to solve the question with 

 certainty it seems to me for the reasons given and because the paralysis 

 of the arms occurred in the same characteristic manner as in the legs 

 — that the hemorrhage met with on section was not the cause of the 

 paralysis of the lower limbs. 



As it is held by some that sensations of pain are conducted by 

 the grey substance of the cord it is instructive to note that the feeling 

 of pain in the legs was not diminished or affected in this case. 



This speaks against the theory but on the other hand slight ex- 

 tension of the hemorrhage renders the case not strictly conclusive. 



It is further interesting to know that no disorders of bladder or 

 rectum were found although hemorrhage was found in the lumbar swel- 

 ling at the exit of the 2°* lumbar nerve and this not far from the sup- 

 posed innervation centre of the bladder. All the other symptoms are 

 easily explained hj degeneration of the peripheral nerves and particu- 

 larly the pains caused by the process there going on. Of special interest 

 is the circumstance that the muscular sense was little deranged excep- 

 ting in the hands and especially when remembering that by intoxications 

 there is often a pseudotabes characterised by ataxy. 



Another difficult question to solve is whether changes in the me- 

 dulla or in the peripheral nerves should be regarded as simultaneous 

 or the one primary to the other. It is probable that this question can- 

 not be settled by this case alone but requirers examination of others 

 where or the peripheral nerves or ganglion cells of the spinal cord are 

 found degenerated. 



