OP^ THE SPIXAL CORD 211 



Sometimes one can get a hint earlier. If the distri- 

 bution of the paralysis does not correspond to 

 the distribution of the anaesthesia, and if the sym- 

 ptoms are asymmetrical, it is probable that they are 

 due partly at least to concussion. In either case it 

 is very seldom that any useful purpose will be served 

 by operating, unless the injury involves the cervical 

 region or the cauda equina. 



When the cord is involved, but has not suffered 

 a functional transection, the paralysis will probably 

 be spastic in nature, and operation is more hopeful 

 because there may be something exercising injurious 

 pressure which can be removed. 



Hcemorrhage into the spinal membranes produces 

 pain and spasm by involving the issuing nerve roots. 

 In addition, there will probably be some evidence of 

 pressure on the cord, producing spastic paralysis and 

 some anaesthesia below the lesion. 



Hcemorrhage into the centre of the cord sometimes 

 abolishes the pain and temperature senses while 

 tactile sense escapes. There will probably be spastic 

 paraplegia as well. 



It will not be necessary to refer here to the diagnosis 

 of the later compUcations, such as myelitis and the 

 various neuroses. 



Unfortunately the central nervous system is so 

 highly specialized that it has lost the power of 

 regeneration after injury, not only in man (unless we 

 accept the evidence of the famous Stewart-Harte case !) 

 but also in nearly all animals. The newt, it is true, 

 can form a new cord if its tail is lopped off, but the 

 newt has marvellous powers of regeneration, and can 



