o26 Diseases of Joints. 



whether he was sitting or standing. A month later it had extended along 

 the ribs on the right side. These symptoms gradually increased until 

 December 1888, when he was admitted into the Iniirmary. At that time 

 he had no pain or weakness in his legs, and as soon as a Plaster-of- Paris 

 jacket had been applied he returned home. The pain in his spine was 

 not relieved, but that in his ribs disappeared. Soon, however, he felt a 

 loss of sensation in his legs, beginning first in the left thigh, and extending 

 to other parts of the lower limbs. About a month after the jacket had 

 been applied, the pain in the back increased, and he had difficult}' in 

 walking. On January 10th, 1889, he returned to Mr Miller's ward, and 

 was then able to walk into the waiting room with the aid of an umbrella. 

 His legs were weak, and the pain in his back worse, and at his own request 

 the jacket was removed, He made an effort to get up, but found that he 

 had entirely lost the power of his legs, and so had to be carried from the 

 waiting room to the ward. After ten days he was taken to the Medical 

 House. At that time a projection of the tenth, eleventh, and twelfth dorsal 

 spines was noted, and both lower limbs were completely paralysed. The 

 plantar reflex was present on the left side, but not on the right. Ankle 

 clonus was obtained on both sides, and also patellar reflex, but not exagger- 

 ated. No cremasteric reflex was obtained, but the anterior abdominal and 

 thoracic reflexes were lively. The patient could tell when his bladder 

 was full, but had difficulty in starting micturition. His bowels sometimes 

 moved without his knowledge. The muscles of the paralysed limbs were 

 firm and not wasted. No trophic lesion was visible. There was a con- 

 stant dull pain in his back near the prominence, M'ith occasional sharp 

 pains, followed by drawing up of his legs. The pain was sometimes felt 

 when he moved his trunk. When he coughed there were occasional 

 sharp pains following the line of the ribs attached to the diseased portion 

 of the spine. Over the eighth dorsal spine even a light pressure caused 

 pain. There was no marked tenderness over the tenth, eleventh, and 

 twelfth dorsal spines. The other systems were normal. On May 4th the 

 sensation was perfect in both feet, and the area of insensitive skin less. 

 He could flex his knees occasionally, and had better control over his rectum 

 and bladder than formerly. 



The spine was trephined on May 31st by Mr Miller. After 

 removing the soft parts, the tenth dorsal spine, which was softened and 

 inflamed, was removed with bone pliers. The spinous process above it 

 was next looked for, but was absent, and the corresponding lamina was 

 atrophied to the thickness of ordinary letter paper, and could easily be 

 broken with the finger nail. The dura mater was opened, and much cerebro- 

 spinal fluid welled out. Excepting that the spinal cord was thinner and 

 smaller than normal, nothing wrong was detected. The wound was then 

 closed. Shortly after the operation, symptoms of spinal meningitis 

 appeared, but by July 4th they were rapidly disappearing. 



It was noted on August 5th for the first time that at each in- 

 spiration there was a sinking in of the wall of the chest near the afl"ected 

 part of the column. On palpation, the vertebral ends of the tenth 



