could occur, showed that in transmission of motion the grey substance effects this in every direction. We have seen that with sensitive impressions, the same law holds. How and why two such different elements as white and grey matter should both serve to conduct motor impulses we know not; nor do we know how the isolated transference of the impulse of the will is conveyed to determinate muscles. Equally ignorant are we, whether the cell processes which transmit motion are also capable of transmitting sensation.

Betwixt the sensitive and motory properties of the cord, analogy would appear to exist on more points than one. Thus, as in the case of sensation, the elements which conduct motion, white as well as grey, are in themselves not motory. To distinguish this property, Schiff proposes to term these elements "kinesodic." The experiment of Longet, in which it was supposed that galvanic irritation of the white columns produces motion in the parts behind, shows nothing beyond the fact that the muscles supplied by the nerve-roots going from the point when the excitation is applied, may be excited to action. The only motory parts of the cord are fibres of the anterior roots, which traverse obliquely, or at right angles, the anterior white columns. As already indicated, the fibres of the latter are not prolongations of the anterior roots, but originate in the cells of the grey matter.

On dividing one-half of the spinal cord, it is found that although there is no complete paralysis of motion, certain groups of muscles have their action weakened, and some are paralyzed. Amongst the

latter are the muscles of respiration on the same side, and if the section is made above the origin of the phrenic nerve, the respiratory movements on that side are wholly suspended; but if the section is lowersay opposite the last cervical vertebra-the paralysis is confined to the external respiratory muscles. This result is specially due to division of the lateral columns.

Space forbids us entering upon the causes of the hyperesthesia which is observed after section of parts of the spinal cord, and we can do no more than remind the reader of the remarkable proneness to convulsive movements which Brown-Séquard found to follow certain lesions of this organ.

In concluding this exposition of the views of Schiff, it may be of interest and service to the practical reader to put here verbatim the pathological corollaries which that physiologist deduces from his researches in the laboratory, so that by comparative observations at the bedside, and in the post-mortem theatre, the truth of these conclusions, as well as their diagnostic value, may be tested:

"1. Although, contrary to a common supposition, a limited disorganization of the posterior columns does not produce insensibility to pain in the parts behind, and a corresponding limited lesion of the anterior columns does not produce loss of movement, a total disorganization of these columns produces in the former case anæsthesia, in the latter paralysis.

"2. When perfect anesthesia is the result of an injury which affects the spinal cord at a limited spot only, somewhere in the neighbourhood of only one or of some dorsal or cervical vertebræ, not only the posterior columns, but the

а

whole of the asthesodic substance (including the anterior horns) must be affected at the injured part.

"3. Complete paralysis in all parts of the body behind a diseased portion of the cord in the long direction may occur

"a. Without any lesion of sensibility, save only constricting pain at the level of the diseased part, in cases of mere compression of the cord through dilatation of the vessels, with effusion, exudation or affection of the sheath.

"b. Without lesion of sensibility, and without any pain, perfect paralysis must occur in disease of the antero-lateral columns and of the total kinesodic substance, if one may suppose this substance to be affected independent of the æsthesodic.

"c. Should it be certainly proved that the central parts of the grey substance contain no kinesodic elements which conduct longitudinally, one would expect perfect paralysis of the posterior parts of the body, if anywhere, in the long direction, the antero-lateral columns, the four grey cornua and gelatinous substance of Rolando are affected, spontaneous pain is absent, sensibility to pain remains, but on account of the simultaneous limitation of the transverse extent of the æsthesodic substance, perception of pain is retarded.

"d. Paralysis occurs in disease of the anterior column and the whole grey substance; in this case sensibility to pain is lost, but sensibility to touch remains.

"e. Disease of the kinesodic substance, and of some parts of the anterior column, is accompanied with paralysis affecting certain parts and passing by others.

"4. Contraction and convulsions in parts of the body behind the injured spot can never be the consequence of an isolated irritative affection of the antero-lateral columns, or of the grey substance, since no motor fibre-i. e., none which upon irritation call forth movement-traverse the spinal cord in the long direction.

5. These symptoms, however, may occur in a transitory form in disease of the anterior columns, exclusively in the muscles supplied by the nerves traversing the diseased portion that is on a level with the injury.

"6. Convulsions of the posterior extremities, with cramp, and generally with contraction, in very great irritability, with extension, also, which makes their free movement impossible, occurs in diseases of the higher divisions of the cord in the dorsal or cervical regions. In such a case, it is from disease of the posterior columns or the nerves traversing them, which act reflectively on the motory parts. Some change of the reflecting grey matter, analogous to that produced by certain narcotic poisons, might also give rise to contractions of the feet.

"7. Contraction may also be produced by slight pressure on the cord. In such a case, the contraction depends on a paralysis of the extensors, and it disappears in sleep, or if the person lies very quiet, and also in the early stages of ether narcotism; whilst in cases of cramp from irritation of the posterior columns, a much higher degree of narcotism is required.

"8. Disease of the posterior columns can also (through the laws of reflexion) call forth convulsion and contracture in parts higher up, towards the head. "9. Disease of one posterior column, which causes slighter reflex contractions, has its effects confined to the limbs of the corresponding side.

"10. Isolated degeneration of the posterior columns, a little way above the cauda equina acts:

a. In an irritative way, by producing pain (spontaneous or on pressure) in those nerves which traverse the diseased part, and often a constricting pain at the part affected, and a little above it. The longitudinal fibres of the posterior columns call forth, in the part of the body behind,

a constant sensation of touch, described as formication with varying sensation of heat and cold. Sense of pain in the parts behind continues, and is even exalted, as long as the posterior columns are hyperæmic.

b. When such a lesion acts in a paralysing way, we find at the level of the paralysed roots a circle of the body which is quite anaesthetic, whilst sensation to pain is present above and below this ring. This anesthetic circle is not sharply defined, and appears of different breadth at different times. Below this circle, sense of tickling, touch, and temperature, is absent. Pain or pressure is very well perceived, but is imperfectly localised.

c. When a disease at first acts irritatively (softening, for example), and extends along the cord from below upwards, the painful circle travels with it, leaving an extending anæsthetic circle. Below this, objective sense of touch is absent, but instead of it, there is subjective and perverted sense of touch (formication).

"11. When, with motion unaffected, a painful ring is present without alienation of sense of touch, we should find that the nerve-roots alone, outside the cord or within it, were affected.

"12. When, besides the posterior columns, the whole æsthesodic substance is diseased, we shall find behind the diseased spot perverted sensations of touch and no sense of pain.

"13. A disease of the spinal cord which first produces convulsions and then a perfect loss of voluntary movement in the provinces of nerves which go off behind, extends to the anterior and posterior columns and the kinesodic substance; it does not however require to go so far into the parts conducting sensitive impressions in order to produce perfect anesthesia.

"14. A disease of the cervical portion of the cord, which, with paralysis of the extremities and the trunk, permits the respiratory movements to take place, does not affect the lateral columns.

"15. Isolated degeneration of one lateral column suspends the respiration on this side only. If both lateral columns below the fourth vertebra are diseased, the lower ribs are not used in respiration, which becomes strongly abdominal.

"16. When the lower part of the cord is paralysed, the motions in the different muscles of the upper part of the body become more frequent and stronger.

"17. Since only a small bridge of grey matter is sufficient to transfer sensitive or motory impressions, it is possible that in many cases, especially when this grey substance is surrounded by softened parts, softening occurs after death, and the connecting link of grey matter is not observed, and fluid matter fills up the gap.

"18. The above physiological experience may be applied to cases of wounds which scarcely disturbed the function of the cord (a bridge of grey matter being left ?).

"19. It is rare to find that after a lesion of the spinal cord, feeling or motion is permanently lost on one side only."

Space does not permit our alluding to the influence which the spinal cord exerts on the functions of respiration, circulation, nutrition, heat, and digestion. We have been principally anxious to expose the views of our German brethren on the structure and functions of the cord, and must offer this as a reason for having made but slight refe. rence to writings which can be readily found in the English literature of the subject.

65-XXXIII.

2

REVIEW II.

On Rupture, Inguinal, Crural and Umbilical; the Anatomy, Pathology, Diagnosis, Cause, and Prevention; with New Methods of effecting a Radical and Permanent Cure; embodying the Jacksonian Prize Essay of the Royal College of Surgeons, London, for 1861. With numerous Illustrations. By JOHN WOOD, F.R.C.S. Eng. (Exam.), Demonstrator of Anatomy at King's College, London; AssistantSurgeon to King's College Hospital; Surgeon to the Lincoln's Inn Dispensary.-London, 1863. 8vo, pp. 326.

MR. WOOD's book upon Rupture is one which deserves at our hands more than a mere passing notice. Whether we consider the number of those who are afflicted with hernia, or whether we look to the good hope which is held out of curing many of these, the subject is full of interest to the practical surgeon, as well as to all those who are anxious to see the healing art making progress in the great contest which it is carrying on against death and disease.

It has been estimated by Malgaigne that in France one man in thirteen, and one woman in fifty-two, are affected with rupture; and there is no reason to think that the proportion would be very different among our own population. And not only is hernia a very common complaint, but it is one which is always attended with great inconvenience, and which may at any time put life in the utmost peril; moreover, it often forms a serious disability, preventing some from entering trades or professions for which they are otherwise well suited, and obliging others to relinquish the occupations by which they obtain their livelihood. Boys are frequently unable to gain admission into naval or military schools because they are ruptured, and cases have already arisen in the brief history of Mr. Wood's operation in which it has enabled lads to pass the inspection of a medical board by which they had previously been rejected. This is one of the best proofs that could be given of the satisfactory results of the operation.

It would appear, from official reports, that about three men in every thousand are annually lost to our army and navy by ruptures. Governments have always been anxious to prevent this waste of material, and on one occasion, at the beginning of last century, as we learn from Mr. Wood, our own Sovereign bestowed the honour of knighthood, together with substantial pecuniary rewards, on an individual who undertook to cure ruptures by the application of oil of vitriol—a cure which must have been so far from being complete or permanent that it is difficult to understand how it gained any credit at all. serves, however, to show how important it is that there should be some means of curing ruptures, and preserving the efficiency of those whose maintenance and instruction has cost the country a large sum of money.

This

Again, rupture is not only a complaint which affects a large number of the community, and deprives us of the services of many of our

soldiers and sailors, but it places the lives of those who are the subjects of it in constant jeopardy. At any moment the hernia may become strangulated, and give rise to the most alarming symptoms, frequently terminating in death. It is true the patient may wear a truss, and if the rupture is of moderate size a well-fitted truss may serve to control it; but then the truss must be worn almost constantly. It can never be laid aside except when the patient is in bed. It is always troublesome and inconvenient, and unless it fits closely the rupture will be liable to come down behind it; while if the protrusion is of large size, it is hardly possible to keep it in check at all by means of a truss.

Here, then, is the disease that we have to deal with a complaint which is very common-which constitutes a serious disability, but which is not necessarily fatal, and which frequently admits of a palliative treatment. This palliative treatment, however, must be lifelong; it is apt at the best to be irksome, and to many cases it is not applicable at all. Mr. Wood has instituted a very fair comparison between hernia on the one hand, and varicose veins, hæmorrhoïds, and such other complaints as admit of both palliative and radical treatment on the other, and he draws the just conclusion that, if an operation is justifiable in the one case, it is at least equally allowable in the other, provided always that such operation is not attended with any extraordinary risk.

In the present treatise, which is an expansion of the Jacksonian Prize Essay for 1861, the author describes the operation for inguinal hernia which he has been in the habit of performing for the last five years, and which has met with so much success that it may fairly be considered to have taken its place among the resources of operative

surgery.

The volume before us is divided into three parts. In the first, the author treats of inguinal hernia, and after describing the anatomy of the parts concerned and the pathological changes which accompany rupture, he proceeds to explain his own operation for effecting a radical cure. This, together with the appendix, which contains an account of 60 cases that have been operated on, is by far the most important portion of the book. In the second part the author deals with femoral hernia. First of all, the reader is reminded of the anatomy of the region, and then Mr. Wood describes an operation which he believes would effect a permanent cure, but which he has never yet performed on the living body. We are inclined to think that this operation will never meet with so much favour as that for inguinal hernia, partly because it is more difficult to perform, partly because it is attended with greater danger, and partly because femoral rupture is generally met with in women whose occupations are usually light, and whose cases call for less active treatment. Umbilical hernia is the subject of the third part, and for this variety also Mr. Wood has an operation to suggest, which he has performed several times. with perfect success.

All the operations which our author recommends are based upon the same principle, and consist in stitching or pinning together sub