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CONTRIBUTIONS
TO THE
PATHOLOGY OF THE SPINAL CORD.
BY WILLIAM BUDD, M.D.
COMMUNICATED BY JOHN G. (^) PERRY, ESQ.
READ MARCH 26TH, 1839.
THE functions of the spinal cord have, of late, much
engaged the attention of physiologists, and have
been studied with great success by Marshall Hall,
Muller, Volckmann, and others. The leading fact,
which their investigations have developed, may be
thus briefly stated:-When the connection of the
spinal marrow^ of^ an^ animal^ with the^ brain is severed
by decapitation, or otherwise, and a stimulus is ap-
plied to^ the^ surface^ of the body, the influence of
that stimulus is transmitted to the spinal marrow,
and, being thence^ reflected^ to^ motor^ nerves, causes
contraction, of various muscles. In the experiments
which show the different steps of this process, it is
certain that the agency of sensation and volition is
excluded. The part which the spinal marrow takes
in the action has suggested the term reflex function.
It has been further shown, that the brain has a re-
DR. W. BUDD ON THE
flecting power of the same kind: that the muscular
contractions excited in this way, are, in all cases,
independent of volition; but that, in reflex (^) opera-
tions of the brain, sensation is probably concerned.
I shall not stop to inquire into the originality of
the recent investigations on this subject: it will be
allowed by every one that the physiologists above
named have made many and important additions to
the facts established by former inquirers, and have,
with a precision not attained by these, assigned to
the functions of the spinal cord their real domain in
physiology and (^) pathology: and in whichever of
these aspects we regard the subject, we are unavoid-
ably led^ to^ acknowledge the interest and importance
it owes to the valuable researches of Dr. Hall.
The (^) investigations of phvsiologists have consisted
chiefly in experiments on the lower animals: it is
the object of this paper to show that, under certain
circumstances, the operation of the reflex function
is exhibited in man, in the same way as in decapi-
tated animals. This I shall do by a series of cases
of affection of the spinal marrow: as in these cases
the inquiries are instituted on rational beings of our
own species, they offer peculiar advantages for the
study of^ some of the conditions of the reflex func-
tion.
CASE I.
John Lang, aged 43, and of temperate habits,
without known cause gradually became crooked in
DR. (^) W. BUDD ON THE
I observed a very limited motion of the great and
second toes; but had I not watched very narrowly,
these movements would (^) have escaped (^) my notice:
after having occurred once, or at most twice, he
could not repeat them.
These are the only voluntary movements of the
lower extremities which the patient can execute.
When, however, any part of the skin is pinched or
pricked, the limb^ that is thus acted upon jumps
with great vivacity: the^ toes^ are retracted towards
the instep, the foot is raised on the heel, and the
knee flexed so as to raise it off the bed: the limb is
maintained in this^ state of tension for several se-
conds after withdrawal of the stimulus, and then becomes suddenly relaxed. Once or (^) twice, while
the left leg was thus excited, the great and second
toes of the right foot were (^) simultaneously drawn
towards the sole: the converse never occurred, and,
in general, while one leg was convulsed, its fellow
remained quiet, unless stimulus was applied to both
at once. The contractions excited bv stimulating
the left leg are uniformly more vigorous than those
excited in the right by a like stimulus. In these
instances, the pricking or pinching was perceived
by the patient; but much more violent contractions
are excited by a stimulus of whose application he is
perfectly unconscious.
When a feather is passed lightly over the skin in
the hollow of the instep, as if to tickle, convulsions
occur in the corresponding limb much more vigo-
rous than those induced by pinching or pricking;
PATHOLOGY OF THE SPINAL (^) CORD.
they succeed one another in a rapid series of jerks,
which are repeated as long as the stimulus is main-
tained. In^ these experiments the patient is quite
unconscious of any thing touching his limb. When
asked if (^) he feels any thing, his invariable (^) reply is,
" No, I feel nothing, but you see my leg feels well
enough." When any other part of the limb is irri-
tated in the same way, the convulsions which ensue
are very feeble, and much less powerful than those
induced by pinching or pricking. No movements
are excited in his lower extremities by tickling any
point in the upper half of his body, though such
tickling occasion laughter.
Convulsions, identical with those (^) already de-
scribed, are at all times excited by the acts of defe-
cation and micturition. At these times the convul-
sions are much more vigorous than under any other
circumstances, insomuch that the patient has been
obliged to resort to mechanical means to secure his
person while engaged in these acts. To this end
two large loops of saddlers' webbing are nailed to
the floor; into these the feet are inserted; while
two longer loops, also nailed to the floor, are ad-
justed over the knees as soon as the patient is placed
on the night-stool: an attendant is also required to
hold down the thighs. During the act of expulsion
the convulsions succeed one another rapidly, the
urine is discharged in (^) interrupted jets, and the pas-
sage of the faeces suffers a like interruption. The
convulsions become more feeble towards the com-
pletion of the act, and the stream of urine becomes
PATHOLOGY OF THE SPINAL CORD.
At thg period when the paralysis was the most
complete, ,there was some difficulty of breathing
and palpitatioa; and both these syxnptoms were al-
ways increased when the patient fell asleep, so that
he was soon awakened by the distress they occa-
sioned.
The interest of this case lies in the coincidence of
these two circumstances:-total loss of voluntary
power in the lower extremities,-involuntary mus-
cular contractions, excited^ by application of stimu-
lus to the skin or mucous^ membranes.^ There^ can
be no doubt that these^ contractions were^ of the^ same
nature, and excited^ by the^ same^ process as^ those
observed in a decapitated animal. Although sen-
sation was^ never^ quite extinct^ in^ Lang's lower ex-
tremities, it was^ evidently not^ concerned^ in^ the^ pro-
duction of the^ involuntary contractions; for^ when
an artificial mode of stimulus was employed, the
convulsions were uniformly the most vigorous in
that case in which the application of it was not felt
by the^ patient, namely, when the hollow of the foot
was lightly toucbed with a feather. Here then we
have oral evidence from the subject of experiment,
that these acts are quite independent of sensation
and volition. The fact that such vigorous convul-
sions were excited by touching the hollow of the
foot with a feather, is of great interest, and tends
to -how that the nerves which transmit these im-
pressions to the s-pinal marrow are,-if not the same
with those of true sensation,-most actively excited
by a stimulus which produces strong impressions on
DR. W. BUDD ON THE
the sensitive nerves. Every one knows how urgent
is the sensation of tickling in the hollow of the foot.
Volkmann has proved that these two kinds of nerves
(if there be two kinds) arrive at the spinal marrow
in one bundle, namely, the posterior roots. That
their distribution should be alike, is obvious, for
their purpose is the same,-the reception of external
impressions.
We must not fail to remark, that in the case of
Lang convulsions^ were never induced bv excitement
of the passions.
Although paralysis lasted nearly two years, the
lower extremities continued stout and muscular. This
is interesting, because it has been found to occur in
other cases of the same kind. In paraplegia, with
entire loss of motility, the palsied limbs usually
waste in a remarkable manner.
CASE II.
A young lady, of scrofulous habit, after having
been affected with caries of the cervical vertebrae,
and symptomatic abscess in the pharynx, for about
two years, became paralyzed in the (^) arms, at first
exclusively, but^ in^ a short time afterwards in the
right leg also. When I saw her, paralysis of the
arms was complete as regards (^) motility; sensation
was much impaired, but not extinct. The leg was
palsied only in regard to (^) voluntary motion, and ex-
hibited involuntary contractions under the same cir-
cumstances as in Lang's case. They were, however,
DR. W. BUDD ON THE
CASE III.
Robert Holland, a sailor, aged 17, of florid com-
plexion, and robust growth: healthy until his pre-
sent illness. In August 1837, received a severe
blow on his back from the boom of his ship, which
did not, however, disable him; he continued his
work as usual. From that time suffered (^) occasional
pain of the loins and weakness in the back, especially
when stooping. This continued without other
complaint until the beginning of December, when
he began to experience digiculty in running,
and a sensation, when he attempted to run, as
if his legs were tied; he could still climb the
rigging, and continued his usual work through-
out that month. The Ist of January 1838, he was
obliged to desist, on account of increased impedi-
ment to the movements of his legs. From the 1st
to the 4th he was still able to walk, though with
much difficulty; when he attempted to stoop he fell
on his knees, and could not rise again without the
help of his hands. No weakness of the arms; up to
that time there had been no involuntary movements
of the legs. On the 4th of January was confined to
bed on account of inability to stand, or to move his
lower extremities. On the 8th of January he was
admitted to the Seamen's Hospital; on admission,
his lower extremities were observed to be in exten-
sion and very rigid, with sensation unimpaired, ex-
cept slight numbness of the thighs. There was, for
a few days after admission, difficulty ofmaking water,
162
PATHOLOGY OF THE SPINAL CORD.
which was passed with much straining. The^ tetanic
condition of the lower extremities continued; and in
the interval between admission and the 11th of
March 1838, the state ofthe patient was as follows:
Sensation in the lower extremities unimpaired;
voluntary motion abolished in these limbs, which
are rigid, from permanent contraction of^ the mus-
cles. The legs are sometimes extended, sometimes
bent upon the thigh, and the transition from one
condition to the other is quite involuntary. When
these limbs are in extension it requires great force to
bend them in the slightest degree; and when that
force is withheld, they immediately return to their
former position; the converse holds when the legs
are flexed. When any part of the skin of the lower
extremities is (^) pinched, the (^) corresponding limbjumps with great vivacity; if^ previously in extension, it momentarily assumes a state of flexion, and vic
versd. Occasionally, when one leg is thus excited,
its fellow is, at the same time, similarly affected, but
not so^ powerfully. The^ muscular^ contraction thus
excited is (^) very powerful; it is (^) quite involuntary, and
cannot be modified in^ any way by influence of the
will. When any other part of the body is (^) pinched
no analogous movements are induced; but when the
patient voids his urine, both legs are^ always affected
in the same way as by pinching their integument.
When the legs have been much stimulated by pinch-
ing, they become affected with a quivering motion,
which lasts some minutes: this also occurs after
micturition; no pain whatever in the legs, nor sense
M (^2)
PATHOLOGY OF THE SPINAL CORD.
projecting portion of the spine, had a dark, greyish,
stain, externally, and was much more vascular than
the portions above or below the curvature, which were pale and quite natural in appearance. Below the curvature, however, the dura mater was dis- tended by transparent serous fluid. The diameter
of the cord was considerably smaller in the portion
corresponding to the curvature, than in any other
part throughout its whole length. The cord was re-
moved contained in the dura mater, and the latter
laid open in its posterior aspect. There was no pus
in the sheath. The vessels of the pia mater were
very tortuous, and much congested with florid blood
in the parts above and below the curvature, but more
so below, and less in the part corresponding to the
curvature, than either above or below it. No change
whatever in the appearance of the^ arachnoid, or of
the inner surface of the dura mater.
The cord itself was of natural size; and a portion,
about two inches in length, corresponding to the
curvature, softened in the posterior columns. Th
tissue was not difluent, but became flaky and par-
tially dissolved, when^ a^ small^ and gentle current of
water was^ poured on^ it.^ This^ did^ not happen when
a like current was similarly directed on other por-
tions of the cord. This breaking down of the tissue
was much more marked in the posterior than in the
anterior columns, which^ were^ scarcelv, ifat^ all, soften-
ed, and resisted^ considerable^ traction. After^ the^ arach-
noid had been removed, the posterior columns had
still sufficient consistence to retain their form.
DR. W. BUDD ON THE
The affected portion was quite white, exhibiting
no vascularity or bloody points. The nerves within
the vertebral sheath, arising from the softened part,
were firm, and of natural appearance. The cord,
above and below, (^) perfectly healthy, firm, and of
good colour. When the contents of the chest
were removed, an abscess was (^) found, surrounding
the bodies of the diseased vertebree, its anterior wall
being formed^ by the aponeurosis of the vertebrae.
The abscess contained yellow, (^) inodorous, grumous pus. Both lungs offered grey (^) granulations, and some
tubercles, partially softened. The right lung was in
a state of hepatisation.
REMARKS.
The absence of any feeling of fatigue in the lower
extremities, after such a long period of muscular
action, is very remarkable, and seems to show that
fatigue is associated with the exercise of voluntary
actions only. It is not felt in the sphincters. It is
also worthy of remark, that the sensibility of the legs
was unimpaired, although the posterior columns of
the spinal cord were chiefly affected.
Extensive reflex actions, like those described in
the preceding cases, are the most striking symptoms
of apoplexy of the pons varolii. In an admirable
article on apoplexy, in the "Dictionnaire de mede-
cine et de chirurgie pratiques," M. Cruveilhier quotes
from Ollivier the (^) following instructive (^) case:-
DR. W. BUDD ON THE
attack, and has always remarked convulsions of the
extremities. Since the account of the (^) preceding cases has (^) been in the hands of the secretary, my friend, Mr. Busk, has kindly furnished me with the details of all the cases of paraplegia from injury to the spine that have been receivred into the Seamen's Hospital,
Dreadnought, during the last year. Some of these
were attended with circumstances of uncommon (^) in- terest, and were observed with great care. I (^) shall
therefore give a narrative of them as succinctly as I
can without suppression of important circumstances.
CASE.
Thomas Colborne, aged twenty-six, was received
into the Dreadnought the 14th September 1838, the
day after he had fallen eleven feet into the hold of a
vessel. He was rendered insensible for about twenty minutes by the fall, and did not know on what part of the body he alighted. 'On admission to the hospital
the following circumstances were taken note of :-A
puffy crepitant swelling about the last cervical ver-
tebrae, with extreme tenderness, and acute pain on
the (^) slightest motion of the neck; total loss of volun- tary power in the lower extremities, trunk, and
hands; slight remaining voluntary power in the
wrists; rather more in the elbows, and still more in
the shoulders; less in the left arm than in the right.
Fingers flexed; breathing abdominal; sensation much
impaired in the hands and feet, especially in the lat-
PATHOLOGY (^) OF THE SPINAL CORD.
ter; painful burning sensation in the back of the
hands, without morbid appearance; erection and
frequent motion of the penis; retention of (^) urine; involuntary (^) stools; intellect (^) unimpaired; counte-
nance natural; slight involuntary movements in the
feet when the soles were (^) tickled. This man is still in the (^) hospital (March 6th (^) 1839), and in progress of (^) recovery. The (^) following is a
succinct narrative of his case :-There was no re-
turn of voluntary power in the palsied parts until
the 30th day after the accident, when Colborne was
first able to move his right thumb a little, the fin-
gers of the right hand, at the same (^) time, feeling less stiff than previously. On the 39th (^) day he was able to move these fingers (^) freely, and (^) also had
voluntary power over the recti abdominis.
On the 69th day be regained some voluntary
power in^ the lower extremities; could move the
right foot and leg, and left great toe; and, on the
70th, could raise his heels several inches from the
bed; but there had been no further increase of
power in the hands and arms. There was little
change, as regards voluntary power, from this time
to the 95th day, when he was first able to stand
with support, and enjoyed increased power in the
hands. On the 101st day he could stand without
support, and^ walk^ a short distance. On the 121st
there was much increase of voluntary power; and,
on the 141st, Colborne was able to walk about,
resting his^ hands on the back of a chair, which he
pushed before him. On the 30th day he first be-
PATHOLOGY (^) OF THE SPINAL CORD.
and always the most efficient method, by which con-
vulsions could be excited. From the 26th to the
69th day, involuntary movements in all the palsied
parts continued powerful and (^) extensive, and were
excited by the following causes :-In the lower ex-
tremities only, by the passage of flatus from the
bowels, or by the contact of a cold urinal with the
penis; convulsions in the upper extremities and
trunk, attended with sighing, by plucking the hair
of the pubes. On the 41st day a hot plate of metal
was applied to the soles, and found a more power-
ful exciter of movement than any before tried. The
movements continued as long as the hot plate was
kept applied; but the same plate, at common tem-
perature, excited no movements after first contact.
The contact was distinctly felt by the patient, but
no sensation of heat was perceived by him, although
the plate was applied hot enough to cause vesica-
tion. Ice applied to the soles was also tried, but
did not excite more powerful or more general con-
vulsions than a body at common temperature; the
ice did not cause any sensation of cold to the pa-
tient. Pricking the legs, or pulling their hairs, had
a like effect to that of tickling the soles. Introduc-
tion of the catheter excited convulsions in the trunk
and limbs, and convulsions also occurred during and
preceding evacuation of the bowels; such evacuation
being involuntary, but attended with consciousness
of the act.
There were also frequent spontaneous twitches,
unattended with pain, commencing in the heels, and
DR. W.^ BUDD^ ON^ THE
affecting the legs and arms, and the muscles of^ the
trunk, as high as the ribs; violent spontaneous
movements frequently followed long-continued efforts
towards voluntary motion.^ At three different in-
tervals Colborne took, for some days, one-eighth of a
grain of strychnia three times a day. Great increase
of susceptibility to^ involuntary movements imme-
diately followed, and they were excited by the
slightest causes: bv sudden noise; by the passage
of persons near the bed, or^ by the slightest touch^ of
the coverlids; by blowing on^ the^ legs,^ and^ by^ vari-
ous other slight impressions. Pulling the^ hair^ of
the head excited strong convulsions in^ the arms,
and tickling under^ the^ chin^ still^ more^ powerful
ones. No convulsions^ in^ the upper extremities
could ever be^ excited^ by irritating their^ integument.
Spontaneous convulsions of^ the^ palsied parts were
also more frequent and^ more^ powerful after^ the use
of strychnia, and, for one day, the knees were ob-
served in tonic flexion. On the 43rd day it was
observed that, after the right fore finger had been
excited to involuntary movement for about half a
minute, it became transiently endowed with volun-
tary power, being, under^ all^ other circumstances,
cut off from^ volition.^ The^ involuntary^ action^ of
that finger was always greater than of any other.
It has been already stated, that the discharge of
urine was involuntary, although the patient early
felt desire to^ void^ it.^ At first^ the^ urine^ dribbled
away almost^ constantly; but^ considerable^ quantity
could, notwithstanding,^ be^ drawn^ off^ by^ the^ cathe-
