first met with cases of paraplegia after inflammation of with gastro-enteric symptoms, I thought that owing to so case, the great lumbar nerves had become implicated in th was an actual inflammatory state of the neurilema, acco ing and effusion, which, by compressing the nervous ma paraplegic symptoms. A more extensive view of the s convinced me that this is not the fact; for, if it were nerves would naturally be attended with acute pains sho of their course-for, as far as my experience goes, in ever tion attacking the neurilema, intense pain is felt in th branches of the affected nerve are distributed.

Again, though this explanation might apply to cases mation was general-as where enteric is combined with tion-it would not apply to those cases in which the in localised. Thus, in Mr. Stanley's cases, the' paraplegia s mation principally limited to the kidneys. In seven Stanley's paper, we find paralytic symptoms produced, ment commencing in the brain or spinal cord, but in con tion having its seat and origin in the kidneys; and yet: patients, the paraplegia was as complete as if it had be pathic disease of the cord or its investments. What wa many of these cases were accompanied by spinal tendern experienced practitioners, on a review of the symptoms, upon them as cases of disease affecting the vertebræ, o its sheath. Yet on dissection there was no caries of th tion of ligaments; no remarkable vascularity, softening, spinal cord; no inflammation of its membranes, or effus almost all, the morbid phenomena were confined to the depositions of pus dispersed through their substance, a of the infundibula, ureters, and bladder was thickene formation of purulent matter was not, however, connected further than as being, like it, produced by the same ca the kidney. In one case the paraplegia was very com mation of the kidney had not advanced to the stage

There can be little doubt that others have frequ
of paraplegia after inflaration of the bowels, a
written upon the sy

occurrence of so un
order that we may
diately after the i
patient in such cas
loss of power until
usually made for m
bowels, in consequenc
treatment necessarily
liable to be overlooke
very period when treati
The foregoing observa
of some of you, that the
may be derived from a re

served

systen ol. xviii.

on of the bowels, or f g to some peculiarity in th d in the disease; that there a, accompanied by thicken yous matter, gave rise to the of the subject, however, has it the affection of the were, ains shooting in the direction in every instance of inflamFelt in the parts to which the

cases in which the inflam

with peritoneal inflamma the inflammatory action is egia supervened on inda even cases detailed in Mr. aced, not by any derangeconsequence of an irrita yet in the majority of his I been produced by idio was equally remarkable, erness; so that the most s, were inclined to look or the spinal cord and the bones; no destruc gor suppuration of the usion in its sheath. In e kidneys; there were and the mucous lining d and vascular. The A with the paraplegia, se-inflammation of lete, and the inflamnuration.

*he occurrence

has as yet

muscular system in general. Dr. Bright, indeed, has asserted that inflamma tion of the spinal marrow or sheath, as denoted by spinal tenderness, alway precedes the paralysis produced by lead. It often does, but by no means con stantly; for I have pointed out to you several cases in this hospital in whic not the slightest vestige of spinal tenderness could be detected, either befor the commencement or during the progress of the paralysis which so ofte follows painter's colic. I am not inclined to adopt the supposition that th paralysis in such cases is merely secondary, and the result of the intestina irritation. I think it much more probable that it depends on the poisonou effects of the lead acting directly on the nervous system. The same observa tion applies to the paralysis which so often occurs as a result of large doses o arsenic. Orfila has remarked that some of the dogs he experimented on, and which narrowly escaped dying in consequence of large doses of arsenic, became when they recovered from the immediate effects of the poison, permanently paraplegic. I look upon this paralysis as a direct consequence of the dele terious action of the arsenic on the nervous system, and not as the result of the gastro-enteritis it invariably produces. The fact, however, is well worthy of attention, that both arsenic and lead produce intestinal irritation in the first instance, and loss of muscular power in the second. A knowledge of this fact will prepare us for understanding the connexion which appears to exist between intestinal irritation and paralysis.

In a lecture published by Dr. Stokes, in the London Medical and Surgical Journal, he makes the following observations :-" Here, then, we have wellmarked paraplegia without any perceptible organic change in the spinal cord or its investments, but presenting distinct traces of disease in the kidneys. This leads me to observe the very close connexion which exists between the kidneys and spinal cord-a connexion which has been long recognised by medical practitioners, but only in a limited point of view; for, though they were of opinion that disease of the kidneys and a discharge of ammoniacal urine were the results of spinal disease, they never seem to have reflected that the reverse of this might happen. It seems, however, now to be almost completely established, that disease of the kidneys may produce symptoms which are referable to disease of the spine. Medical men have been too much in the habit of looking at this matter only in one point of view. They know that disease of the spine will produce disease of the kidneys, and here they stop; but it has been shown that the reverse of this may happen, and that renal disease may produce very remarkable lesions in the functions of the spine. Of this very curious occurrence we have many analogies in pathology. Thus, for instance, in several cases of cerebral disease, but particularly in hydeer halus, we have vomiting; here we have functional disease of the depending on disease of the brain. Take the reverse of this,-obdelirium which attends a case of gastro-enteritis; here you have ons of the brain deranged in a most remarkable manner, and this sympathy with an inflamed mucous membrane. The truth is, ne and kidney, as well as in various parts of the body, we may ns so closely connected in sympathy, that disease of the one rious functional lesion of the other."

en that these observations coincide in many points with the laid down in my lecture on the subject of nervous pathology. r. Stanley makes the following remarks:-"In reflecting on of the first series of cases which have been detailed in this be thought improbable that irritation, commencing in the bladder, should be propagated through sentient nerves to

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