nation. The fact that the patient recovered
completely, and was later able to fill two Viceroyalties, proved that
the lesion must have been of the nature of a concussion of the cord.

The _treatment_ consists in adopting the same measures as in crushing
of the cord, while careful watch is observed for the signs of recovery
of conduction. The usual order of recovery is first the reflexes, then
sensation, and lastly, the motor functions.

#Traumatic Spinal Haemorrhage.#--Haemorrhage into the vertebral canal is
a common accompaniment of all forms of injury to the spine, but the
lower cervical region is the common seat of the severe type of
haemorrhage resulting from acute flexion of the spine such as occurs
especially in a fall on the head from a horse or a vehicle in motion.
The blood may be effused around the cord--between it and the
dura--(extra-medullary), or into its substance (intra-medullary).

_Extra-medullary Haemorrhage--Haematorrachis._--The symptoms associated
with extra-medullary haemorrhage are at first of an irritative
kind--muscular cramps and jerkings, radiating pains along the course
of the nerves pressed upon, and hyperaesthesia. It is only when the
blood accumulates in sufficient quantity to exert definite pressure on
the cord that symptoms of paralysis ensue, and it is characteristic of
extra-medullary haemorrhage that the paralysis comes on gradually. When
the effusion is in the cervical region--the commonest situation--the
arms are more affected than the legs. The paralysis of the arms is of
the lower neurone type, and the muscles are flaccid and undergo
atrophy; the legs may exhibit a more complete degree of paralysis of
the upper neurone type, with exaggeration of the knee-jerks. Blood may
trickle down the canal and collect at a level lower than that of the
lesion which causes the bleeding, and produce paralysis which slowly
spreads from below upwards--_gravitation paraplegia_ (Thorburn). There
is blood in the cerebro-spinal fluid.

The _treatment_ is on the same lines as in total transverse lesions.
When there is evidence of progressive pressure on the cord, the blood
is removed by spinal puncture if possible, or by laminectomy performed
at the level suggested by the symptoms; operation is, however, rarely
called for.

_Intra-medullary Haemorrhage--Haematomyelia._--Traumatic haemorrhage into
the substance of the cord occurs almost invariably in the lower
cervical region, and results from forc