ible stretching of the cord by
acute flexion of the neck. The blood is usually effused into the
anterior cornua of the grey matter and into the central canal, and
there is a varying degree of laceration of the nerve tissue, in
addition to pressure exerted by the extravasated blood.

The severity of the _clinical features_ depends upon the extent of the
lesion. In contrast with what results in extra-medullary haemorrhage,
the symptoms are paralytic from the outset.

When the haemorrhage is only sufficient to cause _pressure_ on the
cord, the paralysis is usually most marked in the lower extremities
because the conducting fibres are pressed upon. This is associated
with evanescent anaesthesia for temperature and pain, while tactile
sensibility is preserved. There is retention of urine and faeces, and
in young men, priapism. As the fibres which supply the dilator pupillae
are involved, the pupils are contracted. The symptoms gradually
subside as the extravasated blood is re-absorbed, sensation being
restored before motion, and recovery may be comparatively rapid.

When the blood extravasated in the cord causes disintegration of its
substance, there is complete paralysis with atrophy, and anaesthesia in
the area supplied by the segments of the cord directly implicated. The
paralysis in the parts below the lesion assumes the spastic form. As
the lesion is usually in the upper part of the cord, it is the arms
that are most frequently affected. In less severe degrees of damage
the paralysis of the most distant parts, _e.g._ the feet, may be
transitory. Even in cases in which the loss of function below the
level of the lesion has been complete, recovery may take place, but it
is apt to be marred by a spastic condition of the muscles concerned,
due to sclerotic changes in the cord.

Except that operative treatment is contra-indicated, the _treatment_
is the same as for extra-medullary haemorrhage, and at a later period
measures may be employed to relieve the spastic condition of the
muscles.

#Total Transverse Lesions.#--Total transverse lesions, that is, those
in which the cord is completely crushed or torn across, are much more
common than partial lesions, being an almost invariable accompaniment
of a complete dislocation or of a fracture-dislocation of the spine.
Even when the displacement of the vertebrae is only partial and
temporary, the cord may be completely torn across. Similar lesions may
result from stabs or bul