The Labyrinthine Reactions of Experienced Aviators

0bdominal reflexes on one or both sides, exaggeration of thle knee-jerks, patellar clonus, ankle clonus, and-most important-plantar extensor response of tlhe big toe, witl fanning of the otlher toes, paresis, loss of sense of position, uiid diminution of bone sensibility show that there is a lesion involving the pyramidal tracts an'd the posterior columin. The superficial sensibility is usually unaffected. Thje diagnosis of the exact localization of disease of the spinal cord is of great importance from two points of view-namely, in prognosis and in the rare cases where surgical interference is contemplated. The prognosis is always most grave where tllere is clinical evidence of extensive diffuse myelitis and wlhere the lesion affects certain regions of tlle spinal cord owing to dangerous symptoms and complications arising. These lesions in the upper cervical region may affect the phrenic neurones. Again, a lesion in which the symuptoms point to a complete transverse myelitis is evident by an absolute loss of sensibility below the lesion paraplegia and loss of control over the sphincters. In such cases cystitis and secondary infective nephritis are liable to occur; also large sacral bedsores, unless great care be taken by the doctor and nurse. When the lesion affects tlle lumbo-sacral region and the lower motor neurones are destroyed there is, in addition, atroplhy witlh reaction of degeneration of the muscles of the lower extremities; tlle sphincter troubles are more serious and bedsores are almiost sure to occur in spite of careful treatment and nursing. Anatomical Diagnzosis in Relation to Surgical In terference. A precise anatomical diagnosis in cases of extra-medullary tumour of tlhe spinal cord and meningitis circumscripta is essential before operative interference can even be contemplated. Extramedullary tumour is really a more lhopeful surgical operation than cerebral tumour. The difficultv of diagnosis lies, however, in the fact that we cannot always be sure that the tumour is outside the cord. It may be intramedullary. Tlle existence of definite symptoms of root irritation prior to pressure symptoms serves as a means of localization of the situation of the tumour and affords evidence of its extramledullary situation. The earliest symptom noticed by the patient in extra. medullary tumour is pain or paraestlhesia, generally on one side and only in the area of distribution of a root and associated with hyperaestlhesia of thle corresponding skin area. As the tumour increases in size it produces sooner or later a unilateral comnpression …