Tuberculous Disease of the Portio Vaginalis
Authors: J. D. Williams
Journal: BMJ (1895)

to ahiswer: Do organic lesions of the cord resalt from this molecular disturbance?It is important in this connection that we should exclude pre-existing disease, for it has been stated on good authlority that organic disease never starts from a traumatism such as is here implied, and that where it is stated to have done so the probability is that there was pre-existing disease.I shall submit notes of a case where pre-existing disease was seriously aggravated, and I hope to prove that organic disease may originate in miners after injuries such as I have described.CASE IV.Aggravation of Pre-existing Symptoms-J.F., aged 55, was examined October, 1898.He attributes his condition to an accident during the previous year.He states that in November, 1887, whilst walking down an incline in a coalpit he slipped and fell backwards.straining his yack and striking it against the ground.He was carried home, and re- *£nainedin bed for three weeks, during whi.h time his legs were very weak, and he could not retain his urine, having to get up seven or eight times in the night.After this he got up and moved about the house.Twenty-years before this he fractured his right leg.For ten years pre- vious tc the fall he was not quite steadv in his wali.He was obliged to steady himself with a stick, and his gait somewhat resembled his present one, except that since the accident it had become more unsteady.He is fairly wedl nourished, but gives the impression of a man in failing health.There Is a general shaking of the body when he stands; the walk is very unsteady and jerky.When he slands with his eyes closed his condition is tyvically ataxic.The tongue is unsteady, constantly tremlulous.The patellar reflexes are exaggerate d.Wrrist reflexes are marked.There is no ankle-clonus.The head twitches.Very sensitive to pressure on the Spine, ,CAsE v. Organic Disease following Injary.-T.T., aged 29, single.He ,et withl an accident In April, 1886.He was completely buried under a .Very heavy fall, which altogether he estimates must have been about 3a tons.le vwas carried home on a man's back and put to bed at once.-He passed urine the day after the accident without instruments.The bowels, he says, acted all right.Ile was in bed for a week; could not mpve his legs.He got up and walked about the house for a few days, *and then went out " hobbling" about on sticks.He began to work three *eeks after the aecident.Occasionally after working hard he had paius in the lower part of his back.He left the Mon .Valley for the Rhondda in Ju]X, 1887, and pain in the lower part of the back was still felt after work- ing hard.From this time forward he continued to suffer from pain in the back, and, as far as could be made out, it was after his return again 'tb Monmouthslhire in August, 1893, that he began to notice weakness and trelnbling in his legs, and, as he stated, in "his system generally.",There was no history of specific disease.When seen in April, 1894, he 'crawled about the room.There was evident weakness of both legs; the reflexes were exaggerated; tactile sensation was defective up to the umbilicus; he said he had complete control over his bladder; occasion- ally he had to run off quickly to relieve his bowels.There was an acne rash on the shoulders, and some discoloured spots on shoulder, arms, and *thorax.There were no scars on the penis nor in the throat; he had riglht external squint; the upper extremities were apparently normal; he said he could use them as well as ever.