The  characters  of  the  paralysis  in  relation  to  the  seat  of  the  disease  are
described  in  the  chapter  on  "Compression."  In  the  most  frequent  cases
the  dorsal  cord  is  damaged  and  the  condition  of  the  legs  is  that  of  spastic
paraplegia.  If  it  is  situated  in  the  cervical  region  there  is  muscular  atrophy
in  the  arms,  sometimes  combined  with  palsy  without  atrophy,  according  as
the  disease  is  at  the  level  of  the  cervical  enlargement,  or  above  this.  There
is  the  same  spastic  paralysis  in  the  legs  as  when  the  disease  is  in  the  dorsal
region.  When,  as  is  commonly  the  case,  the  arms  suffer  from  damage  to
the  nerve  roots,  they  suffer  before  the  legs,  but  if  the  disease  is  so  high  up
that  the  arms  suffer  from   the  damage  to  the  cord  itself,  the  legs  may  be


CARIES.  181

paralyzed  before  the  arms,  as  in  the  case  of  the  child  .mentioned  above.  In
this  case  the  muscles  of  the  shoulder  were  wasted,  the  disease  being  near  the
level  of  their  nerves,  while  the  forearm  muscles  were  not  wasted.  In  this
case,  as  in  others  of  similar  seat,  the  diaphragm  was  paralyzed.  The  muscu-
lar part  of  the  spinal  accessory  may  be  involved,  and  the  power  of  support-
ing the  head  may  be  almost  lost.  Very  rarely,  from  disease  of  the  highest
cervical  vertebras,  the  other  nerves  of  the  medulla  are  implicated.
