Sept. 9. Left quite well. Has got fat, and has now a cheerful face and manner. Says she feels a different being, and is quite astonished at her own improvement. Has lost all her nervous twitchings and other uncomfortable symptoms, and has now a comfortable night’s rest. CHAPTER IV. SPINAL IRRITATION, WITH CASES There are perhaps few terms so difficult to define as spinal irritation, for the gradations from hysteria to this state are extremely easy; and, indeed, it will have been seen that in the foregoing chapter most of the patients complained of pain in the spine, and that there was more or less functional disturbance in all of them. The term is also used so freely and vaguely that great caution is necessary in attempting to explain its meaning. Dr. Handfield Jones’s term, “Spinal Paresis,” seems to me an excellent one; by it he means “a state in which, without demonstrable organic change, there is greater or less enfeeblement of the functional power” of the spinal cord. The sensory or motor power may be affected, but rarely both together. The cause of spinal irritation, or paresis, may be defined in one word—“debility;” this debility always, or almost always, being due to inhibitory irritation. This state of things may give rise to wide and varied disorders, all the symptoms of which are asthenic in their character, and all of which are marked by extreme nervous prostration. Without doubt,—for all authors agree on this point, one of the most prominent causes is peripheral irritation of the pudic nerve, producing undue exhaustion. It is difficult to say how this is produced, but most probably it is that, “owing to the intimate commissural connections between the lumbar enlargement of the cord, where the pudic nerves are implanted (they themselves being small and remote in their origin from the brain); and the superior and nobler nervous centres, the intense excitation of even a small and remote centre is communicated to the others, which, as this subsides, fall as much below, as they have previously been stimulated above par. The depression is proportional to the previous excitement.” The cases I shall have to relate which may fairly be called cases of spinal irritation are few in number, for the reason I have stated, that they are but a continuation of hysteria,[3] and, indeed, but a state of things of which epileptiform and epileptic fits are the direct sequence. Footnote 3: _Vide_ Cases in previous chapter.