MENINGITIS, Spinal.
This is rarely met with as a primary affection, being generally an ex tension along the spinal membranes of the mischief due to the tubercle bacillus, to the Diplococcus intracellularis or to the pyogenic organisms causing a septic cerebral meningitis. Occasionally it may be the result of the direct infection in carbuncle or bedsores without involving the cerebral meninges.
The treatment is that already detailed under cerebro-spinal fever and the other types of meningeal inflammation. Absolute rest in bed on the side or with the face downwards and the application of the spinal ice-bag, free dosage with Bromides and Iodides and mercurialisation. Lumbar puncture should be resorted to early, and may be repeated at intervals as long as the fluid is ejected under abnormally high pressure through the needle. Counter-irritation of the spinal region by blistering or the cautery has its advocates.
Where the affection has resulted from punctured or gunshot wounds involving the spine (external pachymeningitis) the surgical procedure should be carried out on the lines indicated in septic cerebral meningitis.
Chronic spinal meningitis is generally a manifestation of syphilis, and is allied or identical in its treatment to syphilis of the brain, already detailed. Horsley regards the affection as a pachymeningitis, in which a history of syphilis is not always to be found. He advocates laminec
torny, incision of the sheath of the cord and flushing with a i in t,000 Perchloridc of Mercury solution, as recommended by Cushing, the skin wound being sealed up without drainage. Inunction with mercury or the intravenous method of Bacelli should be resorted to in all cases.
method of administering Au to-salvarsanised Serum or Mercurialised Serum by the spinal canal as described under Locomotor Ataxia has proved successful in many cases of late years which otherwise would have been hopelessly invalided.
The treatment of chronic internal or kypertrophic pachymeningitis of the cervical region is as unsatisfactory as is that of the allied cerebral affection known as 1Iimatoma of the Dura Mater. No drugs exert any specific action over the peculiar kemorrhagic tendency in the spine or cerebrum. The only hope lies in rapid mercurialisation and counter irritation, as a percentage of the cases show a syphilitic history.
The treatment of the chronic external pachymeningitis which sometimes forms a part of tuberculous softening of the spinal column is identical ‘vitli that of the compression myelitis present.