MYELITIS.
Rest, as near to being absolute as possible, should be insisted upon from the onset of the first symptoms. The best position is the horizontal. Most authorities insist upon the danger in permitting the spine to become the lowest part of the body, and recommend the lateral posture with occasional change to the prone. The nursing is of the utmost importance; a water or air bed is of great use, and in some instances it is essential for the prevention of bedsores, which often are the cause of death in this affection.
The primary cause must be sought out and treated; thus syphilis will demand Mercury and Iodides and the intraspinal measures indicated in brain and spinal meningitis when these affections are the result of the spirochete.
The treatment of the compression myelitis, which is the serious factor in Pott's curvature of the spine, will be found detailed in the article on Caries of the Spine. Myelitis arising as the result of wounds and fractures of the spinal column will he described under Spinal Injuries.
The worst forms of myelitis coining under the care of the physician are those which arise during the convalescent stage of typhoid fever, influenza, diphtheria, malaria, gonorrhoea and other microbic infections. A milk diet is the most suitable in all cases, and attention must be paid to the condition of the bowels and the bladder.
In acute cases cold to the spine by means of the spinal ice-bag is the safest remedy which our present knowledge can supply. Where there is great pain and tenderness a dozen leeches may be applied in two or three places on each side of the spine, and, after they fall off, cupping-glasses may be applied over the bites with great advantage in some cases. Dry cupping has its advocates. The cautery or blisters are sometimes re commended, and occasionally good has resulted from hot sand-bags, poulticing and hot fomentations. Gowers pointed out that both cold and heat act in the same way by lessening the tendency to stasis of the blood, and unless where there is danger of haemorrhage he preferred hot applications, but in the application of heat the danger of sloughing and bedsores must never he forgotten.
The course of acute diffuse central myelitis is uninfluenced by any form of treatment.
Drugs arc of little value in most cases, hut even in non-syphilitic myelitis has been found to do good. It should be given in small doses, and the perchloride is the best preparation. Salivation by inunction is contra-indicated in the great majority of cases. Ergot, though theoreti cally indicated, has rarely proved useful. Iodides in the later stages are often valuable, and many authorities combine with them small doses of Belladonna.
Vaccine therapy may be tried in chronic septic cases where the meninges are extensively involved, as in compression myelitis.
After the acute symptoms have passed off, galvanism may be employed. The continuous current from 15 Leclanche elements may be used by placing one large moistened electrode over the cervical spines, and the other over the lower part of the spinal column. The electrodes should be not only thoroughly saturated with liquid, but they should be warm. A strong solution of common salt in hot water answers perfectly. Ten minutes will be long enough for each seance. The electrodes should be moved up and down the spine, and the applications should be made once a day.
Faradisation and Massage of the wasted muscles, with Phosphorus by the mouth, and Strychnine injected into the muscular substance or sub cutaneously, may be of the greatest benefit, but this latter drug should never be administered during the acute stage when great exaggeration of the tendon reflexes exists. Counter-irritation is occasionally bene ficial, and in the chronic form of the disease is often most valuable when combined with Massage and Faradisation in those cases where the muscles are flaccid and wasted. The writer has seen best results from the judicious use of Corrigan's button applied lightly at a dull red degree of heat.
The treatment of bedsores, which are so prone to occur, is of the utmost importance, and the numerous remedies which arc available will be found under Bedsores. The state of the bladder will require the closest atten tion, and rigid sterilisation of the catheter is imperative; fcetor of the urine should be instantly met by the internal administration of ro-gr. doses of Urotropin. With this remedy the washing out and injection of the bladder by antiseptics is often unnecessary. The soft rubber catheter lubricated with Glycerin of Borax should be used to relieve retention of urine, which sometimes occurs without the patient being aware, and the physician should be upon his guard lest he mistake the dribbling of an over distended bladder for incontinence of urine.
The treatment of contractures and spastic conditions of the legs is to he pursued under recognised orthopedic principles. The operation of resetting the posterior roots of several of the spinal nerves in the cervical or lumbar region has given most satisfactory results, especially when combined with tenotomy, tendon implantation and other orthopzedic measures. By these means bedridden patients have been enabled to move about and live in comparative comfort, the contractures and in voluntary spasmodic movements being entirely removed by the root section, though the paralysis has remained.