MYELITIS. Inflammation of the substance of the spinal cord. The spinal cord is liable to the same inflammatory affections as the brain. [MESINOMS.] It is covered like the brain with membranes, which may be diseased independent of the substance of the cord, which like the soft part of the brain may also be diseased independent of its membranes. Inflammation of the cord and its membranes is a fre quent accompaniment of a similar disease on the brain.
The membranes of the cord may be inflamed separately or together. The duns mater of the cord may be inflamed on its free or its adherent surface. This is sometimes the case in caries of the vertebra. This inflammation may be attended with effusion or ulceration. The spinal arachnoid and pia metier may also be inflamed, and the same results observed ae in the same membranes in the brain. These membranes are red and injected to a considerable extent, and serum or lymph are effused according to the severity of the inflammation.
The symptoms of inflammation of the different membranes cannot be well made out. The one great characteristic of all these inflamma tions is intense pain. This pain extends along the spine, and passes to the limbs, and is not unfrequcntly mistaken for rheumatic pain. With the pain there is a tendency to the disturbance of the mus cular action. There may be rigidity or tetanic contraction of the muscles of the back, amounting in some cases to perfect opiathotones. The muscles of the lower extremities may be affected in the same way.
There may be also retention of urine, priapism, and obstinate consti pation. In the commencement of the disease neither the pulse nor the tongue are much affected, but as the disease advances the pulse becomes rapid and the tongue brown, as the patient falls into a low typhoid condition.
The treatment in these maw should consist of Opiates to alleviate the patient's sufferings, and of local bleeding, and purging with neutral malts. The hot bath in the acute stage, with setons, mesas, and leeches in the chronic stage should be employed. Mercury is not recommended.
Inflammation of the 'substance of the cord occurs independent of any affection of its membranes. This may also occur idiopathically, or as the result of accident. The symptoms of inflammation of the cord are very varied, according to the part of its structure which is 'affected. Tracing the Inflammation from above downwards, all or any of the following symptoms may be observed. Convulsion, of the muscles of the head and face, difficulty of articulating, or an entire loss of voice, spasm of the muscles of the jaw, difficulty in swallowing, irregular or spasmodic breathing, palpitation or intermitteut action of the heart, constriction of the chest, dyspncca, nausea, and vomiting, pains In the bowels, sense of a cord tied round the belly, difficulty in making water, retention of urine, incontinence of urine, constipation, involuntary evacuations, convulsions of the voluntary muscles, and palsy.
If the seat of the disease Is above the origin of the phrenic nerves, or the third cervical vertcbrre, (loath speedily takes place, as the nervous influence is no longer transmitted to the diaphragm, and other muscles of respiration. Vilen the injury Is below the origin of the phrenie nerves, or at the level of the fifth and sixth cervical vertebne, the inspiration is free, but the expiration is laborious from paralysis of the intercostal and abdominal muncher. The patient can yawn, but cannot sneeze. The upper extremities are also usually paralysed in this case. If the inflammatory affection Is a little lower down, as opposite the seventh cervical, the palsy of the upper extremities is incomplete, but that of the truuk and lower extremities is complete. When the lesion occurs opposite the first or second dertsel vertebrs, the upper extremities may not be at all paralysed, hut the lower limbs will be perfectly so, and the respiratory muscles are still affected ; but when the lesion is in the part opposite the lumbar .vertebras, only the lower extremities mid the bladder are affected.
From these general remarks, it will be seen that the symptom of inflammatory affections of the cord can only be understood by reference to the physiology of the spinal cord. [NERVOUS in NAT. Thar. Div.] Inflammatory affections of the spinal cord, when independent of accident, are usually fatal ; nevertheless, recoveries are sufficiently numerous to justify the medical man in the persevering use of judicious remedies. Cases often occur in which tho active disease is arrested, but in which the paralytic affections remain.
In the treatment of this disease, care must be taken not to push antiphlogistic remedies too far. Bleeding is not recommended after paralysis has taken place. At first, purgative(' may be had recourse to ; but as the case becomes chronic, tonics, and even stimulants, will bo borne and found necessary. Counter-irritation over the region of the affected part of the spine should be produced by blisters, &c.; but care must be taken that there is no tendency to gangrene, is likely to set in in these cases. One great point to be attended to in all these cases is, the state of the bladder. Although urine may be passed, voluntarily or involuntarily, the bladder may nevertheless, from its paralysed condition, remain in a distended state, and if the water is not drawn off by the catheter bad consequences will result. It is also of great importance to keep the patient clean and dry, as if this is not attended to ulceration will occur in the !Arts with which the urine is in contact, and increase the suffering and danger of the patient.
(Watson, Lectures on the Principles and Practice of Physic ; Aitkin, The Science and Practice of Medicine.)