SPINAL MENINGITIS. The membranes of the spinal cord may be affected separately, but it is common for inflammation to spread from one to the others. inflammation of the dura, pacify meningitis, has already been described. Acute leptomeningitis, or acute spinal meningitis as it is called. involving the pia. is often of obscure origin, but is known to be due to exposure to cold, sunstroke. and injuries to the spine; and it sometimes complicates pneumonia, scarlatina, typhoid fever, and septicaemia. Not infrequently a tubercular inflammation accompanies a like process in the cerebral pia mater. The attack begins with the usual symptoms of muoningcaI inflammation, namely, vomiting, chill. fever, and pain. The pain is in the back; it may be local or general. and it is increased by movement or pressure. There are also shooting paroxysmal pains radiating along the eourse of the nerves arising in the affected area, aild extreme sensi tiveness of the skin and muscles to which those nerves are distributed. Irritation of the anterior nerve-roots leads to spasms of the museless pro ducing rigidity of the spine with ex treme arching fopisthotonos). In addition there is the usual accompaniment of fever. After a few days the symptoms of irritation give way to paralysis and insensibility, and the disease either proves fatal from exhaustion and failure of the respiratory mnselos or lapses into a chronic condition with wasting and shortening of the muscles. Sonic patients recover after several months, while others ultimately die from bed sores, or from renal or vesical complications. In
this form of meningitis the pia mater is reddened and congested and small henturrhages may occur. An exudation, at first grayish in color, hut later purulent and yellow o• greenish-yellow, takes place into the meshes or upon the surface of the pia, and the spinal fluid is rendered turbid and opaque. The inflammatory process may ex tend to the substance of the spinal cord (causing myelitis), o• to the inner surface of the dura !miter, involving of course the arachnoid and gluing the three membranes together. Treat ment comprises rest in bed, upon the side or face, active purgation, and cups or leeches along the spine. followed by the application of ice. In ternally drugs are given to relieve pain and diminish sensibility. In the chronic stage coun terirritants are applied along the spine, and mer eurials or iodides are administered. During con valescence tonics, cold douches, and the electric current arc of great service.
chronic /cptomeningitis may be a continuation of the acute form or it may he chronic from the beginning, and has been attributed to cold and exposure, syphilis, chronic alcoholism, and in jury. It often occurs in connection with de generative processes of the cord itself. The eon dit ion is one of gradual thickening of the pia mater with compression and atrophy of the nerve roots. The symptoms are the same as in the acute form, with the difference that they come on gradually and there is no fever. Muscular spasm and rigidity arc less marked.