Home >> Manual Of Medical Diagnosis >> Diseases Of Uncertain Or to Neuralgia >> Diseases of the Spinal_P1

Diseases of the Spinal Cord

pain, irritation, inflammation, spasm, character, action and nervous

Page: 1 2

DISEASES OF THE SPINAL CORD - inflammation of the spinal cord, except as a consequence of accident or injury, is confessedly so rare, that it demands but lit tle notice in a work, the avowed object of which is to conduct the student to right principles of diagnosis. In its general character it ranks among acute diseases, and it is often accompanied by symptoms of cerebral inflammation : these may arise either from the actual spread of the inflammatory action to the membranes of the brain, or they may be produced merely by the sympathy necessarily existing between parts whose functions are so closely connected: such symptoms have been found, both with and with out sensible change within the cranium.

The history of the case perhaps reveals the previous occur rence of some accident or strain, or casual exposure to cold, which may be reckoned among its more usual causes. In every instance it gives an account of a sudden seizure as the starting-point from which to date the sequence of the phenomena, while the greater or less rapidity with which they succeed each other, enables us to judge of the relative severity of the attack.

The early stages of the disease are liable to be confounded with rheumatism and neuralgia; but on closer investigation it will be found that there is more of general disturbance than the local and limited nature of the attack would warrant us in expecting, were the pain due to either of these diseases. It is always cha racterized by pain somewhere in the region of the spine and, generally pretty high up ; of a fixed character, and notably in creased by any quick change of posture. In well-marked cases this pain is accompanied by spasm having somewhat of a tetanic character, especially in the muscles of the neck and upper part of the back ; paralysis sometimes comes on early. These are exactly the signs which, d priori, we should expect to meet with in inflammation of the cord, as they are due either to the irrita tion or the subsequent disorganization of the large bundles of nerve fibres. In many cases we are perplexed by the paucity and comparatively slight character of the symptoms directly traceable to the spine, and their very constant association, when they have attained a certain degree of severity, with others which are more distinctly cerebral. Paralysis, or loss of sensation, indicates a further advance : the inflammation is no longer limited to the membranes, but, as in the chronic forms of the disease, some change has actually passed upon the nerve fibre.

The condition of the bones should next occupy our attention, in so far as-their regularity of position, capability of movement, and tenderness on pressure are concerned ; and it may be laid down as a rule in diagnosis, that when the cord is inflamed, and especially when spinal meningitis is present, any sudden twist or jarring movement gives more evidence of pain than.mere pres sure. Permanent displacement, as a result of caries, may have proceeded to a very great degree without any distinct evidence of its impeding nervous action ; and when paralysis at length occurs, it is often due to inflammatory action set up by the con tiguity of diseased structure. Probably this cause operates even more than the pressure dependent on increasing dis tortion: in such circumstances the characters of an acute attack are generally wanting.

As connected with this subject a few words must be said upon the some what fashionable ailment denominated spinal irritation. It is a great misfor tune when a name is given to any affection which conveys an erroneous impression of its nature; irritation of a nerve produces either momentary spasm or transient sensation, as the course of the nervous influence is centri fugal or centripetal : and a continuance or repetition of the irritation will pro duce the same phenomena in a more or less continued succession : in this view all pain and all spasm may be classed generally under nervous irritation, and so the true spinal irritation which characterizes the first stage of inflammation of the cord produces fixed local pain, and distinct local spasm. On the other hand, excessive tenderness or sensibility—hypertesthesia, as it is called,—such as occurs in inflamed states of organs, whether with or without actual pain, as well as the excessive mobility seen in chorea or delirium tremens, may be said to be due to irritability when the ordinary stimulus excites unusual action, but there is no proof of irritation. Again, loss of sensation and loss of motion are not evidence of either irritability or irritation, but of interruption to the transmission of nervous influence, or loss of power in the brain to take cog nizance of the one or originate the other.

Page: 1 2