SPINAL DISEASES 269
duced by injuries or diseases of the spinal col- umn, or structural affections within the spi- nal canal. The affection is therefore almost always cerebro-spinal. (See BRAIN, DISEASES OF THE.) Fibrinous exudation, serous effusion, and generally pus follow the inflammation, the serum being often tinged with blood. The at- tack may be acute or chronic. When acute it extends over the whole or greater part of the embranes of the cord, but chronic menin- tis is usually limited in extent, and the in- mation is accompanied by fewer patholo- gical changes. Acute spinal meningitis is re- garded by many authorities as incurable, while others assert that mild cases sometimes recov- er. The symptoms are pain in the spine and the extremities, increased more by move- ents of the body than by pressure. There also spasms of the muscles of the back, ther persistent or convulsive, often producing at rigid bending of the body backward called opisthotonos ; also tonic contraction of the thoracic muscles, and consequently difficulty of breathing. These symptoms are followed by paralysis, caused by pressure of the products of the inflammation (fibrinous exudation, effused rum, or pus). The paralysis may be confined the lower extremities, or it may be general, and it is usually limited to motion, while there is preternatural sensibility. The disease runs a rapid course, often terminating fatally within a week. Apnoea, or suspension of the respira- tory function from involvement of the roots f the respiratory nerves, is the usual mode of eath. The treatment, in cases not dependent on blood poisoning, comprises the application ~ cups and leeches, setons, moxas, blisters, timonial ointment, and croton oil, and also belladonna and chloroform and the warm
- h to relieve pain. Iodide of potassium is
'ten given in large doses to promote absorp- on of the products of inflammation. The diet ould be nutritious, but some authorities in- ict the use of animal food. Epidemic ebro-Spinal Meningitis. Although there cases of cerebro-spinal meningitis which idiopathic, and it is therefore then to be garded as truly a spinal disease, the vast ma- rity of cases are of epidemic origin, and the inal lesions are therefore secondary affec- ons, depending upon blood poisoning. The isease is then called epidemic cerebro-spinal eningitis, a dangerous affection which has " late prevailed extensively in different parts the United States and Europe. From the pearance of certain spots upon the skin uring the course of the disease it has been posed to call it spotted fever ; but as these ts are not a constant accompaniment, the reposition has not been adopted. The name as given to an epidemic which prevailed in ew England between 1807 and 1816, which supposed by many to be the same disease, t the identity is not established. Some have rded epidemic cerebro-spinal meningitis as variety of typhus, but the greater suddenne*ss of the attack and the absence of the mulberry rash of typhus indicate a difference of origin. The disease usually begins with a chill, fol- lowed by great vertigo, violent headache, ob- stinate vomiting, and muscular stiffness, which soon passes into tetanus. The face is pale, the pupils contracted, the conjunctivas red, and the skin exceedingly sensitive. The head is strongly drawn back, even at the end of the first or second day, and there is delirium, which soon passes into the stupor of coma. The bodily temperature is variable, the high- est occurring in the most rapidly fatal cases. Wunderlich recognizes three forms. One, rap- idly fatal,_ is accompanied by a high tempera- ture, which rises toward the approach of death to 108 F., and continues to rise for some hours after death. A second form is slight, with fever of short duration and very irregu- lar course ; a third is protracted, but marked by very great variation of temperature. The pulse at the commencement is usually not more frequent, often slower than normal, and is often intermittent. It increases with the disease, but rarely reaches more than 100 beats per minute until near the fatal termination, when it becomes very small and frequent. The urine is increased in quantity and deposits a large amount of urates, and there is sometimes hamaturia. In from 20 to 60 hours after the commencement a peculiar eruption usually ap- pears upon the skin of the neck, abdomen, back, arms, legs, and face, composed of dis- tinct dark red or purple spots, somewhat larger than a pin's head. They are not raised above the surface, and do not disappear upon pressure ; sometimes they do not become visi- ble till after death. The tongue is moist and creamy until the spasmodic stage is established, when it becomes dry, dark-colored, and cov- ered with sorcles. The duration of the disease varies from a few hours to several weeks ; cases are reported as terminating fatally in three or four hours, but more than half the deaths occur between the second and fifth days. Convalesence may begin from the fifth day to the fourth week or later, and is always tedious, relapses being common and often fatal. The treatment is various. Bloodletting has been practised, but with unfavorable results, as might be expected from the depression of the vital powers. The use of quinia is regarded with favor, and opium has its advocates ; ether and chloroform have been used by inhala- tion as sedatives; and tincture of cantharides is said to be of service in cases marked by ex- treme depression. Counter-irritation, by the actual cautery applied along the spine, or by blisters, has been followed by alleviation of symptoms. The use of cold compresses to the head, and of leeches behind the ears,_ is also recommended. Myelitis, or inflammation of the body of the spinal cord, is similar to cerebritis, or inflammation of brain tissue, and may terminate fatally either in the acute in- flammatory stage, or by softening, by unde-
