270 SPINAL DISEASES fined suppuration, or by abscess; the most common mode being by softening, the disor- ganization involving the whole cord or only one column. Acute myelitis, except as a se- quel to spinal meningitis, or when caused by a wound, is rare. The symptoms are similar to those of spinal meningitis, and it must be borne in mind that the two diseases are rarely unconnected, one inducing the other, the pri- mary disease being predominant. Paralysis often comes on in a few hours, and is more pronounced than in meningitis. It is usually confined to the lower limbs, but involves the upper extremities when the affection reaches as high as the fifth pair of cervical nerves. When the inflammation is in the upper cervical and occipital sections of the cord, death may take place almost immediately from arrest of respiration. In chronic affections the palsied limbs usually become atrophied, and indura- tion or sclerosis of the cord ensues, caused by an abnormal growth of connective cellular tissue, accompanied by atrophy of nerve tis- sue. Myelitis attacks subjects of all ages, but more commonly adults, and is more frequent in the male than in the female sex. The treatment depends upon the intensity of the 'attack; in the majority of acute cases little more can be done than to endeavor to relieve the most urgent symptoms, such as promoting the action of the bowels and preventing re- tention of urine. Strychnia may be some- times used in the earlier stages of acute mye- litis with advantage, and so may the electric current, and in chronic cases with decided bene- fit. Spinal Apoplexy, or haemorrhage within the spinal canal, may be caused by injuries to the spinal membranes, or by degeneration of the cord. Extravasations of blood derived from the membranes are chiefly formed in the lower part of the spinal canal, and the changes found in the substance of the cord, and the blood clot, are similar to those in cerebral apoplexy, as described in BRAIN, DISEASES OF TOE. The effusions cause irritation, pain in the back, spasm of muscles below the seat ef injury, and finally paralysis. Spinal apoplexy is distinguished from other paralytic affections by observing that the attending paralysis is usually not accompanied by fever or general loss of nervous power, and other symptoms. The treatment is rest and attention to the gen- eral state of the health, with moderate counter- irritation. Progressive Locomotor Ataxia (Gr. araf/a, want of order). This name has been given to a form of paralysis characterized by disorderly muscular movements in conse- quence of loss of coordinating power, which has been recognized only within the present century. Duchenne described it in 1858-'9 more fully than any previous author, and gave it its name. Its pathology and location had been pointed out by Dr. Todd, but its causes were more fully investigated by Duchenne. Romberg called the disease tales dorsalis, and it has also been called myelo-phthisis. There is not much loss of muscular power, except as general debility advances, but the diminution of sensation is more marked. The patient has a peculiar gait in walking, throwing the legs out in a jerking and uncertain manner, and when the disease is pretty well advanced throws his arms out like a man balancing on a tight rope. He seems to be somewhat in the condition of one who is walking in the dark over uneven ground. That which has been termed the " muscular sense " is impaired. The harmony of the reflex impressions by which muscular contractions are regulated and the limbs moved and adjusted is so far disordered that either too much or too little contraction is produced at each step. The foot will be thrown out and not properly brought to the ground, and as if to relieve this deficiency the patient by an effort of the will brings the foot down at the next step with too much force. A chief characteristic is the inability to walk or stand with the eyes closed. It needs the assistance of sight to keep the body erect. The walk is uncertain and reeling even with the eyes open, but if the patient shuts them he will fall. As the disease progresses, the upper ex- tremities become affected, and it is difficult for the patient to tie his cravat or button his coat, or perform any motions requiring coordina- tion of muscular movements. There are cer- tain premonitory symptoms which have been relied upon, such as fugitive shooting pains in different parts of the body, of a neural- gic character; but they are often found un- connected with the disease, and often absent when the disease is present. One of the early symptoms is incontinence of urine consequent upon relaxation of the sphincter muscle, and an irritable state of the mucous membrane of the bladder; and there is often increased sexual activity, which however declines in the progress of the complaint, and at last ends in impotence. A characteristic feature of the disease is transient localized paralysis, such as that of the sixth pair of cranial nerves, which supply the external straight muscle of the eyeball, or the third pair, which supply the elevators of the eyelid, and the constrictor of the iris, so that there is drooping of the lid and dilatation of the pupil, one eye being usually affected more than the other, and vis- ion is sometimes impaired or lost. In some cases these paralytic affections are permanent. When the paralysis of the limbs begins on one side, which it frequently does, it is much often- er upon the left than the right side. Before the disease is much advanced, although the gait is irregular and jerking, the patient re- tains the power to walk considerable distances in spite of the great exertion which he makes. After a time the power of locomotion is lost, the patient is confined to his bed, he becomes unable to feed himself, and speech is difficult, sometimes impossible. The disease is distin- guished from ordinary paraplegia, or anterior spftial paralysis, by the careful and circumspect
