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The following table will show, as nearly as possible, the influerj" of different plans of treatment on the duration of the disease.
In the 11 eases where the arachnoid and pia mater were inflamed (or the pia mater alone), the termination was invariably fatal. In one, a male, set. 29, the symptoms were developed by epilepsy, to which he had been for some time subject, and which had appeared soon after his marriage; death ensued on the second or third day. In another, a male, set. 20, it arose from tapping a cyst which communicated with the spinal canal; death ensued on the 3d day; while in a 3d case, a male, set. 50, it arose from the effusion of blood into the spinal canal, death took place on the 12th day, in the midst of clonic convulsions. In the other 7 cases death ensued in 1, a male, a?t. 29, on the 7th day; in 2 on the 9th day, in 1, a male, set. 29, from coma, in the other, a male, set. 28, from convulsions; in 2 on the 10th day, in 1, a male, aet. 24, from coma, in the other, a female, ait. 22, while in a warm bath; in 1, a male, set. 19, on the 11th day; in another, a male, ret. 35, on the 20th day, from inflammation of the membranes of the base of the brain; and in a child 3 days old in 24 hours, from exhaustion after convulsions. In this case it is probable that the inflammation had existed prior to the occurrence of the convulsions, for a longer period than 24 hours seems necessary for lymph to form.
The termination was fatal in the 7 cases where the membranes and the cord were affected.
In one, aet. 19, it ensued on the 8th day after convulsions; in a 2d, aet. 18, on the 14th day, exhausted and depressed; he was sensible until fi hours before death; in a 3d, set. 35, retention of urine came on, 11 days after pain in the back with fever and lassitude had been experienced, and death took place on the 9th day from general paralysis; in a 4th, a?t. 56, on the 21st day, from sloughing of the sacrum; in a 5th, set. 35, on the 23d day, from exhaustion consequent on diarrhoea and sloughing of the sacrum; in a 6th, a>t. 46, on the 26th day, from diarrhoea and general paralysis; in the 7th the patient was a child, and death ensued from hydrocephalus; its duration is not stated.
The termination was fatal in the 13 cases of inflammation of the membranes of the cord and of the brain, with or without implication jf the substance of the brain or cord. .
The following table will show the ages of the patients, and the duration of the disease.
Age. Duration of the Disease.
Adult, fatal on 4th day. 61, „ „ It occurred on the 11th day of peripneumonia, which
was progressing to a cure.
21, „ 9th day. 24, „ 10th „
3J, „ 9th „ after admission to hospital. 60, „ 12th „
5, „ 16th „
13, Sudden hemiplegia on 11th of March, death on 14th of April. Tu
bercles in brain.
24, Fatal on 8th day. 26, „ 9th „ 40, „ 9th „
14, Extended over a period of some weeks.
Sex and Age.—Of the 39 cases of acute inflammation and its complications 28 were males and 8 females; the remaining 3 were cbildrenv their sex was not named.
Jn 7 of the 8 cases where the arachnoid was inflamed, 4 of the patients were males and 3 females. The ages of the first were 24, 28, 42, and 80; of the last, 15, 18, and 21.
In 10 of the 11 cases of inflammation of the arachnoid with implication of the pia mater, or inflammation of the pia mater alone, 9 were males and 1 female. The ages of the first were, 19, 20, 24, 24, 28, 29, 29, 35, and 50; the age of the female was 22.
In 6 of the 7 cases where the membranes and the cord were both inflamed, the patients were males, and their ages were, 18, 19, 35, 35, 46, and 56.
In the 13 cases where the membranes of the brain and cord were inflamed, with or without implication of the substance of the brain or cord, 8 of the patients were males and 5 females. The ages of the first were 3£, 13, 15, 21, 24, an adult, 50, and 60; while the ages of the last were 12, 14, 14, 26, and 40.
Causes — 1. Of Spinal Meningitis.—Exposure to cold and wet, particularly if accompanied by fatigue, disease of the bones of the spine, or injury to the spine, seem to be the most frequent exciting causes. In one case it was induced by blood effused into the canal consequent on a fall; in another, from the formation of an ulcer on the surface of the tumour present in spina bifida; in a 3d, from the extension of inflammation excited by tapping a large cyst which communicated with the spinal canal; in a 4th, the patient had suffered for five years from an oedematous affection ot the scalp, when headache set in, which yielded to treatment, but was followed by inflammation of the eyelids, which by the use of leeches had nearly subsided, when severe pain in the back declared itself. The sudden suppression of the menstrual discharge may act occasionally either as an exciting or predisposing cause. Inflammation of the lungs, kidneys, bladder, or intestines, may act in the same manner, or by the extension (particularly in diseases of the two first organs) of the inflammation along the walls of the vessels, or by the conveyance of inflammatory products to the membranes. In some of the cases, particularly those in which the pia mater was inflamed, symptoms of a rheumatic nature, more or less intense, and of variable duration, preceded the development of the symptoms.
2. Cerebro-Spinal Meningitis.—Nearly the same causes which induce spinal meningitis induce inflammation of the membranes of both situations. In one case it was induced by fright; her sister had been seized with the disease a few days before. In a 2d, it set in just as a favus of long standing was nearly cured; in a 3d it was induced by a long march, made immediately after being discharged from the hospital, where he had been under treatment for intermittent fever; in a 4th, after torticollis had existed for some days, it declared itself after a long walk on a very hot day; in a 5th, disease of the spine had existed some months; in a 6th, to sleeping in the sun when tipsy; in a 7th, to sleeping on the ground in a cold winter's night; in an 8th, it supervened on hemiplegia, induced by tubercles in the brain.
The disease under this form sometimes rages epidemically, often at the same time as typhus. Hoyle states that the English troops sent to Sicily suffered severely from it; and during the wars of the Directory and Empire, troops from the north, when in garrison in the towns of the south, were very liable to it.
General Symptoms of Spinal Meningitis.
1. Of the Arachnoid.—The close resemblance which the symptoms, indicating the existence of inflammation of the arachnoid, bear to those present in congestion of the cord, render it sometimes difficult to distinguish one from the other; not that it is of any practical importance, for the treatment to be adopted in both is essentially the same. In congestion, fever is rarely present, and the pain is of ;i dull weighty character, and although paralysis is more or less complete, it is seldom attended, unless it is about to pass into inflammation, by shocks of pain or convulsive jerks. In inflammation of •he arachnoid, the fever is generally severe, and the pain of a burn
ing character. In some cases, however, where the lower part of the canal is the seat of the inflammation, it may be very slight, and continue so if the inflammation does not extend. With the pain a feeling of numbness, with pain and paralysis of the muscles is experienced in the lower part of the extremities, which gradually creep upwards to the body, which at length becomes similarly affected. Sometimes the paralysis is more marked in one extremity than the other, but this difference is seldom of long continuance unless the result of the inflammation is the formation of false membranes, which press on the nervous cords of one side more than the other.
When the paralysis extends to the lower part of the body, retention of urine ensues, and with it, from paralysis of the rectum and sphincter ani, either obstinate constipation or involuntary escape of the contents of the bowels. The last state generally succeeds the first when purgatives have been given. As the inflammation extends upwards or fluid accumulates, the walls of the chest and the upper extremities become paralysed. When the first takes place, a feeling of intense oppression will be experienced, sometimes general, at others more marked at one point than another, and inducing a sensation as if a cord or band was bound tightly round it. When the paralysis of the walls of the chest is complete, respiration will be carried on solely by the diaphragm, assisted slightly by the muscles of the neck, and it will be slow, sometimes sighing and interrupted, particularly on motion, by accesses of suffocation.
The upper extremities rarely become so severely or extensively paralysed as the lower. When the inflammation affects the whole extent of the arachnoid at the same time, the pain will exist along the whole length of the spine, and the paralysis will be general, and rapidly developed. But when the inflammation is confined to one point, as for instance to some part of the dorsal region, and if the result is the formation of false membranes, or serum or pus bound in by adhesions, and not in sufficient amount to press on the cord or nerves, and interfere with the reception or transmission of impressions, paralysis will then be absent, for it is only as a mechanical cause that the effused matters in inflammation of the arachnoid produce paralysis. It is therefore common to find, in inflammation of the upper parts of the canal, from the effused matters poured out gravitating to the lower part, paralysis of the lower extremities and of the bladder and rectum.
The paralysis of motion is nearly invariably accompanied by that of sensation. In two of the cases only was it increased, and this without the cord being apparently affected. Whether this state of increased sensibility of the cutaneous surface is due to irritation of the nerves of sensation or not it is difficult to say. It is not, however, improbable but that it may be.
The parts supplied with nerves from that part of the cord where the membrane is inflamed, are sometimes the seat of transient shocks of pain or slight convulsions, and sometimes of tremulous motions. The shocks of pain and the convulsions occur under X* circumstances; in one, from motion of the parts, in this case ibev generally pass upwards; in the other, from impressions (such * sudden mental emotion or noise) received through the brain, in the case they pass from the centre to the periphery.
These sliocks are often very troublesome, and occur just as ttr patient is about to fall asleep, or if when asleep, he begins to dream, in both instances awakening him.
Case I.—A delicate female, set. 15, not accustomed to exertion, cam* '. London in 185t to Bee the exhibition. During the first two days she walk*: a great deal, and on her way home to her lodgings, on the evening of the ii day, very much fatigued, she got wet. She passed a very restless night, siJ felt as if her whole body was bound tightly up in a bandage, but towsrs; morning she fell asleep, and awoke nearly free from it. But she complaiofJ of a feeling of general lassitude, and drew her mother's attention to her feet, which felt benumbed and somewhat painful. She remained in bed until tlx evening, when she got up for the bed to be made. Then she complained tks: her legs, as high as the knees, were benumbed, and she was scarcely able r» stand. She passed a somewhat restless night, was feverish, and drank a grea: deal. In the morning, the legs, as high as the thighs, were benumbed isi painful, the lower part of the back was also the seat of burning pain. Sh= was now seen by a medical man, who gave her some medicine which opened the howels, which were confined, and inducing diarrhoea and inability to control the escape of their contents. The urine began to dribble away from her. At length, on the 4th day, a catheter was passed, and a larjft quantity of urine drawn off, and from this time it was introduced daily. She was now seen by a physician. She was cupped, and leeches were applied several times. In the course of the next 12 days she regained the power of controlling the evacuation of the contents of the bladder and rectum, and sons? slight power over the lower extremities. She was now brought into the country, where I had an opportunity of observing the case.
The power of motion in the extremities was still limited, they could be slightly retracted and moved on the bed, but not raised. Sensation was obtuse, and this existed as high as the trochanters. Pain existed accompanied bv numbness, both were increased by motion, and lasted some time ; the pulse wa? quick, but soft and compressible, skin rather warm, tongue red, thirst, particularly towards night severe, urine high coloured, pain in the lower part of the hack, but of no great severity, and unaccompanied by tenderness, bat slightly increased by bending the back.
The cupping and the application of leeches were repeated several times, and small doses of calomel with Dover's powder given, with the effect of rendering her mouth slightly sore. From the time that this effect was produced, her recovery was rapid, and on the 35th day from the commencement of the attack she was able to walk about as usual.
Case II.—A robust carter, set. 24, on the 24th of April 1850, when wet and fatigued, threw himself on some straw in his stable, and went to sleep for several hours. On awaking he felt very cold, and made great efforts to shake it off by exerting himself, hut to no purpose. He passed the night suffering severely from pains in his back and limbs, and in the morning he was unable to go to work. Some epsom salts were taken, but without effect. He was seen on the evening of the 25th. His face anxious, flushed, and covered with perspiration, as was also the rest of his body. Pulse full and strong, skin hot, thirst severe, tongue white in the centre, but red at its edges and apex. The lower extremities were motionless and insensible, and the seat of severe numb