Volume 1

A clinical treatise on the diseases of the nervous system / by M. Rosenthal ; with a preface by Professor Charcot ; translated from the author's revised and enlarged edition by L. Putzel.

  • Rosenthal, Moriz, 1833-1889.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: A clinical treatise on the diseases of the nervous system / by M. Rosenthal ; with a preface by Professor Charcot ; translated from the author's revised and enlarged edition by L. Putzel. Source: Wellcome Collection.

Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.

    247/300 (page 231)
    The cord is variously affected in the different forms of cancer of the vertebne. In moderate softening- of the vertebnie the medullary paren- chyma is only slightly involved, and over a slight extent. But when the vertebral lesions are more intense, the compression may cause softening and destruction of a considerable portion of the cord. I published a caso of this kind in 1864 (2d edition of my Treatise on Electrotherapeutics), and this observation demonstrated how small a number of nerve fibres will suffice to maintain a satisfactory amount of motor power. A man, a3t. forty-seven years, stated that, for the past year, his legs have become weaker and sveaker. On examination a prominence was found extending from the last cervical to the first dorsal vertebra. The lower limbs were paralyzed and there was par- tial anajsthesia and abolition of electro-muscular contractility ; reflex action can still be produced from the inner portion of the thighs. The patient was able to walk slowly wlieu he was supported imder the arras by an asusfiant. Upon the morning of the third day of his admission I found him completely paraplegic. There was complete ani\3sthes;a of the lower limbs, the buttocks and the back as far as the upper dorsal veriebrai. and extending forwards to the sides of the abdomen. Electro-muscular con- tractility, the galvanic excitability of the nerves and reflex movements were completely abolished. Uiiou the following day paralysis of the sphincters occurred, with extreme dilatation of the right pupil. The patient died at the commencement of the second week. At the autopsy the spinal column was found slightly curved in the form of a capi- tal S, and, from the last cervical to the third dorsal vertebra, was replaced by a can- cerous mass. The cord was compressed to such an extent that the meninges were in apposition and only enclosed a small quantity of softened medullary tissue. The dura mater was thickened, and adherent to the arachnoid ; the dorsal and lumbar portions of the cord were indurated. On microscopical examination, the degeneration was found to affect chiefly the posterior and lateral columns. The diagnosis of cancer of the vertebrae is frequently encompassed with great difficulties. Certain cancerous products may remain latent during life, and, as the preceding history shows, carcinomatous compression of the cord may develop without the production of severe pain. On the other hand, curvatures of the spine and lancinating pains also occur in caries of the vertebne and in compression of the spinal nerves by aortic aneurisms or by hydatid cysts. The peculiar qualities of the pain, in can- cer of the vertel)ru^, consist in their extreme violence, their increasing in- tensity, and their resistance to narcotics, A paraplegia which becomes more and more marked, or a hemi-paraplegia dolorosa (Charcot), following a unilateral subsidence of the vertebra?, enables us to exclude caries of the vertebne and indicate the existence of carcinoma or of a tumor developing in the spinal canah The final appearance of arterial or venous thromboses, cancerous infiltration of the thyroid gland, digestive tract, breasts, testicles, abdominal viscera, lymphatic glands or bones, the increase of the cachexia, and, finally, the much more frequent occurrence of carcinoma at an ad- vanced age, enable us to diagnose cancer of the vertebrte in certain cases in the living subject. It goes without saying that the prognosis is absolutely unfavorable. The patient may survive for several months, a year or even more. They finally succumb to marasmus and dropsy, and, in lesions of the upper cervical vertebrre, to intercurrent cerebral symptoms. The treatment consists in repeated injections of morphine, and in con- tinually increasing doses of opium, chloral, or chloroform; these remedies may alleviate the excessive pains for some time, but they become more and more ineffective, and the patient g-reets death as the only deliverer from torture.