Diseases of the spinal marrow / [Robert Bentley Todd].

  • Todd, Robert Bentley, 1809-1860
Date:
1835
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the spinal marrow / [Robert Bentley Todd]. Source: Wellcome Collection.

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    wall of the spine being so resisting, except at its inferior extremity, where this wall is com¬ pleted by a ligamentous expansion closing the sacral canal. Morgagni* relates a case from Genga, in which spinal dropsy of this kind manifested itself externally at the situation of this ligament. A child, aged four years, was attacked with hydrocephalus in consequence of a blow on the head. About a month after¬ wards a tumour appeared at the coccyx; it was opened, and the head appeared to dimi¬ nish gradually in size as a large quantity of water was discharged from the puncture. Com¬ pression on the head increased considerably the impetus with which the fluid flowed from the opening ; a circumstance which proved that this tumour communicated with the head, and resulted from the distension of the spinal membranes. It should be observed, however, that spinal effusion is not necessarily co-existent with hydrocephalus, for the exit of the fluid from the ventricles may be and often is pre¬ vented by the closure of the opening beneath the valve of Vieussens. Sometimes we find a viscid almost jelly-like matter effused round the cord, but this is most probably merely a post-mortem effect. Effusion of blood into the spinal cavity, or between the membranes, constitutes the disease termed spinal apoplexy. The blood is generally found in a state of coagulum. This effusion may arise from concussion of the cord, occa¬ sioned by a fall from a great height—by a blow inflicted on the back; it is found also after death from cerebral apoplexy, hanging, teta¬ nus,f hydrophobia,! and in children whose death has been occasioned by difficult parturi¬ tion. Sometimes a portion of the spinal mar¬ row itself is so mixed up with the coagulum as not to be distinguished from it, in which case the hemorrhage would appear to have origi¬ nated in the tissue of the marrow. Convulsions, paralysis, sometimes a diminu¬ tion, and at others an increase, of sensibility, pain in the back, are the most usual symptoms which have been observed in such spinal lesions. In a case related by Dr. Abercrombie, of a child seven days old, the symptoms were re¬ peated attacks of convulsions with trismus, and sometimes universal tonic spasm. Death took place on the fourth day. On dissection, a long and very firm coagulum of blood was found lying between the bones and membranes of the cord on the posterior part of the whole cervical region. A case of encysted spinal apoplexy is recorded by Dr. Stroud. The cyst was an inch in length, and about half an inch in diameter ; it was external to the cord, and existed at the upper part of the dorsal region on the left side. The patient died universally paralysed; the disorder, however, set in with hemiplegia, to which succeeded paraplegia, and then the palsy spread. * Epist. 12, § 9, and Ollivier, loc. cit. vol. ii. p. 494. t Vide Reid on Tetanus and Hydrophobia. % A. T. Thomson, Med. Chirurg. Transactions, voL xiii Purulent effusions in the spinal canal are the | surest indications of inflammation of one or j more of the meninges, which likewise present; 1 other characters to particularize them. Effusions of air, constitutingpnewnatorachisf > have been described by Ollivier as occurring in the spinal canal. We are not acquainted with ,' any writer who has fully confirmed his expe- rience on this point. Otto has met with air in ' the spinal canal, but, he says, not under such l unequivocal circumstances as would justify | him in regarding it as a morbid product. An- j. dral does not at all allude to its occurrence. ! M. Ollivier says, u It is not very rare to find j . the lumbar portion of the meningeal canal more or less swollen by a gaseous fluid, inodo- rous and colourless, which cannot be attributed to putrefaction, inasmuch as I have seen it in the spinal canal of subjects recently dead, and could not discover it in a great number of others which were dead some days. I have not remarked that this disengagement of gas took place as a consequence of any particular disease.”* The cases in which he has found air in the meningeal sheath did not present symptoms of spinal disease before death; in most of the cases the examination was made twenty-four hours after death. Billard met | with a case in connexion with ramollissement f of the brain and spinal marrow. In the treatment of spinal effusions it is ob¬ vious that the practitioner must have in view I not only the removal of the effusion, but also that of its cause, when that cause may happen Jj to continue. To effect the latter object, it is | evident that he must vary his treatment accord- \ ing to what the symptoms would indicate as the most probable cause; but to remove the effusion various remedies may be had recourse to. Sometimes it fortunately happens that the effusion is absorbed as soon as its cause is removed, and thus the application of one re- j medy answers a double purpose. When after j accidents of the spine there are numbness and i pains in the limbs, symptoms in all probability denoting an increase in the natural spinal effu¬ sion, these symptoms are often removed with a remarkable rapidity after a free local depletion or a pretty extended counter-irritation. This latter object may be effected by the usual blis¬ ter, by the moxa, by setons or issues, or by frictions along the spine with any irritating ap¬ plications that will produce a discharge. Of these we decidedly prefer the last; they are often purely local in their action; whereas when blisters are used, some active principle of the cantharides seems to be absorbed into the system, which though it may not be manifest from appearance of strangury, yet we cannot help thinking, produces in a similar way that aggravation of symptoms which so constantly follows the injudicious ap¬ plication of blisters. Mercurials may be ad¬ ministered with benefit in these cases, either internally or through the medium of the skin. Perfect rest, the horizontal posture, and an ex¬ emption from such causes as may disturb the