408 Historical 



A physician bled him before he entered the hospital and several 

 times placed on his loins cupping-glasses, a blister sprinkled with 

 strychnine, and cauteries with the cautery already there. When he 

 entered the hospital, the paraplegia was complete; no movement of 

 the lower limbs; no contraction even by electricity, they said; loss of 

 sensitivity, even electrical sensitivity. The upper third of the thigh a 

 little sensitive; the patient sometimes had spontaneously a burning 

 sensation in the legs; paralysis of the bladder, sluggishness of the ali- 

 mentary canal, the belly swollen: the bladder was emptied twice a 

 day. Pressure on the spinal column was not painful. A painful 

 erythema existed in the sacral region, that was the beginning of the 

 gangrene of decubitus, which developed later. No fever. In the pres- 

 ence of such symptoms which came on suddenly with pain in fne 

 loins, a hemorrhage in the spinal column was assumed, and orders 

 were given again for cupping-glasses and leeches on the anus, cath- 

 artics, and vinegar enemas, since the cathartics were not effective. 

 There was a slight improvement: sensitivity increased a little on the 

 upper part of the thighs, but soon the disease made progress; a 

 cystitis developed with gangrene of decubitus, fever, chills, incon- 

 tinence with retention, involuntary evacuations; finally, on account of 

 the progress of the gangrene, the sacrum was wholly bared. During 

 the last days of the sickness sores appeared on the heels. 



Death occurred on the fortieth day from the beginning of the 

 sickness. The patient had preserved his mental faculties intact up to 

 the end. 



Autopsy. There was some difficulty in getting the permission of 

 the relatives for the autopsy. Dr. Jeanopoulos was present. The dorsal 

 canal was opened and blood was found in quantity, half-coagulated, 

 reddish-black, between the dura mater and the canal of the bone and 

 extending from the first lumbar vertebra to the end of the meningeal 

 sac. The outer surface of the dura mater, which was wet with blood, 

 was reddish black and infiltrated with extravasated blood. Its inner 

 surface after being sectioned was found to be whitish and slightly 

 bloodshot. In the lower part of the subarachnoid cavity there also 

 existed an effusion of dark red blood, half-coagulated in a fairly large 

 quantity around the nerves forming the cauda equina. Having made 

 incisions in different parts of the spinal cord, we found that a large 

 part of the lumbar portion and the upper third of the thoracic portion 

 had undergone the white softening to a considerable degree, because 

 hardly was the pia mater cut or torn when the substance of the 

 marrow flowed out, so to speak. The other parts of the marrow, even 

 those which were situated between the softened parts, had the natural 

 consistency; no congestion in either the marrow or the pia mater. 

 Since the relatives of the patient had arrived, no examination was 

 made of the other cavities; only the hypogastrium was opened for 

 an examination of the bladder, the walls of which were much hyper- 

 trophied. 



Such are the observations published in our country up to the 

 present concerning this question. 



If we analyze these different data, we see that death occurred in 

 two manners: either immediately or by lesion of the spinal cord. 



