Acute Myelitis. Poliomyelitis. 157 



akinesis without change of the sensitiveness or with hypersensi- 

 tiveness. If restricted to the upper cohimns there may be sensory 

 paralysis only on the opposite side. 



The heart sounds and pulse are usually altered, palpitations 

 may appear early with acceleration and sharpness of the pulse, 

 and this may alternate with a tardy slow pulse with intermissions. 

 Breathing also becomes accelerated and in violent cases w'ith 

 trembling, though in moderate inflammation with effusion, soften- 

 ing and degeneration, it is liable like the heart beats to become 

 slow and tardy. 



When vertigo appears it ma\' be attributed to extension to the 

 bulb or cerebellum, or to the sympathetic implication of these 

 organs. 



The frequenc}- with which paraplegia occurs in the large lier- 

 bivora suggests a special susceptibility of the lumbar portion of 

 the cord, probably in connection with severe muscular effort of 

 the hind limbs. 



In protracted cases the fever may run very high, being compli- 

 cated by septic poi.soning from the numerous cutaneous sloughs and 

 .sores, as well as by cystitis and nephritis. 



Diagnosis. This nia\' be based on the progressive onset, inilike 

 the sudden attack of congestion ; on the occurrence of primary 

 fever with hyperaesthesia or even mu.scular rigidity, merging into 

 a later paresis or paralysis ; on the retention of urine, followed b}' 

 incontinence ; on the torpor of the rectum ; on the extreme ten- 

 derness of the spine in the region of the inflammatory lesion ; and 

 on the tendency to rapid atrophy of the affected muscles, and the 

 death and sloughing of the .skin under pressure over the promi- 

 nent parts of the body. The definite localization of the muscular 

 symptoms, and the different temperature and secretion of the 

 affected part of the skin, from the unaffected, are further con- 

 firmator}' of myelitis. 



Prognosis. While always grave, myelitis induced by narcotic 

 elements in the food which can quickly be eliminated from the 

 system, and that which has not caused compulsory decubitus, or 

 persistent retention of urine and faeces, may be considered as 

 hopeful. When, on the other hand, the nature and extent of the 

 lesions have entailed a prolonged paralysis, or in the large animals, 

 (especially solipeds), a persistently recumbent position, there is 



