290 DISEASES OF THE SPINAL MARROW AND ITS MEMBRANES. 



lower extremities and their incomplete paralysis. These disturbances 

 of sensation and motility, proceeding from below upward, rarely extend 

 to the upper extremities ; when this does occur, the respiration is also 

 said to be occasionally affected, while the bladder and rectum hardly 

 ever participate in the paralysis. From this combination of symptoms 

 we cannot decide on hypersemia of the spinal marrow with any cer- 

 tainty, unless there are other symptoms of it, and the symptoms dis- 

 appear after bleeding from the haemorrhoidal or uterine veins, which 

 anastomose with those of the spinal medulla, or after local abstraction 

 of blood. It is at least doubtful whether convulsions result from ex- 

 cessive hyperaemia of the spinal marrow, since the hyperaemia found 

 on autopsy after severe convulsions may just as well be the result as 

 the cause of the spasm. The same is true of the association between 

 the spinal hyperaemia, found after febrile diseases, and the symptoms 

 of the fever. " Spinal irritation," which for a time caused a good deal 

 of talk, is a term used to indicate a condition chiefly characterized by 

 sensitiveness of certain spinal processes to pressure, great inclination 

 to reflex movement, and a general hyperaesthesia. We find these 

 symptoms just as frequently as we do headache in many acute and 

 chronic diseases, without its being possible to interpret them. At all 

 events, we are not justified in deciding from their presence, without 

 further proof, that there is hyperaemia of the spinal marrow, any more 

 than we are in diagnosing cerebral hyperaemia in patients who have 

 only headache. 



If the causes of the spinal hyperaemia be made out, we should, in 

 the first place, attempt to fulfil the causal indications. When the hy- 

 peraemia has attained a certain grade and we cannot hope for its sub- 

 sidence without therapeutic aid, we may employ local blood-letting by 

 wet cups and leeches. We should apply the former along the spinal 

 column, the latter about the anus, especially when there is coincident 

 abdominal plethora. The effect of the abstraction of blood is sup- 

 ported by cathartic medicines, particularly the neutral salts. 



CHAPTER II. 



HAEMORRHAGE OF THE SPINAL MARROW AND ITS MEMBRANES 



SPINAL APOPLEXY. 



EXCEPT small ecchymoses, which accompany excessive spinal hyper- 

 eemia, extravasations between the meninges and into the substance of 

 the spinal marrow are very rare. Degeneration of the walls of the 

 vessels, and increased pressure of blood in the arteries, which are the 

 chief causes of cerebral haemorrhages, appear to have no effect on 



