HYPEILEMIA OF THE SPINAL MARROW AND ITS MEMBRANES. 291 



spinal haemorrhage. Intenneningeal haemorrhages may almost always 

 be traced to injuries of the spinal meninges from wounds, contusions, 

 or stretching. Their occurrence chiefly among the newly-born is due 

 to the severe tension to which the spinal column of the child is so 

 often subjected during severe labor. Extravasations of blood in the 

 medulla spinalis are usually terminal symptoms of chronic destructive 

 processes of the cord, and are only rarely due to injuries of the spinal 

 column. 



The extravasations of blood from meningeal haemorrhage are usu- 

 ally considerable ; they collect chiefly in the lower part of the spinal 

 canal, but often fill large portions of the subarachnoid space. Where 

 the haemorrhage is into the medulla, we find it containing a bloody 

 pulp. The changes undergone by the apoplectic clot, when it has ex- 

 is^ed a long time, are little known, but seem to resemble those under- 

 gone by the brain under similar circumstances. 



Apparently intermeningeal haemorrhages only gradually compress 

 the vessels of the spinal cord sufficiently to entirely cut off the supply 

 of arterial blood, and so remove the excitability of the nerve-filaments. 

 In effusions of blood between the meninges, symptoms of severe irrita- 

 tion, pains in the back, and spasms, especially tonic spasms in the 

 parts supplied by the nerves going off below, opisthotonos, rigid con- 

 traction of the extremities, etc., usually precede the paralysis. But 

 where there are large extravasations, there is perfect anaesthesia, and 

 paralysis of the parts receiving nerves from the compressed portion of 

 the spinal cord. If the respiratory muscles be among these parts, 

 death soon occurs ; if they remain unaffected, death may be delayed. 

 It is doubtful whether the conduction can be restored and recovery 

 take place after disintegration and reabsorption of the extravasation. 

 From the above symptoms we can only make a diagnosis of meningeal 

 spinal apoplexy when they have been preceded by an injury of the 

 spinal canal. If the history be imperfect, and we find no causes ren- 

 dering haemorrhage probable, the disease cannot be recognized with 

 certainty. 



Since the substance of the spinal marrow is usually entirely broken 

 down by haemorrhages into it, the conduction from the brain to the 

 peripheral nerves, and from them to the brain, is generally interrupted 

 at the moment of the haemorrhage. The more sudden the symptoms 

 of this interruption anaesthesia, and loss of voluntary motion in the 

 lower half of the body, combined with paralysis of the bladder and 

 rectum appear, the more probable it is that the communication has 

 been interrupted by a rapid breaking down of the spinal medulla from 

 an extravasation of blood, and not by its gradual destruction from in- 

 flammation, softening, or paralysis. When the apoplexy is high up, so 



