292 DISEASES OF THE SPINAL MARROW AND ITS MEMBRANES. 



that respiration is affected, death occurs quickly. If, on the other hand, 

 a part far down be destroyed, death does not result for years, and is 

 generally caused by large bed-sores, or cystitis, induced by paralysis 

 of the bladder. 



Since we cannot, by therapeutic means, hasten the reabsorption of 

 the effused blood, or aid the regeneration of the broken-down nerve- 

 filaments, the treatment of spinal apoplexy can only be symptomatic. 

 At first, as long as there are severe pains in the -back and symptoms of 

 inflammation, the proper treatment is local bleeding, and the applica- 

 tion of an ice-bladder to the part where the haemorrhage is suspected. 

 Subsequently there is usually little to do but to guard the patient 

 against bed-sores, to carefully empty the bladder at regular intervals, 

 and to maintain the strength of the patient. Well-to-do persons, who 

 remain paralyzed from spinal apoplexy, may be sent to Wildbad, 

 Pfaffers, or Gastein. But, the more certain the diagnosis, the more 

 improbable it is that these baths will prove beneficial. 



CHAPTER III. 



INFLAMMATION OF THE MEMBRANES OF THE SPINAL MARROW 



MENINGITIS SPINAUS. 



ETIOLOGY. Inflammation of the dura mater probably never occurs 

 as an independent disease, but it very frequently follows injuries, and 

 especially inflammations of the spinal column. Acute inflammation of 

 the arachnoid is also almost solely observed as an accompaniment of 

 inflammation of the dura and pia mater ; but chronic inflammation of 

 the arachnoid, resulting in partial thickening and ossification, occurs as 

 a primary and independent disease, without perceptible cause. Acute 

 inflammation of the pia mater from epidemic influence has already 

 been described, among the diseases of the brain, as meningitis cerebro- 

 spinalis. Besides this form, there are sporadic cases of inflammation 

 of the pia mater of traumatic origin, or due to inflammation of the 

 dura mater ; and, lastly, although rarely, cases that must be referred 

 to catching cold, or some other injurious influence acting on the body 



ANATOMICAL APPEARANCES. Inflammation of the dura mater is 

 never spread over large surfaces, but is always more or less circum- 

 scribed. At first the inflamed spot appears injected, infiltrated, and 

 relaxed ; later it becomes discolored, friable, and is occasionally cov 

 ered with purulent exudation. The results of pachymeningitis spinalis 

 are permanent thickening of the dura mater, and its adhesion to the 

 bone ; more rarely there is perforation of the dura mater by the pus col- 

 lected between it and the bone, and, as a consequence, diffuse meningitis. 



