MYELITIS. 295 



catarrh of the bladder. Paraplegia occurs in some other spinal dis 

 eases as well as in chronic meningitis. The gait of the patient is not 

 characteristic, and does not differ from the gait in other forms of para- 

 plegia. The old belief that the symptoms of paralysis, due to a col- 

 lection of fluid in the spinal canal, grew worse when the body was 

 upright and less when it was horizontal, from the fluid being dis- 

 tributed more evenly, was purely theoretical and not derived from 

 direct observation. The most important points, in distinguishing 

 chronic meningitis and hydrorhachis acquisita from other diseases of 

 the spinal cord, are the symptoms of irritation, particularly the painful 

 sensations which precede the paralysis ; also the gradual advance of 

 the paralysis from below upward, which does not occur in the disease 

 limited to certain points, and particularly the varying course of the 

 disease, the exacerbations and remissions, which do not occur in dis- 

 eases destroying the spinal medulla. 



TREATMENT. Acute spinal meningitis requires energetic antiphlo- 

 gistic treatment, particularly the application of leeches and wet cups to 

 both sides of the spine. If the disease be of traumatic origin, we should 

 at the same time use cold to the back by means of an ice-bladder, or the 

 frozen compresses before mentioned. In very recent cases, as there is 

 danger in delay, and not much can be lost, we may employ the much- 

 lauded frictions with meiourial ointment, and give calomel internally. 

 If the acute stage passes off and the disease is protracted, we may 

 apply flying-blisters to both sides of the spine ; commencing with them 

 at the neck, we gradually descend to the sacrum, and then begin again 

 at the neck. In meningitis, flying-blisters appear to be more efficient 

 than moxae and the hot iron, which deserve the preference in diseases 

 of the vertebrae, and in inflammations of the spinal medulla limited to 

 certain points. In protracted cases, or at the commencement of those 

 running a chronic course, cold plunge-baths and douches, and particu- 

 larly continued warm baths, ane very serviceable. The reputation of 

 these remedies, in paraplegia generally, depends chiefly on their results 

 in chronic meningitis spinalis, which is the most amenable to treat- 

 ment of the diseases of the spinal medulla and membranes. Such 

 patients are also benefited by the bath-treatment at Wildbad and 

 other similar thermal springs. 



CHAPTER 1 V. 



INFLAMMATION OF THE SPINAL MAEEOW MYELITIS. 



IN the present chapter we discuss also softening and hardening of 

 the spinal medulla, myelomalacia, and myelosclerosis, since we shall 

 consider these degenerations (except where the softening is due tc 

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