298 DISEASES OF THE SPINAL MARROW AND ITS MEMBRANES. 



to the point of inflammation, which is increased by pressure on the 

 spinous processes, but not by movements of the spinal column, which 

 is an important point in the diagnosis between myelitis and meningitis 

 spinalis. This pain is sometimes accompanied by the feeling of a cord 

 tied firmly around the waist. In other cases there is no spontaneous 

 pain, but the corresponding vertebras are sensitive to pressure. If 

 we pass a sponge, previously dipped in hot water, along the spine, the 

 part at the seat of inflammation is generally more sensitive than else- 

 where. These symptoms, which are usually little thought of, are ac- 

 companied by a heaviness and helplessness in the tower part of the 

 body, which sooner or later become perfect paraplegia. The higher 

 up the seat of the inflammation, the more extensive the paralysis. If 

 the lumbar region be diseased, the lower extremities are paralyzed ; 

 if the thoracic region be affected, the sphincters participate in the pa- 

 ralysis ; if the cervical region suffer, the paralysis extends to the upper 

 extremities and corresponding respiratory muscles; with the para- 

 plegia there is generally also anaesthesia of the lower part of the 

 body, but this rarely extends to entire loss of sensitiveness to irrita- 

 tion. While the paraplegia and anaesthesia, slowly increasing, attain 

 a high grade, the affected muscles are still occasionally attacked by 

 spasmodic twitchings, and, if the anaesthesia be incomplete, by painful 

 contractions. This symptom is readily explained by the irritation in- 

 duced in the motor nerves of the extremities from the progress of the 

 inflammation, even after their connection with the central filaments is 

 lost. In cases where the connection between the motor nerves and 

 central filaments is completely broken, so that no muscular contrac- 

 tions are induced by the will, it is not at all impossible for an excite- 

 ment to pass from the sensory to the motor filaments, and for reflex 

 movements to occur. On the contrary, we often see the reflex excita- 

 bility increased in the parts of the spine below the interruption. This 

 pathological experience exactly corresponds with experiment. It is 

 well known that, in decapitated animals, reflex movements occur more 

 readily than in those whose motor nerves are under the influence of 

 the brain. In Greifswald I saw a young woman, who was paraplegic 

 as a result of vertebral disease, in whom the reflex symptoms in the 

 paralyzed part were so severe that the slightest touch on the skin of 

 the lower extremities caused their muscles on both sides to contract 

 spasmodically. It was very interesting to observe that, in this case, 

 when, contrary to all expectation, the paralysis improved, and the pa- 

 tient was able to make voluntary movements of her extremities, the 

 inclination to reflex symptoms entirely disappeared. The course and 

 results of chronic myelitis vary. The disease may run on for years ; 

 frequently it advances to a certain point, and remains stationary. If 



