GROWTHS IN THE SPINAL CANAL. 299 



such patients belong to the educated classes, t or to the mechanics 

 proper, they often continue their occupation in spite of their para- 

 plegia. Those cases of paraplegia, where improvement and recovery 

 take place, as I before said, appear to belong to meningitis spinalis, 

 not to myelitis, as it is very improbable that nerve-elements, which have 

 been extensively destroyed, can be regenerated ; the favorable course 

 of incised wounds of the nerves does not disprove this assertion. In 

 chronic myelitis, death most frequently results after the patient has 

 been confined to bed a long while by the increasing paralysis. The 

 consequent bed-sores, or the cystitis caused by stagnation of the urine, 

 generally form the terminal symptoms, if the patient do not sooner die 

 of tuberculosis or intercurrent diseases. 



TREATMENT. The treatment of myelitis promises little. It is to 

 be conducted on the principles laid down for meningitis spinalis. Only, 

 instead of flying blisters, it is well to apply moxae or the hot iron near 

 the supposed seat of inflammation. 



CHAPTER Y. 



GROWTHS AND PARASITES OF THE SPINAL MEDULLA AND ITS 

 MEMBRANES. 



EXCEPT the cartilaginous and bony plates of the arachnoid, which 

 we have already described, growths rarely occur in the spinal canal. 

 Carcinomata, which are usually of the medullary variety, either form 

 primarily in the spinal medulla or dura mater, or extend from the ver- 

 tebrae to the meninges and medulla. When they grow considerably, 

 they may at last fill the spinal canal, as the medulla atrophies from 

 pressure, or is transformed into cancer substance. Occasionally, after 

 destruction of the vertebrae, they have been seen to spread outwardly, 

 so as to lie just under the skin. Only a few cases of sarcoma and 

 glioma have been observed in the spinal canal. They almost always 

 started from the inner wall of the dura mater, and rarely attained any 

 considerable size. Tubercles in the medulla itself only occur when 

 l here is advanced tuberculosis of other organs. Just as in the brain, 

 they usually form yellow nodules, the size of a pea or hazel-nut. They 

 are usually in the cervical or lumbar regions. Somewhat more fre- 

 quently we meet tuberculous degeneration of the dura mater, under 

 the form of so-called infiltrated tuberculosis, along with tuberculour 

 caries of the vertebrae. Cysticerci and echinococci have also beer 

 very rarely found in the spinal canal. The latter had either devel- 

 oped between the membranes, or an echinococcus sac, near the spinal 



