Acute Myelitis. Poliomyelitis. 159 



akinesis without change of the sensitiveness or with hypersensi- 

 tiveness. If restricted to the upper columns there may be sensory 

 paralysis on the opposite side. 



The heart sounds and pulse are usually altered, palpitations 

 may appear early with acceleration and sharpness of the pulse, 

 and this may alternate with a tardy slow pulse with intermissions. 

 Breathing also becomes accelerated and in violent cases with 

 trembling, though in moderate inflammation with effusion, soften- 

 ing and degeneration, it is liable like the heart beats to become 

 slow and tardy. 



When vertigo appears it may be attributed to extension to the 

 bulb or cerebellum, or to the sympathetic implication of these 

 organs. 



The frequency with which paraplegia occurs in the larger her- 

 bivora suggests a special susceptibility of the lumbar portion of 

 the cord, probably in connection with severe muscular effort, of 

 the hind limbs. 



In protracted cases the fever may run very high, being compli- 

 cated by septic poisoning from the numerous cutaneous sloughs and 

 sores, as well as by cystitis and nephritis. 



Diagnosis. This may be based on the progressive onset, unlike 

 the sudden attack of congestion ; on the occurrence of primary 

 fever with hypersesthesia or even muscular rigidity, merging into 

 a later paresis or paralysis ; on the retention of urine, followed by 

 incontinence ; on the torpor of the rectum ; on the extreme ten- 

 derness of the spine in the region of the inflammatory lesion ; and 

 on the tendency to rapid atrophy of the affected muscles, and the 

 death and sloughing of .the skin under pressure over the promi- 

 nent parts of the body. The definite locahzation of the muscular 

 symptoms, and the different temperature and secretion of the 

 affected part of the skin, from the unaffected, are further con- 

 firmatory of myelitis. 



Prognosis. While always grave, myelitis induced by narcotic 

 •elements in the food which can quickly be eliminated from the 

 system, and that which has not caused compulsory decubitus, or 

 persistent retention of urine and faeces, may be considered as 

 hopeful. When, on the other hand, the nature and extent of the 

 lesions have entailed a prolonged paralysis, or in the large animals, 

 (especially solipeds), a persistently recumbent position, there is 



