DISEASES OF THE SPINAL CORD. 
BY 
R. VAN SANTVOORD, M.D., 
OF NEW YORK, 
VISITING PHYSICIAN TO THE WORK-HOUSE AND ALMS-HOUSE HOSPITALS. ANATOMY OF THE SPINAL CORD. 
567 
DISEASES OF THE SPINAL COED. 
ANATOMY OF THE SPIHAL COED. 
Axel Key U. Retzius:—Studien in d. Anatomie des Nervensystems. Vir- 
chow-Hirsch, Jahresb., 1870, I., S. 28. Arch. f. mikrosk. Anat., IX., S. 308, 1873. 
Stud, in d. Anat. des Nervensyst. und des Bindegewebes. Grossfolio. Stockholm, 
1875 und 1876, I. u. II.—Eichhorst: Entwicklung des mensch. Ruckenmarks. 
Virch. Arch., Bd. 64, S. 425.—Krause, W.: Allgemeine und mikroskop. 
Anatomie. Hannover, 1876.—Schiefferdecker : Regeneration, Degeneration u. 
Architectur desR.-M. Virch. Arch., Bd. 67, S. 542.—Flechsig, P.: Die Leitungs- 
bahnen im Gehim u. R.-M. des Menchen. Leipzig, 1876.—Ueber Systemerkran- 
kungen des R.-M. Arch. d. Heilkunde, Bd. XXIII. u. XIX., 1877.—Lowe, S.: 
Ueber d. Bindesubstanz im Centralnervensystem der Saugethiere. Arch. f. Psych, 
u. Nerv., XII., S. 1, 1876.—Mayser: Experim. Beitrag z. Kenntniss des Bauesu. 
s. w. Ibid., VII., S. 599, 1877.—Hugenin, G.: Anatomie des centres nerveux. 
Paris, 1879.—Unger, L.: Ueber den Bau der grauen Substanz des centralen 
Nervensystems. Allg. Wien. med. Ztg., 1879, S. 491. 
BIBLIOGRAPHY. 
Axel Key and Betzius describe the arachnoid as a membrane which 
lies pretty close to and in parts, especially in the cervical portion of the 
cord, is adherent to the dura mater. Anteriorly, as far round as the 
ligament, dentic., the space between it and the cord, the subarachnoidal 
space, is crossed only by a few fibres. Posteriorly, this space is divided 
up by a longitudinal septum, incomplete in many places, and by numer- 
ous parallel and oblique fibres and membranous septa. These fibres and 
septa are made up of fibrous connective tissues, and aye covered with 
endothelium. The arachnoid itself is composed of layers of fibrillary 
network, and is covered with a layer of endothelium. The pia is cov- 
ered with a subarachnoidal fibre-network, in which the larger vessels are 
located. 
Attention is called to the asymmetry which so often exists between the 
different sides of healthy cords. According to Boll, Key and Betzius, 
the pia sends in funnel-shaped prolongations with the vessels, which are 
continued over the capillaries, and form a system of intercommunicating 
lymph-spaces, which open into the subarachnoidal space. The subarach- 
noidal, as well as the subdural space, is in free communication with the 
sheaths of the nerve-roots and the lymph-vessels of the peripheral nerves. 
The subarachnoidal space of the cord communicates freely with that of 
the brain. 
Unger concludes that the fine, so-callea nerve-fibre network discovered 
oy Gerlacli in the gray matter of the cord is really connective tissue ; 
because, in the chick, it appears before any ganglion cells are visible. 568 
DISEASES OF THE SPIHAL COED. 
Carriere has proved the existence of the anastomoses between the mul- 
tipolar ganglion cells. (Arch. f. mihrosTc. Anat., XV., S. 125, 1877.) 
Mayser has demonstrated that some 
fibres of the anterior roots pass through 
the anterior horns to the gray substance 
of the opposite side. 
The most important recent contribu- 
tion to the anatomy of the cord is that 
of Flechsig. By the study of the devel- 
opment of the central nervous system in 
numerous fetuses and in children, he 
discovered that certain tracts in the 
white substance of the cord develop at 
different periods. From this circum- 
stance he was able to divide the white 
substance into certain tracts or systems, 
which in the fully developed cord are, 
for the most part, no longer anatomi- 
cally separable. These, in the order of 
their development, are first, the anterior 
columns exclusive of their inner fourth 
{pr incipal mass of the anterior columns), 
and the posterior columns exclusive of 
the columns of Goll {wedge-tracts) ; 
second, the anterior halves of the lat- 
eral columns {anterior mixed region of 
the lateral columns); third, the layer of 
fibres lying next to the lateral periphery 
of the gray matter (the lateral boundary 
layer of the gray substance); fourth, the 
columns of Goll); fifth, a thin layer of 
fibres at the periphery of the lateral col- 
umns, reaching from or near the pos- 
terior nerve-roots to about the middle 
of the lateral columns {the direct cere- 
bellar lateral column tracts), and sixth, 
the inner fourth of the anterior columns 
{pyramid tracts of the anterior col- 
umns), and a mass of fibres, including 
the posterior half of the lateral columns, 
except the third and fifth {the pyramid 
tracts of the lateral columns). 
The pyramid and cerebellar tracts, 
and probably the columns of Goll, unite 
the nerve-centres above the cord with 
the different centres, etc., scattered at 
different heights along the cord. The 
Diagram of the Developmental Systems 
of the Spinal Cord after Flechsig. 
I, section at height of the 3d, II at height 
of 5th cervical nerves ; III, at height of 
the 6th dorsal, and IV of the 4th lumbar 
pairs. 1, principal mass of the anterior 
columns; 2, wedge-tracts; 3, anterior 
mixed region of the lateral columns; 4, 
lateral boundary layer of the gray sub- 
stance ; 5, columns of Goll; 6, direct cere- 
bellar lateral column-tracts ; 7, pyramid 
tracts of the lateral columns ; 7', pyramid 
tracts of the anterior columns ; v, ante- 
rior roots. ANATOMY OF THE SPINAL CORD. 
569 
principal mass of the anterior columns, the wedge-tracts, and the ante- 
rior mixed tracts of the lateral columns, for the most part unite the 
gray matter with peripheral organs, or unite different parts of the gray 
matter which lie at different heights on the cord. 
The anterior pyramid tracts appear usually at the height of the 
lower dorsal vertebrae (variable), increase gradually in size, and finally 
pass upward into the pons without crossing over. 
The lateral pyramid tracts appear in the lower half of the lumbar 
enlargement, and increase in size on going upwards. In the lumbar 
portion they are peripheral, but soon the cerebellar tracts appear, and 
separate them from the periphery, and they approach nearer to the 
gray substance. In the cervical portion they touch A he periphery for a 
short distance again. In the pons each crosses over To the opposite side 
in the anterior pyramid. 
The pyramid tracts are probably made up of fibres from the gray col- 
umns, which go either directly into the lateral columns of the same side, 
or through the anterior commissure, into the anterior pyramid columns 
of the other side, and are to be regarded as indirect continuations of the 
anterior roots—indirect, because interrupted by the ganglion cells. 
The relative size of the pyramid columns varies. Usually the greater 
number of pyramid fibres are to be found in the lateral columns. Some- 
times almost all the pyramid fibres are found in the lateral columns; 
sometimes almost all pass into the anterior columns. In the same indi- 
vidual most of the fibres of one side of the pyramid may cross over to the 
lateral column of the opposite side, while most of the fibres of the other 
side may not cross at all, i. e.} may pass into the anterior column. It is 
obvious how this irregular crossing may give rise to the asymmetry of the 
cord mentioned above. The exceptional non-decussation of the fibres is 
important in explaining the exceptional symptomatology of some lesions 
of the cord and brain (hemiplegia on the same side as the brain lesion). 
The direct cerebellar lateral tracts appear in the upper part of the 
lumbar enlargement, partly as a compact bundle of fibres at the peri- 
phery of the posterior half of the lateral columns, partly as a number of 
isolated fibres scattered over its section. • They increase in size in passing 
upward. They receive large bundles of fibres from the region of Clark’s 
columns, and seem to be connected with these tracts and with the cells 
of Clark’s columns (PicTc, Gentralblt., 1878, No. 2). These tracts pass 
through the restiform bodies into the cerebellum. 
The portion of the lateral columns not included in the above varies 
m size in different parts of the cord, corresponding to the size of the 
nerve-roots which enter at any given point. The connections and func- 
tions of the lateral boundary layer of the gray matter are little under- 
stood. The fibres of the anterior mixed region of the lateral columns 
come in part from the lateral parts of the anterior gray columns, in part 
they are to be regarded as the direct prolongations of the anterior roots. 
Their fibres pass in part back into the gray matter, in part into the 
medulla. Their function is wholly unknown. 570 
DISEASES OF THE SPIHAL CORD. 
The principal masses of the anterior columns do not increase in size 
from below upward. They come in part from the anterior roots, in part 
from the gray matter of the cord, and pass only in part directly into the 
medulla. Nothing more is known of them. 
' The columns of Goll are very small in the lumbar region; they in- 
crease steadily from below upward in size. Their fibres come partly from 
the posterior gray columns, partly from the posterior commissure. They 
terminate apparently in nuclei in the medulla. 
The wedge-tracts vary greatly in size in different parts of the cord, 
increasing markedly at the enlargements. They are made up for the 
most part of direct continuations of the posterior roots, but there are 
also numerous longtiudinal bundles of fibres in them. They terminate 
for the most part in nuclei in the medulla, but they enter also into the 
formatio reticularis, the olivary bodies, etc. 
PHYSIOLOGY OF THE SPIHAL COED. 
BIBLIOGRAPHY. 
Balighian : Beitrage zur Lehre von der Kreuzung der motorischen Innerva- 
tionswege im Cerebro-spinalsystem. Eckhardt’s Beitrag zur Anat. u. Physiol., 
VIII., Bd., S. 193.—Luchsinger: Zur Kenntniss der Functionen des Rucken- 
marks. Arch. f. Physiol., Bd. XVI., S. 510.—Schiff: Ueber die Leitung der 
Gefiihls-Eindrucke im Riickenmark. Allg. Wien. med. Ztg., 1879, S. 455.— 
Koch, W.: Ein Beitrag zur Lehre der Hypergesthesie. Virchow’s Arch., Bd. 73, 
S. 273, etc. 
The more recent investigations of Schiff confirm the observations of 
other writers, that when only a small portion of the gray matter of the 
cord remains intact, all the white matter and part of the gray having 
been severed, sensation to touch and pain remain in the parts posterior to 
the section. If, however, the intact portion is small, and in the extreme 
lateral periphery of the gray substance, sensation is retained on only one 
side of the body, together with a slight power of voluntary motion. The 
existence of different tracts for the different kinds of sensation has not 
been demonstrated, although Brown-Sequard, from certain facts in 
pathology, believes that they do exist. Vulpian denies their existence, 
believing that the different kinds of sensation only modify the sensitive 
tracts in different ways. Schiff confirms the observations of Woroschi- 
loff, in that he proves that the white longitudinal fibres of the anterior 
lateral columns, although having chiefly to do with voluntary motion, 
“conduct a trace of sensation to the brain.” Woroscliiloff states that 
each lateral column contains sensitive fibres from both legs, the greater 
number crossing over to the opposite side of the cord. As the experi- 
ments were conducted only on the lumbar portions of the cords of rabbits, PHYSIOLOGY OF THE SPIHAL COED. 
571 
Erb is not inclined to accept the results unconditionally. The complete 
decussation of sensitive fibres is not yet proved. Koch confirms the ex- 
periments of Ludwig and Woroschiloff, who found that section of the 
inner two-thirds of the middle portion of the lateral columns in the lum- 
bar portion of the cord gave rise to hyperaesthesia of the parts lying be- 
low, and on the same side as the section. The fasciae, periosteum, and 
joint-surfaces shared in this hyperaesthesia. In the cervical portion of the 
cord and in the medulla, section of the outer fibres of the lateral col- 
umns gave rise to this phenomenon. Section of the outer portion of 
this region gave rise to hyperaesthesia of the joints alone, cutting the 
inner, of the skin alone; but in neither case was the hyperaesthesia so 
marked as when the whole region was severed. Strong electrical currents 
caused a cessation of the hyperaesthesia. 
From the recent investigations of Flcchsig, it seems probable that the 
pyramid-tracts are the chief conductors of the voluntary motor impulses. 
Luchsinger has proved that under the influence of picrotoxin convulsions 
would occur in the extremities behind the section of the cord, proving 
that, for this poison at least, the convulsion centre is not exclusively in 
the medulla. 
The following summary of the present theories concerning the inner- 
vation of the blood-vessels is taken from Erb’s second edition, no modifi- 
cation of it being necessary from more recent publications. References 
and authorities must be omitted for want of space. 
There are probably ganglion cells on the vessels, or in their neighbor- 
hood, which serve as local vaso-motor centres. These local centres are 
under the influence of the larger nerve-centres, and are connected with 
them through two varieties of fibres, which lie in the peripheral nerves, 
viz., the vaso-constrictor and the vaso-dilator fibres. These fibres con- 
nect with two varieties of vaso-motor centres, which are scattered through- 
out the cord, and perhaps the upper nerve-centres, possibly also through- 
out the cerebral convolutions; but the most important are in the medulla 
oblongata. The two varieties of centres are the vaso-constrictor and the 
vaso-dilator centres. Both kinds of centres may be directly irritated, 
the condition of the vessels depending on which is most so. The con- 
strictor nerves seem to need a stronger irritation than the dilator, in 
order to react. After section of the nerves, their irritability sinks more 
rapidly than that of the vaso-dilator fibres. Reflex influences may cause 
dilatation or contraction of vessels. Vessel-reflexes from the spinal cen- 
tres certainly occur, but they are more limited than those radiating from 
the medulla. Similar reflexes may be excited from the local centres, 
manifested by dilatation of the vessels when the irritation is slight, by 
contraction when it is powerful. 
The location of these centres in the cord is unknown. The vaso- 
motor nerves, as they come from the spinal centres, lie, for the most 
part, in the lateral columns. How they make their exit from the cord 
is, for the most part, unknown. The vaso-motor nerves for the head 
come from the cervical portion of the cord, those for the upper extremi- 572 
DISEASES OF THE SPINAL COED. 
ties from the thoracic portion, those for the pelvis and legs from the lower 
dorsal and lumbar portions. The vaso-motor nerves of the sciatic nerve, 
however, do not pass into it through the sacral roots, but pass through 
the sympathetic. A similar condition of affairs seems to exist in the 
brachial plexus. 
Tschirjew confirms by elaborate experiments the reflex nature of the 
knee phenomenon (Berl. klin. Wochenschr., 1878, No. 17). Gowers 
proved that ankle-clonus resulted from direct stimulation of the muscle, 
the time between the tap on the muscle and the reaction being only 
.4 to .8 of a second, too short a time for a reflex. 
Nothnagel {Arch. f. Psych., VI., S. 832, 1876) and Lewinski {Ihid., 
VII., S. 327, 1877) have proved that strong irritation of distal parts 
(skin nerves) may exert an inhibitory action on tendon reflexes. Erb has 
proved the same fact in a case of spastic paralysis. In Stiimpell’s experi- 
ence, flexion of the great toe has no inhibitory influence on ankle-clonus, 
as stated by Brown-Sequard. Flexion of the whole foot, by relaxing 
the tendo Achillis, causes its cessation. Lanyendorff has proved that the 
brain has a crossed action in inhibiting reflex action, the right side of the 
body being under the influence of the left side of the brain, etc. 
Goltz, Luchsinger, Ostroumoff and Nawrocki have proved the exist- 
ence of nerves which pass through the peripheral nerve-stems, and 
which, on irritation, cause a secretion of sweat. The centres for these 
nerves lie chiefly (Nawrocki) in the medulla, but exist also (Luch- 
singer) throughout the whole length of the cord. The “sweat nerves” 
reach the nerve-trunks through the sympathetic system. 
Remak (see Poliomyelitis Anterior Subacuta), by the analysis of cer- 
tain facts in pathology, has sought to establish the supposition that there 
exist groups of ganglion cells in the cord, which control groups of 
muscles which act functionally together, but which receive their innerva- 
tion from different nerve-trunks. 
Gouty {Gaz. med. de Paris, 1876, No. 22) found that section of the 
posterior spinal roots in frogs had no noticeable effect on the nutrition 
of corresponding parts. He makes the spinal ganglia responsible for 
trophic changes. 
GEHEEAL THEEAPETTT1CS OF DISEASES 
OF THE SPIHAL COED. 
BIBLIOGRAPHY. 
Nussbaum: Nervendehnung bei centralen Leiden. Bayr. arztl. Intelligenz- 
blatt, 1876, Nr. 8.—VoGTr Die Nervendehnung als Operation in der chirurg. 
Praxis. Leipzig, 1877. — Edlefsen: Zur Behandlung des Blasenkatarrhs. 
Deutsch. Arch. f. klin, Med., XIX., 82. HYPEREMIA—APOPLEXY. 
573 
In a case of traumatic paraplegia, in which there occurred strong tonic 
convulsions, Nussbaum stretched the crural and sciatic nerves with the ef- 
fect of stopping the convulsions, but not influencing the paralysis. The 
seat of the lesion, whether in cord or in cauda equina, was questionable. 
Vogt comes to the conclusion that nerve-stretching has no effect on cen- 
tral lesions. It is indicated only when there is functional disturbance of 
a peripheral nerve, either from increased irritability or from disordered 
circulation. In traumatic tetanus the results are favorable. Fdlefsen 
recommends for catarrh of the bladder, oil of turpentine (10-12 drops 4 
or 5 times a day) and balsam of copaiba. lie claims good results from 
the use of chloride of potassium (solution 1-20 of water, a tablespoonful 
to be taken every two or three hours). 
HYPEREMIA OF THE SPINAL CORD AND 
ITS MEMBRANES. 
BIBLIOGRAPHY, 
Fabre: Des phenomenes spinaux dans les affections cardiques. Gaz. des 
hop., 1876, No. 147. 
In the last stages of diseases of the heart, Fabre has observed pain, 
anaesthesia, pargesthesia, and slight paresis, rarely also convulsive 
phenomena, which are probably due to passive hypersemia of the cord. 
APOPLEXY OP THE SPIXAL MEXIXGES. 
BIBLIOGRAPHY. 
Weber: Spinal Meningeal Hemorrhage. Boston Med. and Surg. J., July 8th,. 
1875.—Dowse: Subarachnoid Hemorrhage of spinal Cord. Trans. Path. Soc., 
XXVII., p. 1, 1876.—Lutkenmuller, J.: Ein Fall von Haamatorrhachis. Wien, 
med. Bl., 1878, I., 964, 1879, II., 5.—Dixon, E. L.: Intermeningeal Spinal Haemor- 
rhage Simulating Strychnia Poisoning. Lancet, London, 1879, I., 833. — 
Lancereaux: Hematome de l’arachnoide comprimant la moite gauche de la 
moelle epiniere, etc. Rev. med. fraruj. et etrang., Paris, 1879, I., 23-25. 
Of these records of cases, some of which the writer has not had access 
to, that of Dixon deserves mention. The patient was seized with violent 
tetanoid convulsions recurring at short intervals, and brought on by any 
movement. Consciousness was not affected. Death occurred in two 
hours. On autopsy, the spinal arachnoid cavity was found filled with 574 
DISEASES OF THE SPINAL CORD. 
blood, all other organs being healthy. The resemblance of this case to 
one of strychnia poisoning is its chief jioint of interest. No chemical 
examination of the stomach and contents was made. There was no 
reason to suspect poisoning. 
PACHYMENINGITIS AND PERIPACHYMEN- 
INGITIS SPINALIS. 
BIBLIOGRAPHY. 
riETRULLA: Die Pachymening. cervical, hypertrophica. Diss. Breslau, 1876.— 
Joffroy, A.: Considerat. et observ. relatives a la pachymening. cervic. hyper- 
troph. Arch, gener., 1876, Nov., p. 542.—Lewitsky : Fall von Peripachyme- 
ning. spinalis. Berl. klin. Woch., 1877, Nr. 17.—Leyden : Fall von Rucken- 
markserschutterung durch Eisenbahnunfall. Arch. f. Psych., VIII., S. 31, 1877.— 
Berger, M.: Zur Kenntniss der Pachymeningitis spinalis hypertropliica. 
Deutsche medic. Wchnschr., Nos. 50, 51, 53, 1878. Gibney, V. P.: Cervical 
Pachymeningitis. Med. Rec., N. Y., 1879, XX., 20-22.—Glynn: Internal Hyper- 
trophic Pachymeningitis of the Cord. Brit. Med. J., 1878, II., 805.—Spencer, W. 
H.: Case of Idiopathic Inflammation of the Spinal Dura Mater. Lancet, 1879,1., 
■ 836.—Kohts: Gerhardt’s Handbuch f. Kinderheilk., Bd. V. 
"With reference to the etiology and pathology of these diseases, the 
following cases are of interest: 
The possibility of the occurrence of peripachymeningitis from trauma 
is indicated by cases reported by Lewitzky and Leyden. The case re- 
ported by the former, Erb regards as inconclusive. That of Leyden re- 
sulted from a railroad accident. The jpitopsy disclosed caries of the 
vertebra as its probable point of departure. 
Spencer reports a case of suppurative peripachymeningitis apparently 
primary, and resulting from exposure to cold. Pain in the back and 
lower extremities without paresis was the main symptom. Koht’s case 
was one of tubercular tumors on the outer surface of the dura mater in a 
child. The process seemed to originate in necrosis of a rib with 
(secondary ?) involvement of the lung. The pressure of the tumor 
caused degenerative changes in the cord. 
Olhvier’s case was one of deposit of urates on the anterior surface of 
the dura mater, and on the sheaths of the nerves in a case of severe 
chrome gout. The symptoms during life, which were probably depen- 
dent on this lesion, wrere a sense of constriction about the neck, thorax, 
and abdomen, with fulgurant pains in the limbs. 
Glynn reports a case of typical cervical pachymeningitis resulting in 
death in twenty months. Transverse myelitis existed at site of the lesion 
< of the dura mater. 
Erom a clinical point of view, the cases of Berger and Gibney are of LEPTOMENINGITIS SPINALIS. 
575 
interest. Their cases recovered completely or almost completely after a 
tedious course of over a year. Cold was the apparent cause in Berger’s 
case. Counter-irritation, galvanism, iodide of potassium, and frictions 
with alcoholic liniments were used. One of Gibney’s cases, apparently 
traumatic in its origin (Med. Rec., N. Y., 1880, Sept. 25th), recovered 
without systematic treatment. Ergot and the iodide of potassium seem 
to have had some influence over the disease in his experience. 
Joffroy calls attention to this relatively favorable course of cervical 
pachymeningitis as contrasted with that of transverse myelitis. 
LEPTOMENINGITIS SPINALIS. 
BIBLIOGRAPHY. 
Schwarz: Meningite spin. Arch. med. beige, Dec., 1874.—LAShGUE: Menin- 
gite spinale, supposee de nature rhumatism. Arch, gener. de med., Juin, 1874, 
p. 743.—Schultze, F.: Das Verhalten des R.-M. und der Riickenmarksnerven- 
wurzeln bei acuter Basilarmeningitis. Berl. klin. Woch., 1876, Nr. 1.—Beitr. z. 
Pathol, u. pathol. Anat. des centr. Nervensyst. Virch. Arch., Bd. 68, 1876.— 
Vulpian: Lemons sur les malad. du systeme nerveux, 1877, p. 111.—Meningo- 
myelite subaigue. Chir. med. de l’hop. de la charite, Paris, 1879, 626-632.— 
Dunlap: Meningitis Caused by Penetration of a Fishbone into the Spinal Canal. 
Brit. M. J., London, 1879, I., 289. 
The predominance of the exudation in acute meningitis upon the 
posterior surface of the cord seems to be best accounted for by the 
numerous septa which exist in the subarachnoidal space and the con- 
sequent greater vascularity of the posterior meninges. This is more 
satisfactory than the previous supposition that it resulted .solely from the 
position of the patient or (Vulpian) from the richer nerve-supply of the 
posterior meninges. 
The case reported by Dunlap is of interest because of its unusual eti- 
ology. It was one of inflammation of the upper part of the spinal men- 
inges and of those covering the under surface of the cerebrum and 
medulla, caused by a fishbone which penetrated from the pharynx 
partly through the second right inter-vertebral foramen and partly 
through the first inter-vertebral cartilage into the spinal dura mater. 
Vulpian states that he has seen rapid improvement in a case of acute 
spinal meningitis, caused by cold, follow the administration of large 
doses of salicylate of soda. 576 
DISEASES OF THE SPINAL COED. 
TUMORS OF THE SPIHAL MEHIHGES. 
BIBLIOGRAPHY. 
Dowse: Fibro-nucleated Tumor from the Dura Mater of the Cervical Portion 
of the Spinal Cord. Brit. Med. J., 1875, May 29th.—Biot: Note sur un cas de 
sarcome intrarhachid. Lyon med., 1875, Nr. 31.—Pel: Myxom der Spinalme- 
ningen. Berl. klin. Wchnschr., 1876, Nr. 32.—Gowers: Myo-lipomaof the Spinal 
Cord. Transact, of the Pathol. Soc., XXXII., p. 19,1876.—Hunicken: Sarcoma- 
tose Geschwulst im Wirbelcanal. Berl. klin. Wchnschr., 1878, 382.—Bulteau: 
Tumeur sarcomateuse de la moelle. Progres med., p. 181, 1878.—Wood, H. S.: 
A Case of Spinal Hydatids. Austral. M. J., 1869, I., 222. 
Of these newly reported cases little is to be said. Gowers' case was 
one of lipoma containing a large number of transversely striated mus- 
cular fibres situated at the conus medullaris; Wood’s, one of hydatid 
cysts of the lower end of the dura mater, causing it to project out through 
some of the sacral foramina, hydatids being found also in the liver. In 
the case reported by Bulteau, a spindle-celled sarcoma, about the size of 
the first phalanx of the thumb, was found growing from the pia mater 
at the junction of the cord and the medulla. Nothing in the clinical 
histories of these cases calls for special mention. 
AFLEMIA OF THE SPIHAL CORD. 
BIBLIOGRAPHY. 
Lauenstein, C.: Zwei Falle von Embolie der Aorta. Deutsch. Arch. f. klin. 
Med., XVII., S. 242 u. 491, 1876.—Malbranc, M.: Beob. tiber Aortenthrombose 
u. Aphasie.—Ibid., XVIII., S. 462, 1876.—Vulpian: Legons sur les mal., etc., p. 
98, 1877. — Friederich, A.: Recidivirende vortibergehende Riickenmarkslah- 
mung. Virchow and Hirsch Jahresbericht, II., 1879, S. 113. 
Under this subject the case related by Friederich alone deserves 
special mention. 
The patient was a student, twenty years old, who, since he was eleven 
or twelve years old, had suffered from repeated attacks of paralysis, the 
first one following an exposure to cold. In the attack in which Friede- 
rich saw him, all four extremities became almost completely paralyzed in 
the course of a few hours without loss of sensation or of reflex action. 
In two days recovery was complete without treatment. The patient had 
an hypertrophied heart and a systolic murmur. Friederich suggests that 
a temporary anaemia of the cord was the cause of the attacks. SPINAL APOPLEXY— CUTE TRAUMATIC LESIONS. 
SPIRAL APOPLEXY. 
BIBLIOGRAPHY. 
Webber: Fall von Spinalhamorrhagie. Schmidt’s Jahrb., Bd. 170, S. 25, 
1876.—Fox, E. L.: On Spinal Hemorrhages. Med. Times and Gaz., 1876, Aug. 
23d.—Remak, E.: Fall von atroph. Spinallahmung durch traumat. halbseit. 
Blutung in die Halsanschw. des R.-M. Berk klin. Woch., 1877, Nr. 44.—Vul- 
pian: Legons, p. 92, 1877. 
Beyond the bibliography, the case reported by Remak alone will be 
alluded to. This was a case of atrophic paralysis on one side of the 
body, resulting from an injury which Remak supposed to be a hemor- 
rhage confined to one-half of the cord in the cervical region. 
ACUTE TRAUMATIC LESIORS OF THE 
SPIRAL COED. 
BIBLIOGRAPHY. 
Feinberg: Wirbelfractur und Riickenmarksabscess. Berl. klin. Woch., 1876, 
Nr. 82.—Hulke: Three Cases of Broken Neck. Med. Times, 1876, July 29th.— 
Hayeii : Arthrite de l’articulation de l’axis avec l’atlas, etc. Gaz. des hop., 
1876, No. 147, Soc. d. Biol.—Seeligmuller: Fall von geheilt. Fractur d. Lenden- 
wirbel. Deut. med. Wchnschr., 1877, Nr. 28.—Heynold, H.: Fall von Luxation 
und Fractur des 6. u. 7. Halswirbels, verbunden mit ungewohnl. nied. Tem- 
peraturabfall. Berl. klin. Woch., 1877, Nr. 39.—Nieden, A.: Ueber Temperatur- 
veranderungen (Hyperpyrexie und Apyrexie), bedingt durch Verletzungen des 
Halsruckenmarkes. Berl. klin. Wchnschr., No. 50, 1878.—Rigler, Johs: Ueber 
die Folgen der Verletzungen auf Eisenbahnen, insbesondere der Verletzungen 
der Wirbelsaulen und des Riickenmarks, 1879.—Beck, B.: Ueber Verletzungen 
der Wirbelsaulen und des Riickenmarks. Arch. f. path. Anat., etc., Berl., 1879, 
207-255. 
Injuries to the spinal cord, without lesion of the spinal canal or of the 
soft parts, occur more readily when there already exists some anomaly of 
the spinal column, as in the case of Hayem, in which there existed 
hypertrophy of the odontoid process. 
Beck records a case of softening of the cord in the dorsal region with 
a clot between the dura mater and the bone, which was traumatic in its 
origin, but without fracture of the vertebrae. 578 
DISEASES OF THE SPINAL CORD. 
GRADUAL COMPRESSION OF THE SPINAL 
CORD. 
BIBLIOGRAPHY. 
Westphal: Arch. f. Psych., II., S. 374, 1870.—Frommann: Fall von Wirbel- 
caries u. Degener. des R.-M. Virch. Arch.,Bd. 54, 1872.—Pierret: Plusieurs 
cas de nevrite parenchym., etc. Arch, de physiol, norm, et path., VI., 1874, p. 
968.—Gowers: Caries of Dorsal Spine, etc. Med. Times and Gaz., 1876, Nov. 
4th.—Ramskill: Ibid., Nov. 18th.—Kadner: Zur Casuistik der Riickenmarks- 
compression. Arch, de Heilk , XVII., 1876, S. 481.—Hayem: Gaz. des hop., 
1886, Nr. 147.—Couty: Note sur les troubles vasomot. et therm, observes dans un 
cas de compress, d. 1 moelle. Gaz. medic., 1876, No. 37.—Vulpian: Lemons, 1. c., 
p. 14, 1877.—Masse: De la compression lente de la moelle epiniere. Mon tpel., 1879. 
The secondary degeneration which, in the cases of Westphal, From- 
mann, and Kadner, was observed to extend upward for a short distance 
above the point at which the cord was compressed at the periphery of the 
cord, was evidently situated in the cerebellar lateral column tracts of 
Flechsig. 
In regard to vasomotor disturbances in these cases, Vulpian speaks of 
various varieties as occurring from irritation and paralysis of vaso-dilator 
,u,nd vaso-constrictor fibres. 
Although, as a rule, motor disturbances show themselves first in com- 
pression of the cord from Pott’s disease, yet, as in RamskilVs case, dis- 
turbance of sensation may be first in order of time. On the other hand, 
.compression from behind may cause predominant disturbance of motion, 
;according to Vulpian, because the gray matter suffers less from pressure 
than the white. 
Although, as a rule, there is increase of reflex action in these cases, 
Kadner has shown that in many this increase may not be present. 
CONCUSSION OF THE SPIRAL CORD. 
BIBLIOGRAPHY. 
Willigk, A.: Anatom. Befund nach Himerschutterung. Prag. Vierteljahr- 
schr., Bd. 128, S. 19, 1875.—Bernhardt, M.: Ueber die Folgen der Gehirns- und 
Ruckenmarkserschutterung nach Eisenbahnunfallen. Berl. klin. Wchnschr., 
1876, Nr. 20.—Buzzard, T.: A Railway Case; Shock from an Unexpected Descent, 
etc. Transact, of Clin. Soc., London, Yol. IX., 1876.—Leyden: Fall von Rucken- 
markserschutterung durchEisenbahnunf all. Arch. f. Psych, u. Nerv., VIII., S. 
: 31, 1877. — Eberhard, Gust. : Ueber die Erschiitterung des Riickenmarks. SPINAL IRRITATION—NEURASTHENIA SPINALIS. 
579 
Gotting., 1878.—Bernadis, J. B. E.: De la commotion de la moelle epiniere. 
Montpel., 1879. 
In a case reported by Leyden as concussion of the spinal cord, peri- 
pachymeningitis with cheesy tubercular meningitis and secondary myeli- 
tis from compression were found to have developed. Willigh, in a case 
of concussion which died three months after the accident, claims to have 
found the capillaries and the small arteries and veins throughout both 
cord and brain widely dilated and showing slight fatty degeneration of 
their walls. 
Buzzard has observed disturbance of speech and of the functions of 
the tongue with glycosuria as the result of concussion. 
Bernhardt and Leyden have added to the list of cases in which the 
morbid symptoms appeared after a considerable time had elapsed since 
the injury. Erb has also seen several such cases. 
SPINAL IRRITATION. 
BIBLIOGRAPHY. 
Coghill, J. G. S.: Irritable Spine as an Idiopathic Affection. Brit. Med. J., 
London, 1879, II., 571-573. 
Coghill reports four cases of irritable spine as treated successfully by 
tonics and by the local application of Corrigan’s bouton, heated to a blue 
heat, over the painful spots. 
The cases reported by Benedickt (Neue Behandlungsmethoden der 
Spinal-Irritation. Wien. Med. Presse, 1879, 105, 173) are cases of pure 
hysteria, not of spinal irritation in Erb’s sense. 
SPINALIS. 
BIBLIOGRAPHY. 
Holst: Ueb. Neurasthenie und ub. ihr Verhaltniss zur Hysterie und Anaemie. 
Dorp. med. Zeitschr., VI., S. 15, 1876.—Anjel: Ueber vasomotor. Neurasthenie, 
etc. Arch. f. Psych, u. Nerv., VIII., S. 394, 1878. 
Erb protests against the classification of this disease as a manifesta- 
tion of hypochondria {Jolly). Though often combined with the latter, 
it is to be regarded as of distinctly spinal origin. The recent literature 
given above calls for no comment. 580 
DISEASES OF THE SPINAL COED. 
MYELITIS. 
BIBLIOGRAPHY. 
V. n. Velden u. Leyden: Fall von acuter aufsteig. spinaler Paralyse. 
Deutscli. Arch. f. klin. Med., XIX., S. 333, 1877.—Lauinger, C.: Beitr. z. Lehre 
von d. acuten Myelitis. Ibid., XIX., S. 424, 1877.—Vulpian: Leqons sur les mal. 
des syst. nerv., p. 144,1877.—Leyden: Ueber experiment, erzeugte Riickenmarks- 
sklerose u. die Ausgange der acut. Myelitis. Berl. klin. Woch., 1877, Nr. 49.— 
Charite-Annal., III. (1876), S. 248, 1878.—Grasset: Mal. du syst. nerveux, 1878. 
—Westphal: Ueb. combinirte (primare) Erkrankungen der Ruckenmarksstrange. 
Arch. f. Psych., VIII., S. 469, 1878.—Kahler und Pick: Ueb. combinirte 
Sy stem erkrankungen des R.-M. Ibid., VIII., S. 251, 1878.—Prout et Joffroy: 
Contribution a l’etude de la myelite aigue. Observ. de myelite a debut apoplec- 
tiforme, etc. Cong, period, internat. d. sc. med. Compte-rendu, Geneve, 1878, 
157-159.—Caizergues, R.: Therapeutique de la myelite sypliilitique. Rev. med. 
franc, etetrang., Paris, 1878, II., 353, 385, 417.—Schuster: Ein Fall von acuter 
Myelitis. Berl. klin. Wchnschr., 1879, XVI., 292.—Atkinson: On the Morbid 
Histology of the Spinal Cord in Five Cases of Insanity.—Leyden, E.: Beit rage zur 
acuten und clironischen Myelitis. Ztschr. f. klin. Med., Berl., 1879, I., 1-26.— 
Ueber die durch plotzliche Verminderung des Barometerdrucks entstehende 
Riickenmarksaffection. Arch. f. Psychiat., 1879, IX., 316-324.—Babesiu, V.: 
Ueber die selbststandige combinirte Seiten- und Hinterstrangsclerose des Ri'icken- 
marks. Virch. Arch., 1879, Bd. 76, S. 74-84.—Vallin, E.: Note sur quelques 
formes du rhumatisme spinal. Gaz. des hop., No. 18, 1878, p. 138. 
Vallin reports three cases of more or less complete paralysis of the ex- 
tremities, two being associated with disturbances of sensation, occurring 
in connection with acute articular rheumatism. In two, the symptoms 
rapidly passed away, a slight hemiplegia remaining in a third two months 
after the inception of the disease, at which time the patient passed from 
under observation. Erb considers it doubtful whether arsenic, phos- 
phorus, mercury, bisulphide of carbon, alcohol, or lead can give rise to 
acute myelitis. 
Leyden reports three cases of a peculiar form of myelitis resulting 
from sudden diminution of barometric pressure. One case was that of 
a laborer who, half an hour after coming out of a caisson, where he had 
been working under increased atmospheric pressure, became suddenly 
paraplegic ; death occurred in the fifteenth day, the patient having 
the usual symptoms of acute myelitis with grave vesical symptoms. The 
cervical and lumbar parts of the cord were healthy. In the dorsal por- 
tion were seen, scattered through the cord, particularly in the posterior 
columns and in the posterior parts of the lateral columns, accumulations 
of large, round, nucleated cells which pushed apart the nerve-fibres, and 
contained among them only a few normal vessels—no neuroglia, no 
blood pigment. The nerve-fibres in their neighborhood showed in 
greater or less extent signs of parenchymatous myelitis. The gray CHROMIC MYELITIS. 
581 
matter was normal. Leyden believes that the process consisted in a 
splitting of the masses of nerve-fibres by oxygen or carbonic acid set free 
from the capillaries without rupture of their coats or with rupture of 
only such small vessels that no noticeable hemorrhage took place, and in 
the subsequent filling up of these spaces with cells. The dorsal portion 
of the cord was probably affected because of its normally lesser consist- 
ency than the enlargements. The other two cases were similar, except 
that one patient was discharged completely recovered in nineteen days, 
the other recovered incompletely in thirty days, at which time he was 
discharged from the hospital. 
Hayem, by tearing out the sciatic nerve of young rabbits, caused a 
cicatricial myelitis which became the point of departure of a progressive 
central myelitis with muscular atrophy. The process consisted in a 
degenerative atrophy of the ganglion celis. A similar, though slower 
result followed simple section of the sciatic nerve. 
Leyden’s latest experiments in the artificial excitation of myelitis 
have enabled him to demonstrate the passing over of acute myelitis into 
cyst-formation and sclerosis. Vulpian has observed similar processes 
after injecting nitrate of silver into the cord. 
v. d. Velden described a case in which numerous small foci of acute 
myelitis were found in the upper thoracic and cervical portion of the 
cord predominantly in the anterior and lateral columns and in the ante- 
rior horns. The process was characterized by changes m the nerve-fibres, 
slight exudation around the vessels, and slight increase in the number of 
glyoma cells. Lauinger, C., has published a case in which the process 
was even more purely parenchymatous. These two cases followed the 
clinical course of acute ascending paralysis. In that of v. d. Velden, the 
galvanic and faradic irritability was fully lost on the second day of the 
illness, while in that of Lauinger the faradic irritability was fully re- 
tained. The reflexes in the latter, which at first were fully lost, returned 
in a few days; an apparent exemplification of the inhibitory effect of the 
acute affections of the cord suggested by Goltz. In the case reported by 
Leyden (see above), faradic irritability of the muscles was good three 
days after the beginning of the disease. 
A case reported by Schuster of acute myelitis is of interest on account 
of its probable syphilitic origin, and the good, although not complete, 
recovery after five months of treatment by warm baths, electricity and 
mercurial inunctions. 
CHROYIC MYELITIS. 
Since the discovery by Flechsig of the various tracts or systems in the 
cord, of which an account is given above, several observers have endeav- 
ored to discover the relations which exist between these systems and cer- 582 
DISEASES OF THE SPIHAL COED. 
tain previously classified diseases of the cord (lateral sclerosis, amyotro- 
phic lateral sclerosis, etc.), and have also endeavored to differentiate a 
new class of diseases which is characterized by a primary affection of a 
number of these systems to the exclusion of others. This latter class, 
the combined-system diseases of the cord, will be here spoken of. The 
relation between Flechsig’s discovery and the previously known diseases 
will be alluded to under the appropriate headings. 
Kaliler and Pick have described a case in which at least four systems 
were involved, and in which the degeneration confined itself approxi- 
mately within their limits. Then there are cases in which the myelitic 
process is not confined strictly within the limits of any distinct systems, 
but is spread, more or less widely, over the section of the cord, as in 
cases described by Westphal, “in which there can be no question of a 
limitation of the affection to the systems of Flechsig. Such cases are 
very frequent and seem not unfrequently as if they were the result of 
a disease which began as a system disease, but which came to be examined 
at a later stage ” {Erb). 
The most important recent contributions to this subject have been 
from Babesiu, Leyden, and Westphal. 
The case reported by Babesiu clinically presented all the symptoms of 
spastic paralysis, with the addition of atrophy of the optic discs, some 
loss of sensation in the feet, retention followed by incontinence of urine, 
and dragging pains in the feet and genitals. On autopsy, in addition to 
some lesions of the brain, etc., which had no probable connection with 
the symptoms observed in the limbs during life, degeneration of the lat- 
eral columns was found, most marked in the thoracic portion, where the 
degeneration reached from the posterior almost to the anterior horns. 
In the cervical expansion, the degeneration of the lateral columns dwin- 
dles down to a small triangle at their periphery, being separated from the 
posterior horns by healthy tissue. Downwards a similar diminution 
takes place. Only in the periphery of the cord does the degeneration 
approach the anterior columns. Wedge-shaped, sunken-in, sclerotic 
spots were found in the lateral cerebral tracts above the anterior pyra- 
mid. The posterior columns in their posterior periphery, and the col- 
umns of Ooll were tolerably evenly affected throughout the cord. The 
central canal was filled throughout with growing cells. Ganglion cells of 
the anterior horns and Clark’s columns normal. The pia mater of the 
cord was thickened, especially in its posterior and lateral parts, and was 
also congested and strongly pigmented. This short abstract of the case 
gives an idea of the class of cases which are grouped under the heading 
“combined-system diseases of the cord.” It is unnecessary to state how 
manifold the symptoms may be in these cases, according to the particu- 
lar system affected, and how still more confused may be the symptom- 
complex when the disease is of the irregular form. 
Leyden believes that only two forms of primary “ system diseases” of 
the cord have been demonstrated, i. e., tabes dorsalis and atrophy of the 
motor parts of the cord (degeneration of the cells of the anterior horns, CHROKIC MYELITIS. 
583 
motor tracts, spinal nerve-roots, and nerves of the muscles). A com- 
bination of these two may exist, giving rise to a “combined-system 
disease.” Kaliler and Pick, Westphal and Babesiu, he thinks, have sys- 
tematized their cases more definitely than the clinical facts warrant. He 
cites several cases of his own, one of which resembled very closely that 
reported by Kaliler and Pick, and states that he believes that all the 
cases of this class are cases of simple extension of disease by continuity 
of tissue with typical ascending and descending degeneration. 
Westphal (Ueber combinirte (primare) Erkrankung der Eiicken- 
marksstrange, Arch. f. Psych., Bd. IX., 691-737) analyzes his pre- 
viously reported cases. He concludes that, although the paralysis in 
these cases bore no constant relation to the lesions of the lateral columns, 
yet this was the main element in its causation. The degeneration of the 
muscles was also an element. Implication of the lateral columns without 
paralysis, as in Friedreich-Schultze’s case (Yirch. Arch., Bd. 70, S. 141), 
might have been due to non-destruction of the conducting fibres by the 
morbid process. Absence of muscular rigidity in his own cases, in which 
both lateral and posterior columns were involved, he accounts for by the 
extension of the affection of the posterior columns in the lumbar region 
to the posterior root-zones, by which extension reflexes were prevented. 
The supposition that the inflammatory process was transmitted by con- 
tinuity of tissue or through the pia mater he rejects, because in all his 
cases healthy tissue intervened between the posterior and the affected 
portions of the lateral columns, and the pia mater was thickened only 
over the posterior surface of the cord. In one case, the affected portion 
of the lateral columns did not extend to the periphery. Westphal con- 
cludes that in certain cases of myelitis the process may extend in the 
long axis of the cord, at least in the lateral and anterior columns, and, 
in general, symmetrically; that there is no manifest single point of 
departure of the process; and that there are no pure system diseases, 
although here and there are indications that this or that system may be 
affected as such. Some undiscovered changes in the gray matter of the 
cord, which was apparently normal in Westphal’s cases, may underlie 
these cases. The existence of some change is suggested by the red re- 
action of otherwise normal appearing ganglion cells, in diseased cords, 
with methyl-violet [Jurgens), whereas in normal cords the ganglion 
cells color blue with this reagent. Westphal rejects the idea that 
what in one of his cases looked like typical ascending and descending 
secondary degeneration (and is so regarded by Leyden), was so in fact, 
because the portion of the cord which would have to be assumed as that 
primarily affected was not involved in its whole diameter, and in cases, 
of disseminated sclerosis the isolated foci of disease have never been ob- 
served to be the points of departure of secondary degeneration. He 
therefore concludes that the affection of the columns of Goll, the cere- 
bellar-lateral tracts, and the lateral pyramid tracts observed in this case 
were primary degenerations of these systems. 
Atkins found irregularly disseminated myelitis in three cases of in- 584 
% 
sanity of different types. In one case of general paresis extensive soft- 
ening of the lumbar and sacral regions of the cord was found. 
Erh quotes the following principles from Renz, of Wildbad, which 
should control the employment of thermal baths in myelitis: During the 
active stages of disease, harm is apt to be done unless the greatest care is 
exercised in their use. This rule holds good, whether the disease is acute 
or chronic. The baths must be cooler, less frequent, and of shorter dura- 
tion the more obviously progressive a chronic disease is. Acute cases 
should not use them till they are convalescent. When a case is improv- 
ing, the time and temperature of the baths may be increased cautiously. 
Only those cases in which the meninges are prominently affected endure 
baths of high temperature and long duration with benefit. 
DISEASES OF THE SPIRAL CORD. 
MULTIPLE CEEEBRO-SPIUAL SCLEROSIS. 
BIBLIOGKAPHY. 
Charcot : Diagnostic des formes frastes de la sclerose en plaques. Progres 
med., Paris, 1879, VII., 97-99.—Frommann, C.: Untersuchungen iiber die Gewebs- 
veranderungen bei der multiplen Sklerose des Gehirns und Riickenmarks. Jena, 
1878.—Pitres, A. : Contribut. a l’etude des anomalies de la sclerose en plaques 
disseminees. Rev. mensuelle, Dec., 1877, p. 893.—Da Costa: Multiple spinal 
Sclerosis (Case). N. Y. Med. Rec., 1879, XV., 313.—Westphal, C.: Ueber strang- 
formige Degeneration der Hinterstrange mit gleichzeitiger fleckweiser Degenera- 
tion des Riickenmarks. Arch. f. Psych., 1879, IX., 389.—Pollard, F.: Case of 
Disseminated Cerebro-spinal Sclerosis in a Child. Lancet, Aug. 10th, 1879, p. 
183.—Dickenson, Cheadle, and Dreschfeld: Cases of Disseminated Sclerosis in 
Children. Med. Times and Gaz., 1879, I., pp. 112, 139.—Bristow : A Case of 
Disseminated Sclerosis. Med. Times and Gaz., 1879, I., 673.—Lomikowsky, M. : 
Laryngoscopischer Befund bei Sclerose en plaques cerebrospinales. Berl. klin. 
Wchnschr., 1879, 610.—Pollak, L.: Multiple Herdsklerose des Hirns und Riick- 
enmarkes im Sauglingsalter. Deutsch. Arch. f. k. Med., 1879, XXIV., 407-415. 
—Leyden, E.: Beitrage zur acuten und chronischen Myelitis. Ztschr. f. klin. 
Med., Berl., I., 1-26. 
This abundant literature furnishes little new information. 
The number of cases (all without autopsies) reported in children 
from five months to eight years of age is somewhat remarkable (Dickenson. 
PollaJc). 
Two of Dreschfeld’s cases were brothers. 
WestphaVs case was one which presented the irregular complex of 
symptoms characteristic of multiple spinal sclerosis. The autopsy dis- 
closed columnar degeneration of the posterior columns, with multiple 
sclerosis of the lateral columns. 
Leyden reports a case in which all the symptoms of the disease 
appeared, but in which almost complete recovery (slight difficulty in LOCOMOTOR ATAXIA. 
585 
speaking, tremor and weakness of legs remaining) occurred after treat- 
ment by galvanism and a bath-cure at Rehme. This case he regards as 
one of acute, multiple cerebro-spinal inflammation which resolved and 
did not go on to sclerosis. He thinks that the case tends to prove that 
sclerosis is a late stage of an acute process, not a distinct process in 
itself. 
LOCOMOTOK ATAXIA. 
BIBLIOGRAPHY. 
Bush : Ein Fall von Tabes dorsalis ; Schwinden der Sehnenreflexe nach 
mehrjahriger Dauer der Krankheit. Petersburger med. Wochenschr., No. 46, 
1878.—Kahler: Casuistischer Beitrag zur Therapie der typischen Tabes. Prager 
med. Wochenschr., No. 36, 1878.—Briersion : Contribution a 1’etude du tabes 
dorsalis ataxique. These, Paris.—Onimus : De la contracture dans l'ataxie. Gaz. 
des hop., No. 88, 1878.—Audibert : Des phenomenes viscereaux dans l'ataxie 
locomotrice progressive. Marseille med., 1878, XX., 521-530.—Kahler, O., und 
Pick, A. : Beitrag zur Pathologie und pathol. Anat. des Centralnervensystem. 
Vrtljschr. f. f>rakt. Heilk., Prag, 1879, I., 1-86.—Erlemeyer, A.: Ueber Tabes 
dorsalis incipiens. Cen. Bl. f. schweiz. Aerzte, Basel, 1879, IX., 3-7.-Ferry, 
Jules : Recherches stastistiques sur l’etiologie de l'ataxie locomotrice progres- 
sive. Par., 1879.—Beluger, A. : Note sur le traitement de l’ataxie locomotrice 
par les eaux de la Malon. Ann. Soc. d’hydrol. med. de Paris, 1879, III., V., 3. 
•—Petit, L. H.: De la ataxie locomotrice dans ses rapports avec le traumatisme. 
Rev. mens, de med. et de chir., Paris, 1879, III., 209-224.—Berger : Zur Sympto- 
matology der Tabes dorsualis; d. schles. Gesellsch. f. vaterl. Cultur, Bresl., 
1878, IV., 216.—Friedreich: Nystagmus bei Ataxie. Bericlit iiber die Ver- 
sammlung der ophthalmolog. Gesellschaft, 198.—Kahler und Pick: Zur Lehre 
von der Ataxie. Vrtljsch. f. d. prakt. Heilk., Prag., 1879, II., 86-97.—Robert, 
A.: Ataxie locomotrice; amyotrophie secondairedesmembres superieurs; arthro- 
pathie du coude gauche. Progres med., Par., 1879, VII., 326.—Berger: Zur 
Aetiologie der Tabes dorsalis. Breslau arztl. Ztschr., 1879,, I., 70.—Vul- 
pian : Ataxie locomotrice progressive (5 cases). Chir. med. de l’hop. de la 
Charite. Par., 1879, 807-832, 823-828.—Erb, W.: Zur Pathologie der Tabes dor- 
salis. Deutsches Arch. f. klin. Med., 1879, XXIV., 1-52.—Christian, J.: Des 
rapports de l’ataxie locomotrice progressive avec la paralysie generate. Union 
med., 1879, XXVIII., 157.—Hardy: Ataxie locomotrice. Gaz. des hop., Paris, 
1879, LII., 1033.—Vallin : Des alterations trophiques des os maxillaires dans 
l’ataxie locomotrice. Union med., Par., 1879, XXVIII., 737-749.—Drosdoff : 
Archiv f. Psych., IX., 203, 1879.—Berger: Ueber Sehnenreflexe. Centrabl, f. 
Nervenheilk. und Psych., etc., 1879, No. 4. 
With reference to the etiology of tabes dorsalis it is to be noted that 
Vulpian affirms that hysteria, especially in its convulsive form, has a de- 
cided influence on the development of the disease. Among forty-four of 
the cases analyzed by Erh in a recent article, twenty-seven were found to 
have had syphilis, which usually had developed several years before the 
tabes, and which was usually light in its antecedent symptoms. Fournier 
found twenty-four out of thirty, and Vulpian fifteen out of twenty cases 586 
DISEASES OF THE SPINAL COED. 
of tabes which were syphilitic. Erb is therefore inclined to believe that 
syphilis has a more direct connection with tabes than he has formerly 
held. 
Kalder and Pick advance the supposition that ataxia and other forms 
of spinal disease, occurring after acute infectious diseases, are the result 
of accumulations of the fungi which cause the acute diseases, in the 
central nervous system, and which give rise to nutritive disturbances of 
greater or less gravity and extent. 
As examples of the previously known fact that the morbid process in 
tabes is in most, perhaps in all cases not confined to the posterior col- 
umns, cases reported by Hayem, Prevost, Kahler and Pick, and West- 
phal may be cited. In Hayem's case, sclerosis of part of the lateral col- 
umns, numerous changes in the gray substance, sclerosis of the ascending 
root of the trigeminus and of the so-called “respiratory bundle” existed 
in addition to a lesion of the posterior columns. The cases of Westphal 
and Kahler and Pick have been referred to under myelitis as cases of 
combined system-diseases of the cord. Also a case communicated by 
Friedreich ( Virch. Arch., Bd. 70) is to be mentioned, in which an ex- 
tensive annular degeneration existed, resembling the lesion found in one 
of Kahler and Pick's cases. In all these cases, the direct cerebellar lateral 
tracts were involved in addition to the posterior columns. The sup- 
position is advanced that the ataxia results from the implication of those 
columns and not from the disease of the posterior columns. This sup- 
position is far from being proved. 
In his recently published analysis of fifty-six clinical cases of locomo- 
tor ataxia occurring in his own practice, Erb gives a tabulated statement 
of the relative frequency and importance of the symptoms of the disease 
which cannot be transcribed here in full, on account of my limited space. 
In this paper he lays greater stress than formerly on the occurrence of 
spinal myosis, or, as he proposes to call it, reflex immobility of the pupil, 
to distinguish the condition from immobility of the pupil during accom- 
modative effort and from complete immobility, and to include those cases 
in which the pupil fails to respond to light, but in Avhich it is of normal 
size or is dilated. Erb found the symptom in fifty-four per cent of 
patients examined. Vincent found it in ninety-two per cent. It is 
probably not an early symptom. It is only found in progressive paraly- 
sis of the insane with equal frequency (nineteen out of twenty-one cases 
Vincent). Atrophy of the optic nerve occurred in only six out of forty-nine 
cases. Tendon reflex was absent in all but one of fifty cases. This is proba- 
bly always an early symptom. Mechanical irritability of the quadriceps 
was always fully preserved (tested in thirty-two cases). Erb has found 
tendon reflex absent in only two other morbid conditions, i. e., pro- 
gressive cerebral paralysis and in cases of paresis of the quadriceps with 
atrophy and degeneration reaction. In Erb's experience, it is never ab- 
sent in young or middle-aged people in health. Hence he thinks that 
its absence may be regarded as almost pathognomonic of tabes in its 
earlier diagnosis. Cutaneous reflex was absent in six out of forty-seven LOCOMOTOR ATAXIA. 
587 
cases. Analgesia to strong irritant (Berger) was present in thirteen out 
of twenty-nine cases. This symptom, which is not rare in other diseases, 
is often early present, hut it must he remembered how widely sensibility 
varies in normal subjects. 
Oulmont, by careful examination of the disturbance of sensibility in 
ataxic subjects, discovered that it was not only very frequent, but very 
widespread. He discovered certain spots of predilection (in the breasts, 
around the umbilicus, fingers and forearms, backs of the legs, the heels 
and toes, etc.). 
Experiments to determine the farado-cutaneous sensibility in tabes 
conducted by Drosdoff (seven cases), and Erb (four cases), showed di- 
minution all over the body. A broad, soft wire brush was used. It 
appears to be an early symptom and may prove of diagnostic value 
{Erb). 
Remak, E., in two cases discovered that sensibility could be exhausted 
by an abnormally small amount of irritation. 
Pierret has found that all possible nervous disturbances of hearing 
may precede the ataxic symptoms. Althause has recorded a case of the 
same sort. 
Among unusual cases may be mentioned the following: A case of 
“hereditary” tabes in which attacks, several hours long, of spasmodic 
coughing, great feeling of anxiety, rapid respiration, dyspnoea, and cyano- 
sis with frequent and rapid pulse (bronchial crises) is recorded by Kaliler 
and Pick. The same observers record a case of ataxia following malarial 
fever, with recovery after two months under quinine. Slight nystagmus 
and slight stiffness of the legs remained. The nystagmus, difficulty of 
speech, and absence of pains and of sensory disturbances seem to ally 
this case with that reported by Leyden as acute cerebro-spinal sclerosis 
with cure, rather than with locomotor ataxia. Erb records a case of not 
very typical but distinct ataxia following diphtheria (?) and exposure to 
cold which recovered rapidly, under galvanic treatment, in six months. 
Ataxia associated with lesion of the left olivary body and a unilateral 
case with a tuberculous nodule in the middle of the left parietal lobe 
are recorded by Kaliler and Pick. The same observers record a case of 
ataxia of apparently cerebellar origin in which the tendon reflex was very 
powerful. They record also a case of tumor of the third dorsal vertebra 
in which ataxia preceded all the symptoms of the transverse myelitis 
which subsequently developed. 
Robert records a case of sclerosis of the posterior columns and of the 
anterior cornua of the brachial enlargement which, in life, was a case of 
typical tabes associated with marked atrophy of the forearms and hands. 
Erb and Hardy record two similar cases of this somewhat rare combina- 
tion (both clinical). 
Kellogg reports two cases very imperfectly, which seem to fall under 
Friedreich’s form of tabes, and which developed in brothers at their 
sixth year. In other branches of the same family were other similar 
cases. Kaliler and Pick have reported a case in which four systems 588 
DISEASES OF THE SPINAL CORD. 
were involved, viz., the pyramid tracts, the cerebellar lateral tracts, with 
Clark’s columns, the wedge-tracts, and the columns of Goll which, as 
the affection was associated with defective development of the cord, they 
have tried to rank as a case of hereditary tabes. As the ataxia was very 
slight, the paralytic symptoms prominent, and there were no disturb- 
ances of the bladder or of sensibility, the justice of this classification 
seems questionable (Erb). 
The rules given by Renz (see myelitis) in regard to the use of thermal 
baths in myelitis hold good for tabes also. He begins with a bath of 
31.0°-32.5° C., of 5-10 minutes’ duration. Every two or three baths he 
decreases the temperature until 29° or 28° is reached. When lancinat- 
ing pains are present, baths from 33° to 34° of 8-15 minutes’ duration are 
best. See obtained good results, when the pains were prominent, from 
salicylate of soda. 
Erb recommends the energetic use of the combined antisyphilitic 
treatment, when syphilis coexists in a case of tabes, much more strongly 
than formerly. In his limited experience with it, he has seen encourag- 
ing results. In one case of atrophy of the optic discs, of two and a half 
years’ standing, he saw material improvement of vision under galvanic 
treatment. 
SPASTIC PARALYSIS. 
BIBLIOGRAPHY. 
Erb : Ueber das Vorkommen. der spastischen Spinallahmung bei kleinen 
Kindern. Betz’ Memorabil., 1877, Heft 12, S. 529.—Seeligmuller: Ueb. spast. 
spinale Paralysen bei Kindern. Amtl. Bericht lib. d. 50. Vers, deutsch. Natur- 
forscher u. s. w., in Miinchen, 1877, S. 299.—Flechsig, P.: Ueber Systemerkran- 
kungen im R.-M. 4. Artikel; Primare Degeneration der Pyramidenbahnen. 
Arch. d. Heilk. XIX., S. 53, 1878.—Pick, A.: Zur Lehre von den Systemerkran- 
kungen des R.-M. Fall von Sclerose later, amyotrophique. Arch. f. Psych., 
VIII., S. 294, 1878.—Stoffella: Ein Fall von Seitenstrangsclerose des R.-M. 
Wien. med. Wochenschr., 1878, Nr. 21 und 23.—Leyden: Ueber spastische 
Spinallahmungen. Berl. klin. Wchnsclir., 1878, No. 48.—Velden, R.. Fall von 
spastischer Spinalparalysie. Heilung. Berl. klin. Wchnschr., 1878, No. 38.— 
Henck, G.: Ein Fall von acuter spastischer Spinalparalysie. Berl. klin. 
Wchnschr., 1879, XVI., 29-31.—Seguin, E. C.: The Present Aspect of the Ques- 
tion of Tetanoid Paraplegia. Arch, of Med , N. Y., 1879, L, 74-83.—Westphal: 
Fin Fall von spastischer choreatischer Paralysie. Charite-Ann., Berl., 1879, IV., 
421.—Schulz, R.: Gibt es eine primare Sclerose der Seitenstrange des Rtlcken- 
marks? Deut. Arch. f. klin. Med., 1878-9,XXIII., 343-356.—Zunker, E.: Mittheil 
v. Kranklieitsfallen welche unter den Sympt. der spastischen Spinalparalysie 
einhergingen. Charite-Ann., Berl., 1879, IV., 241-255.—Nixon, C. J.: Clinical 
Contributions to Diseases of the Spinal Cord. Dublin J. M. Sc., 1879, LXVII., 
289-291.—Feinberg: Fall von spastischer Spinalparalyse. Berl. klin. Wchnschr., 
1879, XVI., 290-292.—Charcot: Sclerose laterale amyotrophique, etc. Gaz. de 
hop., 1879, LIL, 1065-1082.— Ricklin : De la paralysie spinal spasmodique. spastic paralysis. 
589 
Gaz. med. de Paris, 1878, Nos. 27, 29, and 31.—Shaw, J. C.: Case of Progressive 
Muscular Atrophy with Sclerosis of Lateral Columns. Jewell’s J. of Nerv. and 
Ment. Dis., Jan., 1879..—Mitchell, S. W.: Spasmodic Disorders of the Legs. 
N. Y. Med. Rec., June 28th, 1879, p. 601.—Amyotrophic Unilateral Spinal Sclero- 
sis (case). Boston M. and S. J., 1879, C., 248.—Westphal, C.: Ueber combinirte 
(primare) Erkrankungen der Riickenmarkstrange. Arch. f. Psych., Bd. VIII., 
S. 469, and IX., S. 691.—Babesiu, V.: Ueber die selbststandige combinirte Seiten- 
und Hinterstrang Sclerose des Ruckenmarks. Virch. Arch., Bd. 76, S. 74-84.— 
Minot, F.: Cases of Diseases of the Spinal Cord. Boston M. and S. J., 1879, C'., 
432.—Seeligmuller, A.: Ueber Lahmungen im Kindesalter. Jahrb. f. Kinder- 
heilk., XII., S. 321, XIII., S. 226-315.—Mader: Einige Falle seltener Spinal- 
krankheiten. Wien. med. Presse, 1879, 961, 995, 1058.—Stumpell: Zur Kennt- 
niss der Sehnenreflexe. Deutsch. Arch. f. klin. Med., 1879, XXIV., 175-191.— 
Gowers, W. R.: A Study of the So-called Tendon Reflex Phenomenon. Proc. 
Roy. M. and Chir. Soc., London, 1878-79, 366, and a few others. 
Seeligmiiller calls attention to the possibility of the relationship of 
parents being an etiological factor in spastic paralysis in cases which 
he has observed among children. 
No case has yet been published which proves the existence of a pri- 
mary disease limited to the pyramid tracts satisfactorily. Sto fella has 
published a typical, uncomplicated .case of spastic paralysis, in which, on 
autopsy, gray degeneration of both lateral columns, principally in their 
posterior portions and in the lower thoracic and lumbar portions of the 
cord, was found. In these portions of the cord, the degeneration reached 
to the meninges externally, and to the posterior horns internally. Un- 
fortunately the absence of any record of the condition of the brain and 
medulla, and of any microscopical examination of the cord, renders the 
case incomplete, and therefore inconclusive. 
Erb supposes that the lesions actually found in the lateral columns 
in amyotrophic lateral sclerosis represent the type which we may expect 
to find in an uncomplicated case of spastic paralysis. The degeneration' 
in these cases is found predominantly in the lateral pyramid tracts, with 
a much less marked lesion in the principal mass of the anterior columns, 
and the anterior mixed region of the lateral columns. The anterior 
pyramid tracts are also sometimes degenerated. The degeneration 
of the pyramid tracts is marked, involving atrophy of the nerve- 
fibres, etc. In the other tracts of the white matter of the cord, which 
may be involved, an interstitial growth of the neuroglia is found without 
marked degeneration or atrophy of the nerve-fibres (Flechsig and Pick). 
The pyramid tracts are affected throughout the whole length of the cord, 
and the lesion has been traced through the pons into the crura cerebri. 
The anterior gray columns are degenerated, there being nothing 
typical of this particular disease in the microscopic appearances. The 
cells of the tractus intermedio-lateralis, those of Clark’s columns, and of 
the posterior gray columns are normal. The lesion of the gray matter 
is usually most prominent in the cervical enlargement. 
The changes characteristic of bulbar paralysis are found in the 
medulla. The anterior roots of both cord and medulla are gray, de- 
generated, and atrophic. The muscles, especially of the upper extremities, 590 
DISEASES OF THE SPINAL COED. 
present about tbe same appearance as in typical progressive muscular 
atrophy. 
Flechsig and PicJc have concluded that, in amyotrophic lateral scle- 
rosis, we have to do with a disease affecting the ivhole system of nerve- 
fibres and ganglion-cells, which unite the motor centres in the cortex of 
the brain with the muscles. Both these observers are inclined to regard 
the process as a primary disease of the nervous elements, a so-called 
parenchymatous degeneration or sclerosis. Flechsig seems inclined to 
regard the lesions of the anterior parts of the lateral columns, and of the 
principal masses of the anterior columns, as an accidental and immaterial 
complication. Pick regards them as being continued from the anterior 
roots and the primarily affected pyramid tracts. 
With reference to the symp>tomatology of spastic paralysis, Erb, in the 
second edition of his work, calls attention to the great prominence of 
contracture in children affected with the disease. The increase of ten- 
don reflex may usually be found in them if care is exercised in bringing 
the limbs into a proper position for its demonstration. In testing the 
ankle-clonus too strong or sudden flexion must be avoided. 
Numerous cases of more or less typical spastic paralysis are reported 
clinically in recent literature. Many autopsies of cases, in which spastic 
symptoms have been prominent, have also been reported and shed some 
light on the affection. Hallopeau (Des paralysies bulbaires. These, 
Paris, 1875, p. 121) and Schulz each reports a case of tumor of the me- 
dulla, with secondary degeneration of the pyramid tracts, in which spastic 
symptoms were prominent, though associated with other symptoms. 
Pitres (Revue mens., 1877, Dec., p. 902) reports a case which Charcot 
diagnosed as one of spastic paralysis, but which afterwards developed 
other symptoms. On autopsy multiple sclerosis was found. Both 
anterior pyramids and foci in the lateral columns wTere sclerotic. Hydro- 
myelus of the cervical portion of the cord with .symmetrical {secondary ?) 
degeneration of the posterior portions of the lateral columns in the lumbar 
portion of the cord, were found in a case of spastic paralysis, in which 
later disturbances of sensation occurred {Sanger). 
Shaw reports a case giving a typical clinical history of bulbar paralysis 
with progressive muscular atrophy, without contracture, in which, in 
addition to the ordinary lesion of the medulla and anterior horns, sclerosis 
“of a very light character throughout the cord,” was found in the lat- 
eral columns. 
Two cases in which the symptoms of spastic paralysis were prominent, 
though complicated by others, in which no lesions of the lateral columns 
existed, are of special interest. Schulz reports a case of internal hydro- 
cephalus of twenty-five years’ duration, in which some disturbance of sen- 
sation was the only symptom complicating an otherwise typical history 
of spastic paralysis. The cord was normal. 
Mader reports a case in which the white substance of the cord ivas 
normal. The prominent spastic symptoms which existed in life seemed 
to have been caused by a lesion of the cauda equina. The anterior gray SPASTIC PARALYSIS. 
591 
columns were sclerosed in part, and a peculiar, apparently inflammatory 
degeneration of the muscles existed. Inflammatory changes in the bones 
and knees were also found. Other symptoms besides those characteristic 
of spastic paralysis existed during life. A case reported by Bramivell, in 
which rigidity and paralysis of the legs, with numbness and greatly in- 
creased tendon-reflex, disappeared after the discharge of a lumbar abscess, 
may be ranked with this case as being possibly of peripheral origin. 
The cases of combined-system diseases of the cord, above referred to, 
must be here alluded to, as in them spastic symptoms were associated 
with lesions of the lateral columns, except in WestphaVs and Leyden’s 
cases. 
With reference to the conclusions to be drawn from clinical and patho- 
logical experience in respect to spastic paralysis, Leyden, writing in 
1879, states that while the symptom-complex, known as spastic paraly- 
sis, is pretty frequent in spinal diseases of different kinds, it does not 
form a peculiar disease in itself. It occurs in some forms of meningitis 
and myelitis, which are susceptible of cure. He does not think that any 
decided relationship to sclerosis of the lateral columns is manifested in 
cases of chronic myelitis, in which the peculiar symptom-complex occurs, 
although in these cases the periphery of the anterior and lateral columns 
is, to a greater or less extent, affected. The spastic phenomena can be 
explained by the interruption of the conduction of motor impulses from 
the brain by the myelitic process, and the consequent increase of reflex 
irritability below the lesion. Other influences, however, may cause mus- 
cular contraction, such as associated movements from irradiation of vol- 
untary impulses and descending neuritis and myelitis. Erb explains the 
absence of spastic paralysis in those complicated cases reported by Leyden 
and Westphal, by the coincident existence of degeneration of the gray 
substance and of the anterior roots, which must, of course, prevent con- 
tracture as well as increased tendon reflex. Westphal explains their ab- 
sence, in his cases, by the implication of the white matter in the posterior 
root-zone, which prevented reflex action. Erb states that complete 
degeneration of the pyramid columns must cause only paralysis, since 
some power of conduction is necessary for the production of spastic 
symptoms. He concludes (1878) that a decided connection is manifested 
between sclerosis of the lateral columns and spastic paralysis. Cases 
recorded since 1878 seem to support his conclusion, although the peculiar 
symptom-complex of spinal paralysis has been exceptionally found with- 
out lesion of the lateral columns. These cases were not, however, per- 
fectly typical. 
Erb and Charcot lay great stress on the necessity of limiting the desig- 
nation spastic paralysis to those cases which are perfectly typical. Any 
complicating symptom (disturbance of sensation, vesical weakness, etc.) 
throws doubt on the diagnosis. The history of the recently reported 
complicated cases illustrates fully the truth of the latter statement. The 
possibility that certain diseases of the brain may commence, especially in 
children, with the symptoms of spastic paralysis is to be kept in mind 592 
DISEASES OF THE SPINAL CORD. 
(see case of Schulz and clinical observations of Seguin and of Miles, 
spastic infantile paralysis, Med. Rec., 1ST. Y., 1879, XVI., 217). 
Stiimpell calls attention to the relaxation of the limbs, which takes 
place in spastic paralysis, when the legs are deprived of the irritation of 
their own weight by the support afforded by water in a bath. The use 
of the bath is of value in determining the amount of paralysis, the spas- 
tic element being thus eliminated. The same observer saw ankle-clonus 
in typhoid fever and in phthisis without other nervous symptoms, except, 
in some cases, hypersesthesia of the muscles. No change was found in 
the cords of the phthisis cases to explain the phenomenon. He found 
increased tendon reflex in a case of lead paralysis affecting only one arm, 
in a case of poisoning by strychnia and in three cases of poisoning by 
atropine. 
Mitchell saw a case of amyotrophic lateral sclerosis improce in all 
respects under tonic treatment (elixir quiniae, ferri et strychniae, phos- 
phates and cod-liver oil). He saw two cases resembling spastic paralysis 
recover in sixteen hours and three weeks respectively. Hench, G-, had a 
case, very nearly typical, which recovered in thirty-four days. Dry cups 
to the spine and purgatives were used. Velden gives one of recovery after 
thirteen months’ illness. Case was not quite typical. Chloride of gold 
was used for two and a half months previous to recovery (chloride of 
gold, 0.3; distilled water, 15.00; fifteen to twenty drops three times a 
day). Mitchell obtained temporary relaxation of spastic contraction by 
the use of massage. In the absence of the spastic contraction, the patient 
could not stand up. No other cases are reported which shed light on 
the treatment or lighten the prognosis of this class of diseases. 
TREATMENT AND PROGNOSIS. 
HEMIPLEGIA AAD HEM1PAPAPLEGIA 
SPIHALIS. 
BIBLIOGRAPHY. 
Weiss, R: Stich an’s R.-M. zwischen Atlas u. Scliadel. Durchtrennung der 
recliten Halfte. Langenbeck’s Arch., XXI., S. 226, 1877.—Gowers: Unilateral 
Gun-shot Injury to the Spinal Cord. Lancet, 1877, Nov. 17th, p. 728.—Remak, 
E. : Ein Fall von atropischer Spinallahmung durch traumat. lialbseit. Blutung 
in. d. Halsanschwellung des R.-M. Berl. klin. Woch., 1877, Nr. 44.—Schultze, 
F. : Beitr. zur Lehre von den Riickenmarkstumoren. Arch. f. Psych., VIII., S. 
367, 1878.—Henry, James : A Case of Spinal Hemiplegia. Am. Jour, of Med. 
Sci., Oct., 1877, p. 440.—Vnlpian, A.: Myelites chroniques, compression lente 
de la moelle. Clinique med. de Fhop. de la Charite. Paris, 1879, 657, 667. POLIOMYELITIS ANTERIOR ACUTA. 
593 
A short mention of Gowers,* case is all that calls for special mention 
here. In this case, a splinter of bone, knocked off by a pistol-bullet, in- 
jured the right half of the cord between the second and third vertebrae. 
Reflex action was diminished on the affected side. The sensibility to 
pain was abolished, that to touch was retained. The posterior column 
was not directly injured. The anaesthesia reached exactly to the median 
line. 
POLIOMYELITIS AYTERIOR ACITTA. 
BIBLIOGRAPHY. 
Herrmann, J.: De la paralysie infantile chez l’adulte. These, Paris, 1876.— 
Salomon, G.: Yier Falle von spinaler Lahmung Erwachsener. Berl. klin. Woch., 
1877, Nr. 39.—Seeligmuller : Ueb. die Unzulanglichkeit uns. Kenntnisse liber 
das Mitralstad. der spin. Kinderlahmung. Amtl. Bericht d. 50. Vers, deutsch. 
Naturforscher u. Aerzte zu Miinchen, 1877, S. 300.—Rosenthal, M.: Zur klin. 
Charakteristik der Poliomyelitis anterior. Virch. Arch., Bd. 72,1878.—Schultze: 
Beitrage zur Pathol, und pathol. Anatomie des centralen Nervensystem, etc. 
Virchow’s Arch., Bd. 73, S. 444.—Althaus, J.: On Acute Anterior Myelitis in 
the Adult. Am. J. M. Sci., April, 1878.—Seeligmuller: Ueber Lahmungen im 
Kindesalter. Jahrb. f. Kinderheilk., XII., 321; XIII., 226, 315.—Hamon, Henri: 
De la paralysie infantile, ses deformations, son traitement. These de Paris.—Alt- 
haus, J.: On Infantile Paralysis. London, 1878.—Simon, J.: Diagnostic et traite- 
ment de la paralysie infantile. Gaz. med. de Paris.—Muller, F. : Zur Poliomye- 
litis anterior acuta bei Erwachsenen. Oester. arztl. Vereinstg., Wien, 1879, III., 
45.—Sturges, W. A. : Three Cases of Acute Anterior Poliomyelitis in Adults. 
Brit. M. J., 1879, I., 849, 888.—Sainton, H.: Quelques considerations a propos d’un 
cas de paralysie spinale atrophique aigue de l’adult. France med., 1879, XXVI., 
514, 523—Muller, F. : Die acute atrophische Spinallahmung der Erwachsenen. 
Stuttg., 1879.—Kirmisson, E.: De l’integrite de faisceau claviculaire du trapize 
dans la paralysie infantile du membre superieur. France med., Par., 1879, 
XXVI., 673.—Mader : Progressive Myelitis anterior mit Muskelatrophie, Hypo- 
glossuslahmung. Tod.-Ber. d. kk. Krankenanst. Rudolph Stiftung in Wien, ’78, 
350. 
The important recent contribution to this subject is the case of acute 
poliomyelitis in an adult, with autopsy reported by Schultze. The 
patient was a woman, aet. 42. The disease began with a chill, followed 
by eight days of fever. The paralysis was typical in its way of occur- 
rence and in the electrical reactions. Exposure to cold was the appar- 
ent cause. Death resulted from phthisis pulmonalis in thirty-four days 
after chill. On autopsy, degeneration was found in the anterior horns 
of those parts of the cord which corresponded to the affected limbs and 
degeneration of the corresponding anterior roots. At the junction of the 
lumbar and dorsal portion of the cord, a number of slightly and a few 594 
DISEASES OF THE SPINAL COED. 
greatly swollen axis-cylinders among a large number of normal ones were 
found, predominantly in the antero-lateral columns. 
Clinical histories of this disease in the adult, quite typical in their 
course, are given by Althaus, Sturge, and Sainton. 
Seeligmiiller calls attention to the small number of exact observations 
of the initial stage of the disease which have been recorded. The initial 
symptoms are often so slight as not to give rise to careful examination of the 
cases. His last communication contains an analysis of seventy-five cases 
in children, which occurred in his own practice. The analysis led to no 
result which needs to be mentioned here. He records four cases, two of 
them doubtful, in which progressive muscular atrophy occurred in later 
life in patients who had infantile paralysis. 
Kirmisson calls attention to the non-implication of the upper part 
of the trapezius in two cases of infantile paralysis, in which complete 
atrophy of the deltoid, biceps, supra- and infra-spinati, and lower two- 
thirds of the trapezius existed. 
Seeligmiiller saw complete recovery in one case of infantile paralysis 
of the right shoulder after four and a half months of electrical treatment. 
poliomyelitis anterior sitbacitta 
ET CHRONICA. 
BIBLIOGRAPHY. 
Df jejune : Atroph. muscul. et parapleg. dans un cas de syphilis maligne pre- 
'Coce. Arch, de Physiol., 1876, 480.—Ketly, K.: Poliomyelitis anterior acuta et 
chronica. Wien. med. Woch., 1877, Nr. 28 u. 29.—Salomon, G.: Berl. klin. 
Woch., 1877, Nr. 39.—Eisenlohr: Neuropatholog. Beitrage, I. Zur Casuistik der 
subacut. vorderen Spinallahmung. Arch. f. Psych., VIII., S. 310, 1878.—Ro- 
senthal, M.: Zur klin. Characterise d. Poliomyelit. anterior. Virch. Arch., Bd. 
72, 1878.—Erb, W.: Ueb. eine noch nicht beschrieb. Mittelform der chron. 
atroph. Spinallahmung. Vorlaufige Mittheil. Erlenmeyer’s Centralbl. f. Nerven- 
heilk. u. s. w., 1878, Nr. 3.—Bataille, V.: Contributions a l’etude de la paraly- 
sie spinale atrophique de l’adulte. Paris, 1878.—Malone, M. J.: Case of Suba- 
cute Spinal Paralysis in the Adult. Dublin J. M. Sci., 1879, 297.—Kahler und 
Pick: Beitrage zur Lehre von den Veranderungen der elektrischen Erregbarkeit 
bei Poliomyelitis anterior subacuta. Vrtljschr. f. d. prakt. Heilk., 1879, II., 41- 
72.—Edes, R. F.: A Case of Anterior Spinal Paralysis with Formation of Vacu- 
oles in the Ganglion Cells of the Spinal Cord. Bost. M. and S. J., 1879, Cl., 
105-109.—Renaut : Remarques anatomiques et cliniques sur deux points particu- 
lars de l’intoxication saturnine chronique. Gaz. med. de Paris, 1878, p. 394.— 
Dejerine : Recherches sur les lesions du systeme nerveux dans la paralysie diph- 
theritique. Arch, de Physiol., 1878, p. 107-144.—Aufrecht: Die Ergebnisse eines 
Falles von subacuter Spinal paralysie, etc. Deutsches Arch. f. klin. Med., Bd. 
XXII., S. 33.—Kahler u. Pick: Ueber Vacuolenbildung in den Ganglion-Zellen 
des Riickenmarkes. Vrtljschr. f. d. prakt. Heilk., 1879, Bd. II., S. 5-17.—Vul- PIAN: Paralysie atrophique de l’enfance. Chir. med. de l’hop. de la Charite, 
Par., 1879, 772-779.— Remak, E.: Ueber die Localisation atrophischer Spinallah- 
mung und spinaler Muskelatrophieen. Arch. f. Psych., 1879, IX., 576.—Bern- 
hardt : Beitrage zur Pathol, der peripherischen und spinal. Lahm. Virchow’s 
Arch., 1879, Bd. 78, 267.—Ricklin : Considerations sur deux cas d’atrophie mus- 
culaire sans alteration des cornes anterieures de la moelle. Gaz. med., No. 49, 50, 
1878. — Adamkiewicz, A. : Zwei parallele Falle, Poliomyelitis, Bleilahmung. 
Charite-Ann., Berl., 1879, IV., 430, 454. 
The etiological connection between lead poisoning and poliomyelitis 
anterior has been investigated by J. J. Mason (lead-poisoning in frogs, 
N. Y. Med. Jour., 1877, July, p. 36). His results were negative. Erb 
alludes to them as needing confirmation. Vulpian found chronic mye- 
litis with destruction of the ganglion-cells in a dog poisoned by lead. In 
a case of lead paralysis in the human subject, he found degeneration and 
atrophy of isolated ganglion-cells, with some increase of nuclei, and with 
sclerotic spots in the roots of the cervical enlargement. Friedlander 
(Virch. Arcli., 75, S. 24, 1879) records an autopsy of a case of lead 
paralysis in which degenerative changes were found in the muscles, 
nerves and spinal roots, but the spinal cord was perfectly normal. Remak 
criticises this case unfavorably on account of the imperfect clinical 
history. 
As shedding some light on the pathology of the affection may be 
cited the cases of Vulpian and Aufrecht. These were complicated cases 
of irregularly distributed myelitis in adults, in which atrophy of the 
muscles and lesions of the anterior horns existed. The latter in his case 
found certain clear nucleated fibres, with here and there a spindle-formed 
mass of striated muscular substance, which he regarded as muscular 
fibres in the process of regeneration. Scattered through the nerves he 
found small nucleated fibres, in some places split into two parts, which 
he regarded as newly developing nerve-fibres. 
Kaliler and Pick report a case - in which an excessive formation of 
vacuoles in the ganglion-cells of the anterior horns was the only spinal 
lesion found to explain paresis without evident atrophy, which existed 
during life in all the limbs. The only change in the electrical reactions 
was a diminished excitability to both currents in some muscles, princi- 
pally in the extensors of the arms and hands. A similar lesion was 
found in a case reported by Ecles, in which atrophy of forearms and legs 
began to develop less than four months before death. The abstract of 
this case given in the Boston Med. and 8. J. is very imperfect. Dejerine 
publishes a case which, clinically, was not a typical one of poliomyelitis 
anterior, but in which degenerative atrophy of the muscles existed with 
degeneration of the motor nerves and anterior roots. The ganglion-cells 
of the anterior horns in the lumbar enlargement had, for the most part, 
disappeared. There was no indication of an irritative process in the 
connective tissue or on the blood-vessels. This same observer, from the 
examination of five cases of diphtheritic paralysis, concludes that in the 
anterior roots of the spinal nerves a lesion is always found, which corre- 
sponds to that which occurs in the distal end of a cut nerve, and is pro- 
POLIOMYELITIS ANTERIOR SUBACUTA ET CHRONICA. 
595 596 
DISEASES OF THE SPINAL CORD. 
portionate in intensity to the duration of the paralysis. The posterior 
roots are never affected. A light alteration, to which the above is secon- 
dary, is always found in the gray substance, affecting the parenchyma 
and the insterstitial substance equally, and not limited to any particular 
cell groups. 
Ricklin speaks of a case (reported by Debove in the Proqres Med., 
1879, p. 856) in which atrophy rapidly involved the legs, the forearms 
slightly, and the hands considerably, coming on with fever and pain in 
the limbs. These latter ceased after the second day in the arms, in the 
legs they diminished in violence, coming on in paroxysms three or four 
times an hour. Paralysis wras nowhere Complete. Sensibility and the 
sphincters were normal. Death occurred in three and a half months 
from intercurrent pneumonia. On autopsy, the spinal cord was normal. 
Clinical histories of more or less typical cases are recorded by several 
observers, which confirm on the whole Erb’s statements in regard to 
course and prognosis of poliomyelitis anterior chronica. Renant records 
two cases of extensive lead paralysis, which was preceded by high fever, 
with no other apparent origin than the process which resulted in the 
paralysis. Bernhardt records a case of lead paralysis, in which the elec- 
trical reactions were those of Erb’s middle form of poliomyelitis anterior 
(see below). 
Erb states that the fibrillary contractions of the muscles, which are 
usually present in the earlier stages of poliomyelitis anterior chronica, 
may be absent. The atrophying muscles are often painful on pressure, 
and may also be the site of-spontaneous pains. In the more lightly 
affected muscles, reflex action may be only diminished, not, as is usually 
the case, entirely abolished. 
Cases strongly resembling lead paralysis are reported by Erb, Rosen- 
thal, and Adamkiewicz. This latter observer saw a formerly very free 
secretion of sweat disappear with the onset of the paralysis. 
Erb has recently described what he calls a middle form of chronic 
poliomyelitis anterior, which differs from the ordinary type of the dis- 
ease in that the paralysis is never complete, that the reflexes are not at 
all or only partly abolished, and that, while the degeneraction reaction in 
the muscles themselves is marked, the nerves are not at all or very little 
affected. 
Erb has seen four cases of this form of disease. Its course is very 
gradual. The evenly distributed muscular atrophy develops without 
fibrillary contractions. In other respects the symptoms are those of 
typical poliomyelitis anterior chronica. Three of Erb’s cases improved, 
one recovering completely. The fourth developed slight symptoms of 
bulbar paralysis, but seemed to be stationary when it was recorded. The 
constant current applied over the spine was used in the case of cure. 
In this place will be mentioned the results obtained by Remak, from a 
recent clinical study of twenty-one cases, including infantile, lead and 
chronic atrophic paralysis, the latter including four cases of progressive 
muscular atrophy. He finds that in these diseases there exists a marked ACUTE ASCENDING PARALYSIS. 
597 
tendency toward the isolated involvement of certain groups of muscles 
which act functionally together, although the individual muscles of these 
groups are innervated by different' nerve-trunks, and although other 
muscles innervated by these same nerve-trunks are not involved. The 
most important of these groups are the biceps, bracliialis anticus, and 
supinator longus—the muscles on the dorsum of the forearm, exclusive 
of the supinator longus—the quadriceps extensor cruris and tibialis anti- 
cus, the sartorius and the perinei not being involved. These groupings 
have been previously observed in isolated cases. Remak regards this fact 
as pointing to the probability of the existence of certain foci of ganglion- 
cells in the cord corresponding 'to these groups of muscles, and therefore 
to the probability that any disease in which this grouping occurs is of( 
spinal origin, although an affection of the spinal roots or of the plexuses 
near the cord may give rise to a similar grouping of affected muscles. He 
argues that this tendency in lead paralysis is an indication of its spinal 
origin. In a case reported by Schultze, in which all the muscles supplied 
by the sciatic nerves, except the tibiales antici were paralyzed, on autopsy 
it was found that the lower half of the lumbar enlargement of the cord 
was degenerated. The case thus demonstrated that the spinal centre for 
the tibialis anticus is in the upper half of the lumbar enlargement and 
disassociated with the centres of the other muscles supplied by the same 
peripheral nerve. 
acute ascending paralysis. 
BIBLIOGRAPHY. 
Vulpian: Legons sur les malad. du syst. nerv. Paris, 1877, p.,188.—Grasset: 
Malad. du syst. nerv. Paris, 1878, p. 467.—Ketly, K.: Vergiftung mit Sublimat. 
Tod in Folge von aufsteig. acut. Paralyse. Pester med. chir. Presse, 1878, Nr. 
8 u. 9.—Jaffe, T.: Ein Fall von Paralysis ascendens acuta. Berl. klin. 
Wchnschr., 1878, XV., 653.—Dejerine, J.: Sur l’existance des lesions des racines 
anterieures dans la paralysie ascendante aigue. Gaz. med. de Paris, 1878, 375.— 
Recherches sur les lesions du systeme nerveux dans la paralysie ascendante aigue 
(Paris, These).—Fox, A. W.; Case of Acute Ascending Paralysis. Brain, 1879-80, 
II., 418. 
In Ketly’s case of acute ascending paralysis following poisoning by 
corrosive sublimate, the anatomical investigation was negative in results. 
The case reported by Jaffe occurred in a syphilitic subject after excess 
in venery. The abolition of all the reflexes, and the almost complete 
abolition of faradic irritability of nerves and muscles with slight galvanic 
irritability, seems to point rather to acute poliomyelitis anterior. The 
reactions were tested by Frb. No autopsy. 
Fox’s case was almost typical in its clinical course. No changes were 
found in the cord except an apparent slight increase of connective tissue 598 
DISEASES OF THE SPINAL COED. 
in the cervical region of the cord. Sections of the medulla seemed to 
stain with abnormal readiness. Some increase of connective tissue seemed 
to exist about the cauda equina. 
Dejerine claims to have found in two cases of acute ascending paraly- 
sis seen under Vulpian, an alteration in certain fibres of the anterior 
roots (parenchymatous neuritis). The myeline was broken up into frag- 
ments. Multiplication of nuclei in the Avhite substance of Schwann, and 
disappearance of the axis cylinders were noted. The majority of the 
fibres were unaltered. The same lesions were found in the intra-muscu- 
lar nerves of the affected members. 
TUMORS OF THE SPIHAL CORD. 
BIBLIOGRAPHY. 
Schultze, Fr.: Beitr. z. Lehre von den Riickenmarkstumoren. Arch. f. 
Psych., VIII., S. 367, 1878.—Roth, W.: Glyome diffuse de la moelle, syringo- 
myelie, atrophie musculaire. Arch, de physiol, norm, et path., Par., 1878, 612- 
647.—Kohts: Gerhardt’s Handbuch der Kinderkrankheiten. Bd. V. (Tubercular 
Tumor of the Cord).—Mader: Einige Falle seltener Spinalkrankheiten. Wien, 
med. Presse, 1879, 1058. 
In the cases of glioma of the cord reported by ScJiultze and Roth, the 
process seemed to take its point of departure from the ependyma of the 
central canal of the cord. 
Scliultze's case, a telangiectatic gliosarcoma myxomatodes, extended 
from the conus terminalis to the pons. For a while it presented the 
symptoms of a lesion of one-half of the cord. The peculiar combination 
of irritative and paralytic symptoms of striking inconstancy is brought 
forward by Schultze as a diagnostic point in tumors of the cord. The 
other cases reported call for no special comment. 
SECONDARY DEGENERATIONS OF THE 
SPINAL CORD. 
BIBLIOGRAPHY. 
Dejerine, J., et Mayer, A.: Recherches sur les alterations de la moelle 
epiniere et des nerfs du moignon cliez des amputes d’ancienne date. Gaz. med. 
de Paris, No. 39-40,1878.—Issartier: Des degenerations seeondaires de la moelle 
epiniere consecut. aux lesions de la substance corticale du cerveau. These, Paris, SPINA BIFIDA—SYRINGOMYELITIS. 
599 
1878.—Taylor, F.: A Case of Disease of the Brain with Descending Degenerations 
of the Spinal Cord. Guy’s Hosp. Rep., 1879, 169-184. 
Taylor’s case is the only one which calls for special mention. It was 
one of typical descending degeneration, originating in a peculiar gelati- 
nous transformation of the corpus callosum, portions of the optic thalami, 
etc. The gelatinous substance of the cerebrum dissolved in alcohol, 
leaving only the blood-vessels, which showed nothing abnormal except a 
collection of small bright nuclei on their walls. The degeneration of 
the cord was darker and more sharply defined than usual. In the degen- 
erated portion a structureless, almost homogeneous tissue took the place 
of the nerve tissue. The disease followed a fall on the back of the head. 
Paresis and spastic contraction of the limbs were the spinal symptoms of 
the case. 
SPINA BIFIDA. 
BIBLIOGRAPHY. 
Ranke, H.: Zur Aetiologie d. Spina bifida. Amtl. Bericht der 50. Vers. d. 
Naturforscher u. Aerzte, Munchen, 1877, S. 297.—Jalirb. f. Kinderheilk., XII., 
S. 116, ’78. 
Ranke advances the theory that spina bifida lumbalis is caused by a 
growing together of the membranes of the cord and the external skin in 
embryonal life before the closing in of the spinal canal, the closure of the 
canal, being thus prevented. His theory is based on three autopsies, in 
all of which the lower end of the cord was adherent to the sack. 
SYRINGOMYELITIS. 
BIBLIOGRAPHY. 
Schule: Beitrag z. Kenntniss der central. Hohlenbildung im R.-M. Deutsch.. 
Arch. f. klin. Med., XX., S. 271, 1877.—Pick, A.: Beitrag zur norm. u. pathol. 
Anatomie der Centralnervensyst. Arch, f. Psych., VIII., S. 283,1878.—Schultze, 
F.: Beitr. z. Lehre von der Rtickenmarkstumoren. Ibid., VIII., S. 367, 1878.— 
Kahler und Pick: Beitrag z. Lehre von der Syring. und Hydromyelie. Vrtljsch. 
f. prakt. Heilk., 1879, II., 20. 
In Schule’s case, an enlargement of the central canal from softening 
of its walls occurred. The supposition that a congenital hydromye- 
litis may be the point of departure for a syringomyelitis later in life 
{Leyden) is supported by recent observations of Pick, who saw two 600 
DISEASES OF THE SPIHAL COrRD. 
and even three central canals obviously formed by the growth of the 
ependyma and by the dividing off of diverticulum-like processes. 
Schultze considered that in his case the same thing might have happened. 
Kahler and Pick saw in an adult cord a triangular dilatation of the 
lumbar portion, which was otherwise normal, obviously due to a defect 
of development. In a second case, the same condition existed, except 
that there was an increase of connective tissue around it, and the epithe- 
lium was in part destroyed. They found dilatation of the central canal 
in a case of amyotrophic lateral sclerosis and in one of progressive muscu- 
lar atrophy with marked sclerosis of the posterior columns. They 
suggest that the condition noted in the first two cases may be regarded 
as an indication of deficient development, and therefore of predisposition 
to disease. 
TOUIO COYTRAOTIOYS OF VOLUNTARY 
MUSCLES. 
BIBLIOGRAPHY. 
Seeligmuller: Ueber spastische spinale Paralysen bei Kindern. Amtl. Ber. 
der 50. Vers, deutscher Naturforscher und Aerzte, Miinchen., 1877, S. 299,—Ueber 
spastische spinal Paralyse. Jahrb. f. Kinderheilk,, XIII., S. 226. 
Seeligmiiller lias observed two more eases of this rare affection. Tlie 
first was a female public singer, whose mother had suffered from cramps 
in the calves. From her earliest childhood spontaneous tonic contrac- 
tions of the kind described in SeeligmiiUer’s first case (see Erb) would 
occur at times in the muscles of the calves, face, tongue, and hands. 
Otherwise she was perfectly healthy. The muscles of the legs, thighs, 
and upper arms were hypertrophied. Treatment effected very little, but 
some spontaneous improvement took place after its cessation. 
The second case was a strongly developed healthy man, aged twenty- 
eight years, without hereditary tendency to disease. During four or five 
years he had stiffness all over the body. If he sat still for a while he 
would have to stretch and press his knees together before he could rise. 
If he wanted to dance he would have to try for some time before he 
could get going, and then there was no further difficulty. If any muscle 
was caused to contract by electricity it would not relax immediately. 
The right leg, right gluteal region, and the muscles of the right side of 
the back was more developed than those of the left side. Treatment 
with the induced current produced no effect. Massage caused some 
improvement.