Congestion, Apoplexy

Congestion of the spinal cord is a symptom in the course, and a sequel, of sundry acute and chronic diseases. Such, most probably, is its real import, in those who have died of tetanus, convulsions, and hydrophobia. It is almost constantly met with in those cases, combined with an equal degree of congestion of the brain. In other cases, it is set up by inflammatory processes in the vertebrae, by the pressure and irritation of exostoses and swollen or luxated vertebrae, and by morbid growths in the cord itself: and it leads to permanent turgescence and hypertrophy of the medulla.

But it also comes on idiopathically. It then usually pervades the whole cord and its membranes, as well as the brain, and is most frequently met with in early childhood: in adults it is confined to the lumbar portion of the cord. (Compare p. 330).

I have had occasion to attribute several affections to what is called spinal irritation; and subsequent communication with the physicians who had had the treatment of the cases, has proved that I have done so correctly. Sometimes there existed a certain amount of congestion, but very often there was neither congestion nor any other unnatural appearance.

Spinal apoplexy, that is to say, hemorrhage independent of injury, is one of the rarest appearance. When it does occur, it is at the cervical portion of the cord, and almost always in the gray substance.

2. Edema

In both its acute and chronic form oedema frequently affects the cord, infiltering, loosening, and producing what is called "white softening" of its texture. What has been said in general of oedema of the brain, applies also to that of the cord. When it extends over the whole cord, the brain is usually in the same condition.

3. Inflammation

All that has been said of inflammation and red softening of the brain, applies in every respect to inflammation of the spinal cord: only the latter is in comparison much less frequent. In the cord, as in the brain, inflammation attacks sometimes the white tracts, sometimes the gray substance, sometimes both together. But it is a striking fact, and worthy of especial notice, that inflammation of the gray substance affects that part in long streaks, or in its whole extent, restricting itself to that substance, and producing a peculiar condition of the cord as well by the increase of volume which attends its softening, as by a peculiar form of dropsy in which it occasionally terminates. The red softening of the gray substance which accompanies it, and which is tinted according to circumstances, of a chocolate-brown, or a plum-sauce color, rusty brown, or yeast-yellow, corresponds with the central softening of the spinal cord, described by Albers.

The following three cases will be found to represent the characteristics of this process; the preparations taken from them are in the Vienna Museum.

Case I

P. Joseph, set. 23, a journeyman joiner, was admitted into the General Hospital, January 19, 1835. He stated that three weeks before admission, he had stood a considerable time in cold water, and had in consequence experienced violent acute pain in the feet and back, accompanied with fever. A few days afterward, tremulous motions and loss of sensation came on in the lower extremities. On his admission he was unable to stand, though he could move his feet in bed; and he had difficulty in passing his urine: he had no fever. In another fortnight the power of moving the legs was quite lost, the urine accumulated in the bladder, and produced a burning pain as it was passed: the vesical region became painful: fever supervened, and frequent vomiting. In March a slough formed on the sacrum, bloody urine was passed through the catheter, and on the 29th of the same month, the patient died.

Examination Of The Body

There was a large slough on the sacrum. The penis and scrotum were swollen, and on the latter were several dirty brownish sloughs.

The lungs generally were oedematous, and their upper lobes tuberculous. The kidneys were large, their pelves were somewhat dilated, the urinary bladder was moderately distended, and its mucous membrane was covered with an exudation which was a line in thickness; whilst underneath it was of a blood-red color, injected, and here and there changed into a brown slough. The cellular tissue of the scrotum was filled with a brownish fetid ichorous fluid.

Spinal Cord

There was a small quantity of serum in the arachnoid sac. The spinal cord was swollen in the lower part of the neck, and still more so in the upper dorsal region; in the latter part its gray substance was infiltered with a grayish-yellow exudation, and was itself in a state of red and yellow softening (gelbröthlich erweicht). About the second and third dorsal vertebrae, the place of the gray matter was occupied by a firmly fixed cylindrical plug of yellow exudation, more than an inch in length, and from three to four lines in thickness.