Case II

St. Leopold, aet. 22, after a fall on his head, three years ago, had been suffering from pain, which was at first slight and transient, and confined to the occiput, but subsequently became severe and continued, and affected the whole head; it at last extended to the nape of the neck, and the upper extremities.

In the second year of the disease, after a feverish attack, which lasted fourteen days, his spinal column began to bend, and he became subject to continued vertigo. All the symptoms diminished while he was in the recumbent posture, and increased after taking a meal: the latter, moreover, was always followed by ineffectual efforts at vomiting. On his admission into the hospital, he had, on the whole, a florid appearance: the symptoms above mentioned were all present; the countenance was ruddy; the head hot; the pulse was accelerated; the respiration natural; and the bowels at times were sluggish. During two months in which treatmerit was employed, the symptoms at times abated, and then grew worse again. In the latter part of his life, erysipelas came on in the face: for the last two days he had pain in the bowels; and some hours before his death, he lost consciousness, and had paralysis of the lower extremities.

Examination Of The Body

The body was pretty well nourished. The pia mater was infiltrated, and the surface of the brain pale: its white substance was also pale, it was moderately vascular and soft, and contained serum. The vessels at the base of the brain, especially about the pons, were dilated and tortuous.

The lungs were of a dark-red color, and congested; the upper lobe of the left was oedematous.

In the peritoneum there was a pound of serum mixed with flakes of lymph. Numerous hemorrhagic erosions, as large as pins' heads, dotted the mucous membrane of the stomach. The liver was shrunken, and of a deep-yellow color; a few drops of dirty grayish-yellow bile were found in the gall-bladder. The follicles of the small intestines were swollen. The colon contained grayish clay-like feces. The kidneys were flabby and vascular: the urinary bladder was contracted and contained half an ounce of turbid urine.

The vertebral column curved in its upper dorsal region backward, and to the right. The vertebral venous sinuses were very full of blood; the dura mater was relaxed; the arachnoid was opaque, and in the lumbar region contained several small plates of bone. The spinal cord was swollen, and felt soft and fluctuating. The white columns were distended into a kind of bag, and enclosed instead of cineritious substance, a grayish briny fluid infiltrated through a loose delicate cellular structure. The change extended upward nearly to the medulla oblongata and downward beyond the lumbar enlargement of the cord.

Case III

L. Katharina, set. 40, eighteen years before death, had a fall from the top floor of a house, by which the spinal column was fractured in the lower dorsal region. The injury got well with an angular curvature in the back, but left behind it an unsteady, dragging gait, and incontinence of urine. While she was in the hospital, the most marked symptoms were redness of the general integuments, and pain on moving. She died with fever and diarrhoea, extremely emaciated.

Examination Of The Body

Much emaciation. The left lower extremity was oedematous. The vertebral column was bent at an obtuse angle in the lower dorsal region, and above that point was slightly curved in the form of the letter S.

There were cellular adhesions of both lungs, and parietal oedema, and lobular hepatization of the right lung posteriorly. In the right upper lobe there was an abscess as large as a hen's egg, and a second as large as a hazel-nut, close to the pleura.

(The gall-bladder was distended with a fluid, like white of egg; and its neck was obstructed by a crystalline stone as large as a dove's egg.

The mucous membrane of the large intestines was strewn with stalked granulations).

The kidneys were large. The urinary bladder was contracted and empty; and spots of its mucous membrane were softened, dark red, and injected. The right ovarium was converted into a sac of fat larger than a hen's egg.

The substance of the brain was pale and tough.

The dura mater at the base of the skull, especially at its basilar part, and in the neighborhood of the sella turcica, was of a dark-red color, and covered, especially in the former situation, with a yellowish exudation. The cavernous sinuses, the circular sinus, the anterior occipital, and the commencement of the petrous sinuses, were filled partly with a brown friable coagulum of blood, but for the most part with a brown and yellow purulent fluid. The left crural vein, and its branches down to the leg, contained a brown coagulum, the outer layers of which were softening, and becoming purulent; whilst within the pelvis it was filled with a brown ichor-like fluid. The commencement of the hypogastric veins, and the iliac, up to the cava, were filled with a similar fluid. The coats of the veins were thickened and discolored, the inner coat being loose like nap, and dull.

At the part where the column was curved, the canal through the vertebrae was contracted to a narrow fissure. A good deal of serum was accumulated in the sac of the spinal arachnoid, and, in the lumbar region, that membrane was occupied by small osseous plates, of about the size of lentils. The pia mater was traversed by distended vessels, and in the lumbar region, infiltrated with a briny fluid. The spinal cord, from the dorsal curvature to the second cervical vertebra, was converted into a fluctuating bag, which was composed of the white columns, and contained a clear serous fluid, but no gray substance, that having disappeared. The columns were softened and pale: the posterior middle columns were forced asunder more than half a line. The inner wall of the bladder was lined by a delicate cellulo-serous tissue, which projected inward, forming numerous ledges, and also extended in bands across the canal from one wall to the other.

Viewing these cases in order, we observe in the first a very intense inflammatory process (red softening) in the gray matter of the cord, distinguished for the quantity, and plastic nature of its products; the gray matter was augmented in bulk, whilst the white columns around were distended. In the second case, the absorption of one part of the products had commenced, and of the substratum, in which the process was going on, while another part of the products was in course of conversion into a cellular structure, and was infiltered with serum. In the third we find the issue of the process: in the place of gray substance there remained a cavity lined by a part of the products of the inflammatory process organized to a tissue, and constituting the cellular infiltration of Durand-Fardel (p. 310). We have here a dropsy of the spinal marrow, quite peculiar, both as to its cause, and as to its nature: the cases in which it has occurred have been recently collected and arranged by Nonat.

In consequence of inflammation (softening) involving the whole thickness of the medulla, the cord has been found completely divided.