On diseases of the spine and of the nerves / by Charles Bland Radcliffe, John Netten Radcliffe, J. Warburton Begbie, Francis Edmund Ainstie, and John Russell Reynolds.

Date:
1871
Catalogue details

Licence: Public Domain Mark

Credit: On diseases of the spine and of the nerves / by Charles Bland Radcliffe, John Netten Radcliffe, J. Warburton Begbie, Francis Edmund Ainstie, and John Russell Reynolds. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    myelitis, or with those of disease in the bones or ligaments of the spine. 3. Causes.—-The causes of spinal meningitis are often very obscure. In some cases it is rheumatism, or syphilis, or the suppression of some menstrual, hemorrhoidal, or other habitual discharge, or the spreading of cerebral meningitis downwards, or of disease in the bones and ligaments of the spine inwards, which would seem to figure as a cause ; in other cases it is a casual injury to the back, or a chill caught by lying on the back on the cold and damp ground, or some particular disease, as tetanus, chorea, or hydrophobia, to which blame appears to belong. In fact, the causes are legion, and it is impossible to con- nect spinal meningitis with any particular cause or set of causes. 4. Diagnosis.—One or two points of diagnosis have been men- tioned incidentally when dealing with the symptoms of spinal menin- gitis, and with these it is best to be content at present, for before this matter can be gone into advantageously materials must be had which can only be forthcoming when the phenomena of myelitis, spinal con- gestion, and other spinal maladies have been passed in review. 5. Prognosis.—Acute spinal meningitis is, without doubt, a very formidable and fatal disease. There are, indeed, few well-authenti- cated instances of recovery on record, and by some it is doubted whether there be any. Life may be cut short in four or five days, or it may be prolonged to twenty or thirty days, but not often—not often, indeed, beyond six or seven days. In the subacute and chronic forms of the disease, the prognosis is of course less gloomy, but even here it is far from cheering. 6. Treatment.—In all cases of spinal meningitis, rest in the recum- bent position, more or less strictly enforced according to the urgency or leniency of the symptoms, is indispensable, the best position, per- haps, being not strictly on the back, but rather upon the side, and with the limbs a little lower than the back, so as to favour the draining away of blood from the congested parts, and at the same time, to facilitate the use of the local applications to the spine which may be necessary. Upon this point there can be little or no difference of opinion ; upon all other points, in all probability, few will think alike. For my own part, I should be disposed to place most confidence in iodide of potassium and opium, with the local application of ice to the back in acute cases, and to bichloride of mercury, with counter-irrita- tion in one form or other to the spine, in chronic cases. At the same time, I am inclined to think that the present fashion has set very unwarrantably against the old practice of giving calomel and opium, so as to afiect the gums slightly and speedily, and of using local, if not general, bleeding in acute inflammatory disease. There can, I think, be little doubt as to the marked influence for good of calomel and opium in acute inflammation of serous membranes; and it would require very little persuasion to induce me to prefer this mode of treatment to that by iodide of potassium in acute spinal meningitis; and, further, I can readily believe that in such a case recovery would