A handbook of the theory and practice of medicine / by Frederick T. Roberts.
- Frederick Thomas Roberts
- Date:
- 1883
Licence: Public Domain Mark
Credit: A handbook of the theory and practice of medicine / by Frederick T. Roberts. Source: Wellcome Collection.
928/1006 (page 908)
![inflammatory softening by the microscopic appearances. In the i7tflam- maiory form he describes a large number of cells containing fat-granules, tensely distended blood-vessels, numerous young cells, increase of the in- terstitial tissue, swollen axis-cylinders, &c.in simple softening merely swollen and disintegrated nerve-fibres, ganglion-cells in a state of glassy swelling, a few cellular elements and fat-granule cells, and a small (luantity of fatty detritus. It must be noticed that in many cases of chronic myelitis the cord is firmer than natural, on account of considerable increase of connective-tissue elements, and gradual removal of the nerve-tissues Indeed, by some pathologists the condition termed sclerosis, with the par- ticular diseases to which this change gives rise, is believed to be inflam- matory in Its origin. Chronic myelitis is very variable in its distribution, hence named transverse, disseminated, annular, general, &c. Symptoms.—If the cord becomes gradually softened, from whatever cause, the signs of the change are more or less of the following character :— Dull pam or uneasiness over some portion of the spine, increased by pressure, percussion, or the application of a hot sponge or cold, but not by movement; a feeling of tightness round the body; distressing parjes- thesi^ wandering pains, or fidgetty sensations in the legs, followed by gradual loss of feeling to complete anesthesia, this often extending up the body to a variable extent; twitchings, spasmodic movements, and cram])s in the legs, with diminished power, dragging of the legs in walking, and a sense of heaviness and fatigue, culminating in paraplegia ; frequently a marked tendency to painful contractions and rigidity in the paralyzed limbs, the legs being in many cases drawn up involuntarily if left to them- selves, sometimes by jerks, so that the joints become strongly flexed, or one or both limbs being rigidly extended; tendency to wasting of the muscles of the legs, with failure of circulation and nutrition, the skin being often covered copiously with dried epithelium-scales, and bed-sores being very liable to form ; paralysis of the bladder, leading to retention and decomposition of urine, and consequent cystitis and renal mischief; paralysis of the rectum, with unconsciousness of the passage of stools ; gradual loss of sexual power and inclination, though there is often reflex priapism. In short, the symptoms of chronic myelitis or simple softening are_ usually those of slowly-developed chronic paraplegia in its most typical form. The condition of the muscles, and the state of the reflexes will depend on the exact seat and extent of the disease. Often there is an exaggeration of the deep reflexes, but they may be impaired or lost. I he clinical history is liable to vary much from the association of softening with other morbid conditions. In rare instances the cord iray become so extensively diseased as to give rise to general paralysis, with marked wasting of the muscles, and loss of electric irritability. The general health often remains good ; and patients may live for many years. Death may occur from the effects of the cord-lesion; or from intercurrent complica- tions, such as phthisis or pneumonia. IX. Adventitious Growths in the Cord. New growths affecting the cord usually originate in connection with the spinal column, the meninges, or the nerve-roots, and very rarely in the sub- stance of the cord Itself The most important are cancer, tubercle, sypJii- itncjormations, utjlammatory growths, and sarcoma. Of the rarer forms may De mentioned glioma, myxoma, fibroma, lipoma, cartilaginous growths,](https://iiif.wellcomecollection.org/image/b20399893_0928.jp2/full/800%2C/0/default.jpg)
