Licence: Public Domain Mark
Credit: Clinical medicine : cases / by Dr. M'Call Anderson. Source: Wellcome Collection.
Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.
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![tliere was complete paralysis of the lower extremities—so coinplete that he could not even move a toe—but only partial paralysis of the upper extreriiities. He could move his arms, but not with the same ease and vigour as formerly, and he grasped objects somewhat feebly. On using the dynamometer with the left hand, the indi- cator registered 35, and with the riglit only 17 kgs.: the muscles responded imperfectly to electricity. But not only was there paralysis of motion ; the sensation also was very defective from the toes up to the chest, and in the hands too, so much so that he could only feel considerable pressure made with the finger or pin-point. The retiex excitability was likewise completely annihilated. But still more serious symptoms than these were manifest, for the breathing was very laboured and noisy. He spoke with difficulty, and in a hoarse whisper, and dysphagia was so great that on attempting to take a drink he was nearly choked, and it was neces- sary to abstain from feeding him by the mouth. No pain was complained of anywhere, but on examining the spine some tender- ness was detected over the last dorsal and first lumbar vertebras. The application of hot and cold sponges to the spine yielded nega- tive results. The temperature has remained normal throughout, except that in the first week after admission it rose on five occasions up to or above 100°—twice in the morning and three times in the evening—and on the second evening after admission it touched 102°. The day after admission his breathing became so laborious and difficult that for many hours he seemed to be in a dying con- dition, and he was quite unable to swallow anything. The symptoms just enumerated pointed to widespread and alarming inflammation of the spinal cord (myelitis), although it was evident that the continuity of the cord was not destroyed by the disease, else we should have had an increase instead of an annihilation of the reflex excitability and reflex spasmodic move- ments (the spinal epilepsy of Brown-Sequard). [After referring to the points of diagnosis between myelitis on the one hand and meningitis, spinal congestion, and non-inflam- matory (white) softening on the other, Dr Anderson then directed attention to the treatment, as follows.] The treatment was commenced upon the 2^tli of January. On that day he was put upon an air-bed, was kept off his back as much as possible, and the skin over the sacrum, which was red (threatening bed-sore) was sponged frequently with camphorated spirits of wine. A subcutaneous injection of tbs of a grain of sulphate of atropia was prescribed night and morning, and he was fed entirely through the nose by means of a piece of indiarubber tubing on the syphon principle, in the way I demonstrated to you on the 1st February. On the 2Wi January flying blisters to the spine were commenced. On the morning of tiiis day a narrow blister was applied over the lower cervical and upper dorsal region for an hour; on its removal](https://iiif.wellcomecollection.org/image/b21457554_0012.jp2/full/800%2C/0/default.jpg)
