Diseases of the spine and of the nerves / By C.B.R., John Netten Radcliffe, J.Warburton Begbie, Francis Edmund Ainstie and John Russell Reynolds.

  • Radcliffe, Charles Bland.
Date:
1871
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the spine and of the nerves / By C.B.R., John Netten Radcliffe, J.Warburton Begbie, Francis Edmund Ainstie and John Russell Reynolds. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    of castor oil and spirits of turpentine which was administered yester- day. During my visit I had an opportunity of seeing the patient after a paroxysm as well as in it, and I quite satisfied myself that the mus- cular stiffness of the paroxysm soon passed oft', and that in the inter- val between the paroxysms the muscles were relaxed, except perhaps at the back of the neck—with this possible exception, because all along the head remained drawn back to some degree upon the pillow. Jan. 1, 1865.—The night has been perfectly sleepless, with now and then some trifling lightheadedness. The paroxysms of pain, stiffness, and difficulty of breathing are not so frequent (three hours have passed since the last), but the respiration is certainly shallower and less suffi- cient, and the pulse more rapid and unsteady. There is the same want of power over the bladder. When I left the ward it was plain enough that the patient was sinking; when I returned two hours later all was over, death having happened in a fit of choking and suffocation caused by attempting to swallow a spoonful of beef-tea with a morsel of bread sopped in it. Tn the agony, the patient not only sat up in bed, but got out of bed and stood for a moment with his hands bearing upon the shoulders of the nurse who had been feeding him. The body was examined after death by my friend and colleague, Dr. Bazire, and the following notes were taken at the time from his dictation :— Time, twenty-four hours after death. Weather frosty. Cadaveric rigidity well marked. The muscles of the back dark and highly con- gested. On cutting through the posterior arches of the vertebras the vertebral vessels are seen to be gorged with dark fluid blood. There is no effusion of blood outside the meninges in the interior of the canal. The meninges are highly congested throughout the whole length of the canal, but to a considerably greater degree in the region between the scapulas. In this latter region, in addition to the thicken- ing, opacity, and intense red colour of the dura mater elsewhere, there are streaks in its substance of black coagulated blood. The arachnoid is intensely red, and the pia mater extremely congested in the same region. Beyond it, the dark red colour of the dura mater gradually passes into a lighter shade, and becomes a bright pink near the cauda equina in one direction, and near the medulla oblongata in the other. The arachnoid is whitish again near the cauda equina. There is no effusion of serosity, blood, or pus, either between the meninges or on the surface of the cord ; indeed, there seems to be a smaller quantity than usual of cerebro-spinal fluid. The substance of the cord itself looks normal in consistence, colour, and size. The central vessel of the cord is highly congested, and on section of the cord there exudes from the centre fluid black blood in minute drops. The cerebral meninges are normal. The cerebral sinuses are highly congested, and the same appearances of congestion (due probably to the mode of death) are met with in the substance of the brain. The organ itself is normal. The symptoms of acute spinal meningitis are plainly exhibited in this case, and there need be no difficulty in distinguishing those which are of primary importance from those which are secondary. As symptoms of primary importance mav be enumerated these: 2