=Acute myelitis= is an acute inflammation, with softening of the
substance of the cord, giving rise to marked disturbances of motion,
sensation and nutrition. When the whole thickness of a section of the
cord is involved, the condition is termed =transverse myelitis=. When
an extensive area is involved, it is termed =diffuse myelitis=. When
the gray matter around the central canal is especially affected, it is
termed =central myelitis=.
=Etiology.=—There can be no doubt that osteopathic lesions are very
potent predisposing factors. Osteopathic lesions of the spine, even
of a muscular nature, readily disturb the cord circulation. It may
follow repeated exposure to wet, cold or exertion; or be a sequel to
the infectious diseases, as smallpox, typhoid fever, typhus, puerperal
fever or measles. It may be due to traumatism or disease of the
vertebræ, as caries or cancer. Syphilis is a frequent cause.
=Pathology.=—To the untrained, naked eye, the cord may present
little or no change. The nervous tissues are in various stages of
degeneration. On section the substance of the cord is red and soft,
the line of demarcation between the gray and white matter is lost or
extremely indistinct, and minute hemorrhages are sometimes seen. In
very acute cases, affecting the white and gray matter, after injury,
when the membranes are cut, the substance of the cord may flow out as a
reddish creamy fluid.
The nerve fibers are much swollen and the axis cylinders broken up.
Blood discs, leucocytes, and numerous granular fatty cells may also
be present. The blood-vessels are distended and dilated. There may be
thickening and hyaline degeneration of the vessel walls and hemorrhagic
extravasation.
=Symptoms.—Acute Transverse Myelitis.=—This is the type most frequently
met with. The symptoms differ with the situation of the lesion, which
is generally in the dorsal cord. At the onset there may be pain;
numbness and tingling in the back, radiating into the limbs. There
is usually moderate fever, malaise, chills, muscular pains, a coated
tongue and constipation. Symptoms of =motor paralysis= soon develop,
which may become more or less complete. Both motor and sensory symptoms
vary to a marked degree, depending upon the pathologic involvement. The
reflexes are lost at first. They may soon return and are exaggerated
below the lesion. Following this the muscles often become rigid and
contracted. Unless the lesion is in the lumbar or cervical cord,
reaction of degeneration or much wasting of the muscles, as a rule,
does not occur. A girdle sensation frequently occurs at the level of
the disease. At first there is retention of the urine and feces, later
incontinence. Bed-sores soon develop; also drying and hardening of
the skin. The nails become thick and brittle. Death may occur from
exhaustion, or heart or respiratory failure, but it is rare; segments
of the cord may be completely and permanently destroyed, causing
persistent paraplegia. H. A. Greene[126] reports a case, due to injury,
which was greatly benefited by treatment.
=Acute Diffuse Myelitis.=—In the acute forms the course of the disease
is rapid. The trophic disturbances are more marked than in the former
type. This form is likely to follow exposure to cold, injuries, tumors,
syphilis or one of the infectious diseases. There may be chills, fever,
malaise, pain in the back and limbs, and occasionally convulsions. The
reflexes are generally lost. The motor functions are rapidly lost.
There is incontinence of urine and feces, rapid wasting of the muscles
and bed-sores develop. The disease may prove fatal in from six to ten
days.
=Diagnosis.—Landry’s Disease.=—In this the bladder and rectum are
not affected. Trophic disturbances are absent. There is but slight
loss of sensation, no reactions of degeneration and no girdle pains.
=Multiple Neuritis.=—Both arms and legs involved, and slow onset. The
bladder and rectum are rarely involved; the girdle pain is absent.
=Acute Poliomyelitis.=—There are no sensory symptoms and the rectum and
bladder are not affected.
=Prognosis.=—In very acute cases death occurs in from three to ten
days. Milder cases generally recover with some loss of motor power,
although in a few cases treated by osteopathy recovery was complete,
due probably to the case being seen early and thus degeneration
prevented.
=Treatment.=—Lesions of the vertebræ are usually readily found in
cases of myelitis. Generally, deranged vertebræ are found in the upper
dorsal region, and occasionally lesions are located in the lumbar and
cervical vertebræ. The treatment of myelitis is chiefly to correct
these lesions, so that the normal circulation of the cord may be
reestablished. One has to be very =careful= when treating the lesions
not to cause additional injury to the cord. An inhibitory treatment
to the muscles about the lesion may be all the treatment that can be
given at first; nevertheless, it aids nature just so much in overcoming
the excessive irritation of the cord tissues. Nature has the curative
means, provided they may operate unobstructedly. In a few cases the
ribs in the region of the spinal lesion will be found deranged and
interfering with trophic fibers, blood-vessels and lymph vessels of the
cord. The patient should be kept in the prone posture at first.
Warm baths and massage will be found of additional value. The bowels
and bladder should receive special attention. An ice-bag to the spine
may be beneficial. If there is any danger of bed-sores, use alcohol to
stimulate and harden the skin. Rest, liquid diet and good nursing are
necessary. Later on careful exercising of the limbs will be beneficial.
=Chronic Myelitis.=—This defines the conditions when the inflammation
is subacute with the paraplegia and other symptoms which then naturally
appear, present, and also with the signs of both degeneration and
repair. The symptoms develop slowly as compared with the acute form. It
should not be confused with atrophy, pachymeningitis or tumors of the
cord. =Treatment= is practically the same as in acute form. Surgical
measures may be indicated. Loudon[127] reports a case due to injury
which was greatly benefited.