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cords of three dogs, and in each instance produced changes which
he interpreted as comparable to the myelitis of human pathology. But
the inflammation thus provoked was not of the cord-substance alone;
it also involved the membranes, and the inflammatory foci were in
several instances purulent. Now, pus never85 forms in ordinary
myelitis. An abscess of the cord never occurs where a septic agency
can be excluded. In six dogs whose spinal cords I wounded in the
dorsal and lumbar regions by aseptic methods, and who survived
from two to seven days, I never found purulent or indeed any active
inflammatory process, as that term is ordinarily understood, but
exactly such passive and necrotic or reactive changes as occur in
the acute myelitis of human pathology.
83 Klinik der Rückenmarkskrankheiten, ii. p. 115.
84 Cited by Leyden.
85 In the textbooks and encylopædias, without an exception, the statement that pus
may be a product of myelitis is made. This is true of traumatic cases and of such
depending on septic and zymotic causes alone. I am unable to find a single carefully
observed case of the occurrence of pus in simple myelitis in the literature.
88 Baumgarten's case of hyaline exudation, Archiv der Heilkunde, vol. xvii. 276, was
an infectious myelitis and associated with anthrax.
94 According to the first observer, this is probably due to structural differences. The
extramedullary fibres have a sheath and annular constrictions which are absent in the
intramedullary.
99 S. Weir Mitchell and M. J. Lewis found that voluntary effort increases the jerk at
first, but if continued diminishes its excursiveness (The Medical News, 1886, Feb.
13th and 20th).
102 Repeated fractures have been noted in cases marked by profound analgesia. It is
believed that they are not always due to trophic changes, but may be the result of
muscular action, exaggerated on account of the patient's inability to gauge his efforts.
Still, in the majority of cases the presence of positive trophic disturbances of the skin
seems to indicate the probability of some textural change facilitating the fracture.
On July 23, 1884, shortly before mid-day, while lying on the bed, in
which he had lain a helpless cripple for over four years, except when
lifted into the roller carriage, he felt a sudden rush of warmth.
Surprised at this first sensation he had felt for years in limbs which
had been quasi-foreign appendages, he raised up the bed-clothes
and saw that they changed color. There was some tingling for about
three minutes, and a perspiration broke out in the affected members.
With this he found he could move his feet: half alarmed, half exulting,
he sent for his physician, L. Weiss, who found that the patient could
stand and walk with considerable freedom. I was then consulted, and
found the patient presenting a picture of incomplete transverse
myelitis. He could walk, turn about, stand with closed eyes with slight
swaying, and his knee-phenomenon was of short excursiveness, but
exceedingly spasmodic, and this symmetrically so. He was carefully
watched, and against the advice of his physician engaged in
peddling cigars, and subsequently took a position as attendant at the
pauper asylum on Ward's Island. Here he was on his feet fully twelve
hours a day, and his motion, which had continued improving until it
was to all practical intents and purposes normal, aside from a slight
stiffness, again became impaired, and a joint trouble in the
metacarpo-phalangeal articulation of the right little toe, which had
troubled him a week after his partial recovery, recurred.104 On
January 15th of the present year I again examined him. His knee-
phenomenon was greatly exaggerated, cutaneous sensations
scarcely impaired, gait paraparetic, but he could walk great
distances, and claimed to suffer less from the exertion than from the
tenderness accompanying the joint trouble referred to. There had,
therefore, occurred, without any assignable cause—for the patient
was not under treatment for a year or more before the event—an
almost instantaneous restoration of sensation, locomotion, and
sexual power; all of which faculties, notwithstanding the infraction of
every medical direction given, remained established for two years,
with prospects of so continuing a longer period.
104 This was a trophic joint trouble.