On entering the hospital la Pitié, April 28th, 1825, this young man presented all the symptoms of a hypertrophy of the left cavities of the heart: these phenomena, which diminished after a few days, were followed by symptoms of enteritis and peritonitis, which were attributed to excesses in eating. During the continuance of this latter affection, the patient complained of uncommon debility in the abdominal limbs. These symptoms disappeared; and when it was expected to see the patient convalescent, he was affected with complete paraplegia. He lost the use of his legs: they, however, retained their sensibility. As motion in them was lost, this sensibility was even increased; for the patient cried whenever he was touched, or when the position of the lower limbs was changed. The bladder was soon paralyzed, and the sound was used, which caused inflammation of this organ. A broad and deep eschar, followed by ulceration, laid bare the whole posterior part of the pelvis. From this time, the symptoms increased more and more, and the patient died the 11th of August, about six weeks after the first symptoms appeared.
On opening the body, a softened tubercle was found on the surface of the right hemisphere of the brain; the body of the third dorsal vertebra was slightly changed; the corresponding portion of the dura mater presented a cancerous degenerescence, which extended from the body of the third dorsal to that of the fifth cervical vertebra. The bodies of all the vertebræ connected with this alteration were whitish, and slightly softened. The tissue of the spinal marrow was softened, especially on the level with the seventh cervical and first three dorsal vertebræ: the softening occupied the anterior cords, which were of a grayish white color; the posterior cords were slightly softened but only on a level with the first three dorsal vertebræ The lungs were healthy and crepitating; the right contained superiorly a small softened tubercle. The heart was healthy: its size was normal; the left cavities possessed their usual size and thickness. Traces of inflammation were found in the peritoneum, intestines, and bladder. (Journal de Physiol. Experim. July, 1825.)
In this case, we see in a measure the mode in which caries of the vertebræ is produced. This caries is only at its commencement; the vertebræ are affected superficially, and in those parts only which correspond to the diseased portions of the dura mater and medulla. There are none of the local symptoms of Pott’s disease—no collapse of the vertebral column—no gibbosity; yet the paraplegia appeared, as in the cases where these alterations exist: it resulted, then, from the softening of the medulla, or the alteration of its membranes. If a little time had elapsed, and several spinous processes had deviated from their true direction, this paralysis would have been attributed to the commencement and progress of this deviation. These relations between the state of the medulla and that of the vertebræ have been already remarked by several authors. M. Latour, in a memoir inserted among those of the Society of Emulation, has sought to establish that paraplegia, in Pott’s disease, resulted from a primitive alteration of the medulla. Janson has since expressed a similar opinion. Cases have also been published by Louis, which leave little doubt on this subject. (Mem. and Recherches, 1826, p. 410.)
One symptom in the preceding case, which deserves to be noted, is the difficulty of respiration, the palpitations, and other symptoms which led to the belief that the heart was diseased. On opening the body, however, this organ was found perfectly healthy. Similar phenomena are often seen in onanists: it would therefore be wrong to consider them always as signs of an organic alteration of the heart and large vessels.
In the following case, the vertebræ were more changed. The spinal column was gibbous: but this was preceded by paraplegia, and other symptoms of myelitis. This case was published by M. Dalandeterie:—
A shoemaker, twenty-four years old, of good constitution, who has always enjoyed good health, contracted the habit of masturbation at the age of sixteen years, and became so addicted to it, that he indulged seven or eight times a-day: his strength soon diminished, and he lost flesh and his color.
After an interruption, caused by an acute disease, the patient resumed his fatal habit with the same earnestness. He finally became so weak; languid, and pale, that he was discharged from military service, in which he was inscribed.
A little while afterward, this young man, who had never shown any symptoms of scrofula, presented scrofulous engorgements in the groins and axillæ, and swellings, with caries, in several phalanges of the fingers. At the same time, a singular phenomenon appeared: the hair, which was chestnut colored, came off; on growing again, it appeared of several colors: but after coming off once or twice, it resumed its natural shade.
The patient continuing to indulge in onanism, finally became extremely weak, and was obliged to keep his bed. Marked symptoms of myelitis now appeared. The patient gradually lost the use of his lower limbs: first they became weak, and showed a disposition to be crossed; but finally wasted away, and lost the power of motion. He was now obliged even to be turned in bed, as he could not move. The articulation of the feet and knees became stiff and inflexible, and his legs were so much retracted, that the end of the foot only touched the ground, when the patient was placed in an erect position. The sensibility of the limbs, also, was as much affected as their motions; they were cold, numb, and even when pinched they were not painful. The general languor was increased every day. He suffered from thirst, dyspepsia, pains in the stomach, rumblings, night sweats, &c. At this period, the patient quitted a woman with whom he had lived for a year, and who, having but little inclination for coition, caused him to indulge in masturbation.
The erections were frequent, powerful, short, and always terminated with a more or less abundant discharge of mucus from the urethra—perhaps, also from the prostate gland; or even the discharge might be of thin semen. After a while, the ejaculations were composed, instead of semen, of a half-clotted, blackish or yellowish blood: sometimes, as much as a tablespoonful was lost. These emissions were always painful, and were followed by extreme prostration.