8 Injuries of the Spine and Spinal Cord, without Apparent Mechanical Lesion and Nervous Shock, in their Medico-legal Aspects, London, 1883, p. 128.
SYMPTOMS.—Gowers9 remarks that a large number of symptoms formerly assigned to chronic spinal meningitis have nothing to do with that pathological state, but are now known to be owing to alterations within the cord which are frequently associated with it. The symptoms which are really due to the meningeal inflammation—namely, those arising from interference with the nerve-roots in their passage through the thickened membranes—do not differ essentially from those of chronic pachymeningitis of the spine; the principal are pain in the back, especially on movement, extending to the trunk and limbs, hyperæsthesia of the skin in various regions within the domain of the irritated sensory roots, with diminution or loss of the knee-jerk, and areas of anæsthesia due to their more complete compression. The compression of the motor roots gives rise to symptoms which are similar to those of disease of the anterior cornua, consisting chiefly of muscular wasting, with impairment of motion in corresponding regions, without fever.
9 The Diagnosis and Diseases of the Spinal Cord, by W. R. Gowers, M.D., 2d ed., Philada., 1881, p. 73.
The anatomical appearances, which are most pronounced in the posterior aspect of the cord, and diminish from below upward, are often of considerable extent. The membrane is thickened, opaque, and often adherent to the cord. On the inner surface are seen numerous small bodies composed of proliferating connective tissue.10 These, according to Vulpian, are chiefly found in the lower dorsal and lumbar region and on the cauda equina. The dura is very frequently involved in the inflammation; it is thickened, and its inner surface is adherent to the pia, often showing numerous miliary bodies similar to those found in the pia.
10 Leyden, op. cit., vol. i. p. 144; A. Vulpian, Mal. du Syst. nerv., Paris, 1879, p. 126.
DIAGNOSIS.—Chronic spinal meningitis so rarely exists apart from disease of the dura or of the cord that its separate diagnosis must be mainly a matter of conjecture. Leyden justly says we must usually be content to diagnosticate chronic meningitis without attempting any further distinction, except in cases which originate in disease of the vertebræ or of their neighborhood, and afterward penetrate into the spinal canal, and which would probably give rise to pachymeningitis. The diseases with which chronic meningitis of the spine is most likely to be confounded are posterior sclerosis (locomotor ataxia) and chronic degeneration of the anterior cornua (progressive muscular atrophy).11 From the former it is distinguished by the absence of ataxia; from the latter, by the irregular distribution of the symptoms; and from both, by the existence of limited areas of anæsthesia and of extensive spinal pain. It must be remembered that inflammation of the cord complicating that of the meninges, or pressure upon the cord by the thickened membranes may give rise to mixed symptoms. The latter is especially observed in syphilitic cases.
11 Gowers, op. cit., p. 74.
PROGNOSIS.—Simple chronic spinal meningitis is rarely if ever fatal. How far it is capable of amelioration or of cure is not, in the present state of our knowledge, known. When complicated with disease of the cord the prognosis will depend upon that of the latter. Syphilitic chronic meningitis is to a certain extent amenable to appropriate medication.
TREATMENT.—The treatment should have for its object (1st) to relieve pain; (2d) to arrest the progress of the inflammation, and especially to prevent it from extending to the cord; (3d) to promote the absorption of the exudation. For the first object the internal or hypodermic employment of morphia should be combined with external applications, such as fomentations, liniments, ice, etc. Counter-irritation by means of dry cupping, blisters, iodine, etc., with leeches, shampooing, and douches of hot water, may be of some use in retarding the progress of the inflammation, and should be aided by the administration of mercurials and the preparations of iodine. The biniodide of mercury would be useful for this purpose in the dose of one-sixteenth to one-eighth of a grain three times daily, its effect being carefully watched in order to prevent salivation. The same means will also aid in favoring the absorption of lymph. In syphilitic cases an appropriate specific treatment is indicated.