164 HYDATIDS AND CANCER OF THE BRAIN. substance of the brain in a girl of seven years old; and once also I saw cancer affecting the brain and its membranes in a boy two and a half years old. But, though such occurrences are interesting from their rarity, I do not know any circumstance, except the absence of the signs of tubercular disease in the patient, by which you could determine during life that certain cerebral symptoms arose from hydatids, or cancer of the brain, and not from tubercle in that organ. Schädelhöhle,' 8vo. Würzburg, 1853, none occurred in children under 10 years old; and only 4 in young persons between the ages of 10 and 20. LECTURE XII. DISEASES OF THE SPINAL CORD-their study rendered more difficult by the tender age of children. IRRITATION AND CONGESTION of the Cord. INFLAMMATION OF THE MEMBRANES of the Cord-sometimes epidemic-not common as a sporadic affection. Illustrative cases.-INFLAMMATION OF THE SUBSTANCE of the Cord-extremely rare in its acute form-in its chronic form gives rise to symptoms similar to those which occur when bones of the spine are diseased. Cases. TRISMUS-extremely rare in this country-symptoms-post-mortem appearances.— Causes of the disease-influence of vitiated air-treatment almost hopeless. Ar the commencement of these Lectures I called your attention to the predominance of the spinal over the cerebral part of the nervous system, as constituting one of the grand characteristics of early life. Since then, our daily course of inquiry has brought before us numerous confirmations of this truth, and has shown us how slight a disturbance of the functions of the brain may suffice to destroy the harmony of those which belong to the spinal cord. To-day we pass from the consideration of those cases in which the brain is the original seat of disorder, and the spinal cord suffers only secondarily, to the study of others, where that organ is primarily affected. I need not remind you how much obscurity hangs over the ailments of the spinal cord at all periods of life; but in the young subject this is not a little increased by the difficulty that attends the observation of some of those symptoms which would be obvious enough in the adult. Thus, for instance, while impairment or loss of the locomotive power in the grown person could hardly escape our notice for a moment, it might fail to attract much attention in a young child, who often totters in his gait, or even becomes unable to walk, if from any cause his health should fail. Or, again, the impaired sensation, or the vague pains in the limbs, which the adult would be sure to tell us of, would be but ill described by a child, even though it had long been able to talk, while terror might cause it to cry if any attempt was made to examine 166 IRRITATION AND CONGESTION OF THE SPINAL CORD. its back, and might thus prevent our ascertaining the presence or absence of tenderness of the spine. These are difficulties, however, which patience and tact will overcome; for not only the diseases of the spinal cord, but the symptoms by which they manifest themselves, are much the same at all ages, the chief difference being that in the one case they strike the eye even of the careless, while in the other, careful observation is necessary for their detection. Irritation of the cord, however produced, gives rise in the child, as well as in the adult, to impairment of the motor power. A little boy, between two and three years old, remarkably strong and healthy, was observed, without any obvious cause, to fail in his general health, and at the same time to totter in his gait, to become indisposed to move, and, at last, almost entirely to cease walking; and this impairment of his power of walking was quite out of all proportion to the signs of ill health by which it was attended. After watching him for a time, it was discovered that the child had become addicted to the practice of masturbation. This was put a stop to, and he soon regained his health, and with it his power of walking. In this instance the cause of the irritation of the cord, and of the consequent impairment of its functions, was obvious enough, but cases now and then occur in which symptoms of disorder of the spinal cord manifest themselves without our being able to discover on what they depend. Such cases, too, are all the more important from the circumstance that the symptoms which attend them simulate serious disease, and are likely to lead us into the unguarded expression of a very unfavourable prognosis as to their issue. On the 30th of December, a few years ago, I saw a delicate boy, betwen 4 and 5 years old, who had been drooping in health, though without any definite symptom, for a week or two; but had complained of stiff neck for the first time on the previous Christmas Day. This ailment, however, had disappeared, and recurred more than once between then and the 28th; since which last date it had been constant, though not always the same in degree, being less marked in the morning, more so towards night. The child looked out of health, and seemed very languid; he moved very cautiously, as if afraid of the slightest jar; his shoulders being raised, his head thrown rather back, and kept most carefully motionless; while he complained bitterly of any attempt to bend his neck, and said that pressure on the upper part of the cervical spine occasioned him IRRITATION AND CONGESTION OF THE SPINAL CORD. 167 much pain. The boy's appearance and manner were precisely those of a patient suffering from disease of the cervical vertebræ; and a most experienced surgeon, who saw the case with me, expressed himself as very apprehensive that the case was a bad one, though whether the disease was in the spinal cord or in the vertebræ he considered to be uncertain. I certainly took a most unfavourable view of the affection; and was much surprised to learn subsequently that, after the application of four leeches to the back of the neck, the child went to sleep, slept during the night, and awoke the next morning with the most complete power over the muscles of the neck, showing no pain in moving his head, complaining of no tenderness of the spine, nor did any such symptoms manifest themselves at any subsequent period. I have since met with several cases of a somewhat similar kind, which I believe to be of rheumatic origin. The symptoms come on too rapidly to be due to disease of the cervical vertebræ, while they are not sufficiently severe to be attributed to inflammation of the spinal cord, or of its membranes. Headache is not present, nor any distinct evidence of cerebral disturbance. Rest in bed, attention to the bowels, diaphoretic medicines, and warm applications, and stimulating liniments to the back of the neck, of which there is none better than the Linimentum Belladonnæ of the new Pharmacopoeia, have sometimes removed in a couple of days symptoms that seemed most threatening. In such cases, as in many others, the results of treatment yield a most important help towards the formation of a correct diagnosis. Whether in the instance above related the affection was a rheumatic one I do not know, or whether there was some unusual congestion of the vessels of the cord, which the local depletion at once removed, and thus cured the patient. That such a condition existed in the following instance is still more likely, for here there was a local injury amply sufficient to produce it. In May 1845, a little girl, four years old, was brought to me by her mother, who said that ten days before, the child had had a fall on her back, while left in the charge of a servant; that on the following morning she was unable to stand or move, unless supported; and that she had ever since continued in the same condition. Her appearance was rather anxious; her face was slightly flushed; skin warm and dry; tongue slightly furred; pulse frequent, and with power. If placed on her feet, she clung hold of her mother, sank down into a stooping, half-squatting posture, and immediately began to cry. She could walk if firmly supported, but hurriedly 168 MENINGITIS OF THE SPINAL CORD. and unsteadily, stepping on her toes, her legs moving in a semicircle with her toes turned inwards, and one foot being put down just in front of the other. On examining the spine, the integuments from the tenth to the twelfth dorsal vertebra presented a little puffiness, and there was very great tenderness of the spine in that situation; and even when not touched, the child complained of pain in her back. There was no appetite, but great thirst; the bowels were constipated; the appearance of the urine was natural, and neither fæces nor urine were voided unconsciously. She was cupped on the loins to živ., and on the following day was much relieved, moving her legs more readily, and suffering much less from pain in the back. On the 17th she was able to stand, and could walk a little without suffering. Attention was paid to keep the bowels open, and in a few days she was quite well. Besides cases of this kind, however, in which there is some uncertainty as to the cause of the functional disorder of the spinal cord, others are sometimes met with of a more formidable, though of a less obscure kind. Such are the cases, fortunately by no means common, in which the spinal cord or its membranes are the seat of inflammation. Inflammation of the membranes of the spinal cord prevailed epidemically in many parts of France from 1842 to 1844. The victims of the disease, which proved very fatal, were almost entirely youths a little past the period of puberty. An epidemic of a similar kind was lately prevalent in many of the hospitals and workhouses of Ireland; but in that country boys under twelve years of age were almost the only persons who suffered from it. The arachnoid of the spinal cord was found in every instance to be the part chiefly affected, though in most cases the membranes of the brain seem to have been slightly involved in the disease. Notwithstanding the great extent of the inflammation of the membranes of the cord, and the effusion of lymph beneath them, the nervous substance appears to have been comparatively seldom attacked by it, and never with much severity. The disease generally came on very suddenly, and its course was often extremely rapid, some patients dying in twenty-four hours, while few survived the fourth day. Severe pain in the abdomen, attended with vomiting and purging, and a condition of general collapse, marked the outset of the affection. A state of reaction soon succeeded, the surface in the course of a few hours becoming hot, the pulse full, and its frequency varying from 120 to 140, while the face assumed a tetanic expression, and the head was retracted and firmly fixed. General convulsions, |