DOI: 10.7925/drs1.ucdlib_280945
title: Ramollissement of the medulla spinalis

description: Two watercolour medical illustrations depicting ramollissement of the medulla spinalis. It has the alternative reference number 1904 and P15A on the front. There is no Richmond Hospital Museum reference. The artist's name is in the bottom right corner 'J. Connolly Del.t'. The typescript note on the back begins '2. Ramollissement of the Inferior Portion of the Medulla Spinalis, Paraplegia, Retention of Urine, Inflammation of Bladder and Kidney'.
description: Scope and content: The full typescript note on the back reads '2. Ramollissement of the Inferior Portion of the Medulla Spinalis, Paraplegia, Retention of Urine, Inflammation of Bladder and Kidney – Dr Hutton presented a preparation and several drawings illustrative of a case of ramollissement of the medulla spinalis. The subject, a man aet. 36, of swarthy complexion, a sailor, was admitted into the Richmond Hospital on the 25th of November, labouring under paraplegia. It appeared that on the 3rd of November he had left Lisbon for Dublin in a ship laden with fruit; that on the 7th a storm arose which continued without intermission for three days, during which he remained on deck, and was subjected to constant cold and wet. On the 11th he was seized with sever pain in the lumbar region; on awaking next morning his lower extremities were quite numb, and he was unable to pass water. There being no surgeon on board, the captain gave him some aperient medicine, but from that time his urine was retained, and he had involuntary discharges of faeces. On the ship's arrival in Dublin he was brought to the Richmond Hospital; he then appeared much exhausted, and his voice feeble; pulse 60; respiration regular; intellect unimpaired. There was a large slough over the trochanter, on which he had been lying, and on his legs there appeared some traces of lupoid ulceration; another slough laid bare the sacrum, and the theca was exposed. His abdomen was swollen, and the figure of the distended bladder, reaching up to the umbilicus, was distinctly perceptible. His lower extremities were paralysed, flaccid, and insensible, and the want of sensation extended up to the umbilicus. The catheter was introduced, and a large quantity of high-coloured ammoniacal urine was drawn off. In four hours afterwards the bladder again became filled, and the operation had to be repeated. After three or four days vomiting came on; a little blood was thrown up once; the pulse advanced to 69 or 70, but the respiration was not oppressed until two days before his death, when brochial rales came on, and he died on the 2nd of December. The posterior wall of the sacral canal was completely destroyed, so that the theca investing the inferior portion of the cauda equina was exposed. Some sero-sanguineous fluid was discovered within the theca, which gravitated towards the lumbar region, and in quantity amounted to two drachmas and a half. The medulla spinalis itself appeared quite healthy on its exterior, but on being divided extensive disease was discovered, extending from the cauda equina up to the fourth or fifth dorsal vertebra; throughout this extent the medulla was softened and disorganised, but the arachnoid and other membranes of the theca were of natural appearance. Dr Hutton was of opinion that the disease commenced below, at a point here the disorganisation was greatest (about the second lumbar vertebra) and had from that extended upwards. The bladder was enlarged, and exhibited all the effects of intense inflammation; its mucous coat was highly vascular, and in many places had patches of lymph on its surface, on raising which, purulent matter was found beneath; in some parts the mucous surface appeared of a dark green colour; in others there were large spots of ecchymosis. [All these appearances were expressed in a drawing by Mr Connolly, which Dr Hutton now exhibited.] The kidneys were gorged with blood, of an ammoniacal odour, and mixed with floccule of lymph. The intestinal tube was not diseased, only some slight increase of vascularity was observed in the duodenum; the stomach was quite healthy, the liver was engorged, and the lungs were free from disease. The brain was not examined, as there had not been any symptom that could be referred to it. The first symptom noticed by the patient was pain in the lumbar region; did this depend on effusion into the theca, or on the ramollissement of the medulla spinalis itself? There was no inflammation of the membranes, but the fluid was increased in amount. Another point of interest in this case was the sudden paralysis. When ramollissement of the medulla spinalis has been the cause of paralysis, it has usually extended gradually; in this case, on the contrary, it became complete in one night. There was here, also, no rigidity of the lower extremities; this corresponds with what some French pathologists have asserted, as to this being a character of cases in which the membranes are not inflamed. The absence of both sensation and motion was also remarkable, taken in connexion with the softened state of the medulla spinalis, the external portion remaining apparently sound. The cases of Messrs. Webster and Stanley, in the Medico-Chirurgical Transactions, vol. xxii., leave the question still dubious as to the functions of the anterior and posterior columns of the spinal marrow, although that of the anterior and posterior roots of the spinal nerve has been ascertained. On the condition of the bladder Dr Hutton referred to the opinion of those who explain inflammation of this kind of supposing that the retained urine becomes alkaline, and then is capable of irritating the coats of the bladder; in this case the kidneys also were highly congested, and the urine in their pelves(sic) were mixed with purulent matter, indicating inflammation of these glands, which Dr Hutton was inclined to refer, together with that of the bladder and the sloughing of the paralysed extremities, to the lesion of innervation with which the disease commenced'.
description: Numbering/sequence: Original reference number: 1904.
description: Date details: This illustration is undated, approximate dates are given based on dates for the entire collection.