DOI: 10.7925/drs1.ucdlib_280700
title: Softening of the spinal marrow

description: Watercolour medical illustration depicting softening of spinal marrow. It has the alternative reference number 1133, P15A and 272 on the front. The Richmond Hospital Museum reference is D.a.6. The entry for this in P263/1 pg. 16 reads 'Softening of Spinal Marrow. Matthew Tracey aet 35. Dr McDowel'. The handwritten note in the bottom left corner reads 'Matthew Tracey aet 35. Adm.t Dec.r 19-1849-Whitworth Hospital' and the typescript note under the illustration 'Softening of the Spinal Marrow'. The typescript note on the back begins 'Acute Inflammation of the Spinal Cord. A feint handwritten note reads 'Acute Inflammation & Softening of Spinal Marrow'.
description: Responsibility: The doctor could not be identified for certain but may be B.G. McDowel.
description: Scope and content: The full typescript note on the back reads 'Acute Inflammation of the Spinal Cord. Dr McDowel brought forward the following case of acute inflammation, with softening of the spinal cord: Matthew Tracey, aged 35, an in-door servant, was admitted into the Whitworth Hospital on Friday, the 9th December, 1849. It appeared that two days before his admission he found himself unable to discharge the contents of his bladder, nor could he assign any cause for this unusual circumstance. After several hours, the assistance of Dr Adams, of Kingstown, was procured, who passed a catheter, and drew off a considerable quantity of urine. The patient stated that about ten days before the occurrence of retention of urine he had experienced shiverings and pains in the back and loins, and through his limbs generally; these febrile symptoms, which were attended with a sense of lassitude, and with disturbed sleep and frightful dreams, did not, however, prevent him from following his usual daily occupations. On the following day (Saturday) the bladder was still in a state of paralysis, and, by the advice of his medical attendant, he was conveyed in a car to the Whitworth Hospital. Whilst on the way he vomited, and had a discharge from his bowels, of which he was unconscious, but he was able to walk to his ward with some slight assistance, and the bladder emptied. On the day after his admission, when first seen by Dr McDowel, his condition was as follows:- The bladder was greatly distended, but this, which is so generally a source of great distress, did not appear to cause the patient much annoyance, nor did the introduction of a catheter seem to give him any pain. It was next ascertained that during the short time that had elapsed since his admission, complete paralysis of motion of the lower extremities had occurred; their sensibility, likewise, was impaired, and to this extent, that when one of his legs was touched he was conscious of it, but unable to tell on which limb the hand was placed. The lower extremities lay powerless and extended, their muscles were very flaccid, and, to the patient's own sensations, the limbs felt as if they were "asleep". The pulse was 90, and the face had a peculiar collapsed and shrunken appearance, which subsequently never left it. On the following day (Tuesday) the upper extremities likewise had become paralysed, the patient retaining, however, some slight power over the right hand. On the next day (Wednesday), the paralysis of the upper and lower extremities, both as regarded sensibility and voluntary motion, might be deemed complete; there was diminished sensibility of the cutaneous surface as high as the clavicles. Some amount of dyspnoea was observed on this day; the respiration was of a sighing character, and principally carried on by the agency of the diaphragm, assisted by the sterno-mastoid and scaleni muscles. Inspiration was laboured, and the chest no longer seemed to expand. The voice also had become almost inaudible, and it was evident that the powers of life were rapidly failing. On the following day (Thursday) there was profuse sweating, and the dyspnoea was still more distressing than before. The respiration was 30 in the minute, and the pulse 96; the urine was ammoniacal, and deposited large quantities of ropy mucus. From this period up to the time of his death the patient's posture in bed was peculiar. By his own desire he was placed in a sitting position, propped up on all sides by pillows; when thus placed, he said he breathed most easily, and on one occasion, when he was induced to allow himself to be placed in the horizontal posture, dyspnoea of a most alarming kind came on, which for a moment, seemed to threaten the patient's existence. The voice, at this period of his illness, was completely extinct. On this day, and the next following, there was slight raving, but, with this exception, the mental faculties were unimpaired throughout, his intelligence was perfect, and his memory clear. From the first the pupils were contracted. It was observed that no involuntary starting of the muscles of the paralysed limbs ever occurred, nor could those be excited by artificial stimulation of the surface; and even the introduction of the catheter failed to produce any manifestation of muscular contractility in the muscles of the lower extremities. No alteration occurred in the symptoms which have been detailed; the patient sank rapidly; on Friday night the urine flowed away from the bladder, instead of being retained, as had been the case up to this time; and finally death took place, unpreceded by any struggle or convulsion, on the afternoon of Saturday (15th), being the ninth day from that on which retention of urine first suddenly occurred. Post Mortem Appearance – Brain – The brain was rather more vascular than usual, and the sinuses of the head were turgid; but in all other particulars the encephalon was healthy. Spinal Cord – There were no appearances of disease external to the dura mater; but on cutting into the "theca" (which was first done at its lower part), an excessive quantity of turbid serum, of a wheyish colour, and mixed with flakes of lymph, made its escape. The outer surface of the cord, invested by its pia mater, appeared, from the most part, healthy; but for about two inches of its extent, between the dorsal and lumbar regions, it was of a yellowish colour and flattened appearance, and had lost to the touch the firm feel which is essential to this organ as a part of its natural condition. The veins of the cord were also much distended and tortuous. On making a vertical section into the interior, the spinal cord, from the centre of its cervical portion to its termination below, was found to be softened, pulpy in its appearance, and changed to a soft, creamy consistence. Numerous spots of extravasated blood were scattered throughout the softened nervous mass, presenting an appearance similar to that which, when observed in the brain, is above all others indicative of inflammatory softening. The bladder presented all the appearance of acute inflammation'.
description: Numbering/sequence: Original reference number: 1133.