Definition. Causes: violent exertion, blows, falls, morbid blood, fractures, caries, tumors, tubercle, aneurisms. Lesions: Clot between or outside membranes in meningeal hæmorrhage, in gray matter and even in white in myelon bleeding. Cord bulges. If survives, nervous matter absorbed. Symptoms: Sudden stiffness or palsy of given areas; spasms more common in meningeal extravasation. Rapid muscular wasting. No fever at first. Treatment: cold to part; slings; atropia, ergot, lead acetate. Later as for myelitis. Large clot may warrant surgical interference.

In the first of these forms the bleeding takes place between the arachnoid and the two contiguous membranes—pia and dura, or outside the dura. In the second it takes place into the substance of the cord though it may encroach on the pia mater. Both conditions have been attributed to violent muscular efforts or contractions as in draught, racing, fighting, leaping, tetanic convulsions, also to blows on the back, or falls from a height. Morbid states of the blood in which there is a hemorrhagic tendency (scurvy, purpura, hæmophilia, anthrax) may be contributory causes. Spinal fractures, aneurisms, caries, tumors, and tubercle may be additional causes.

Lesions. In meningeal bleeding the clot is found outside the dura, or between the dura and arachnoid which may or may not be ruptured. A clot on the pia mater may press seriously on the cord or may cause rupture of the arachnoid. In hemorrhage of the cord, the effusion usually begins in the gray matter, though it may extend far into the white. It may be circumscribed to half an inch in diameter or affect almost the entire length of the cord. The cord may be distinctly enlarged at the point of effusion, and in exceptional cases the blood may have broken through to the membranes. If the patient survives, absorption and degenerations of the cord are inevitable.

Symptoms. In both forms there is a sudden attack, with stiffness or paralysis of given muscles and without hyperthermia. Rigidity and spasms of the muscles are more characteristic of meningeal hemorrhage, and early paralysis of the spinal. An early hyperæsthesia is also most significant of an effusion in the cord. Rapid muscular atrophy is also characteristic of this. The two conditions resemble meningitis and myelitis but come on much more suddenly and are unattended by fever.

Treatment. Such cases are not hopeful. Cold to the affected part of the spine, keeping the patient in slings to solicit the good effect of gravitation, and giving ergot or lead acetate internally are among the first indications. Later, the treatment would be practically the same as for meningitis or myelitis. In case of complete paralysis from the sudden formation of a large clot, it has even been advised to cut down on the seat of the injury and evacuate the blood, using antiseptic precautions.