ON INJURY OF THE VERTEBRAL COLUMN, PARAPLEGIA, &c.

337 many workers in the field, and much may be expected from He complains of slight cough, and pain in the chest; and the their future labours in further elucidating doubtful and obscure sputa are of a slight rusty hue. Calomel pill omitted. 16th.-The pain at the lower part of the back continues. points. The form in which the present paper has been arranged attention to the to draw their as a He cannot move in the bed; the appetite is bad; catheter still subject perhaps, whole, and much good may result from it. I sincerely hope, necessary. Ordered, extract of nux vomica, half a grain; disul. at any rate, that it will prove a pioneer to other papers on the phate of quinine, one grain; twice a day. For the next fortnight matters continued much the same. same subject by others more capable than myself, and who There was great difficulty in moving the pelvis, together with have devoted more time and attention to the subject. Guildford-street, Russell-square, 1855. inability to pass the urine naturally. 28th.-The dose of extract of nux vomica increased. November 7th.-For the last week the man’s condition, as regards the control over the bladder and its orifice, has someON what altered. The urine has more frequently escaped involunINJURY OF THE VERTEBRAL COLUMN, tarily ; the catheter has been used three times a day. The bowels are now never opened without aperient medicine; and PARAPLEGIA, &c. the power over the sphincter ani seems to be very incomplete. BY GRAILY HEWITT, M.B. Lond., The condition of the mobility has considerably improved; he SURGICAL REGISTRAR TO ST. MARY’S HOSPITAL. can now get out of bed, and help himself along, holding by the hands; he walks with the aid of crutches, but is unable to THE two following cases-one of concussion of the spinal stand alone, or to sit up in bed without putting his hands be. cord, and the other of fracture and crushing of one of the hind to prop himself up; has now very little pain in the back, vertebrae, illustrate very well the effects generally produced by only a sense of stiffness. The skin over the sacrum feels numb, injuries of the vertebral column. The bones composing that and is less sensitive to pinching than it should be. The senpart of the skeleton are not often fractured, and owing to the sibility of the skin of the lower extremities is apparently peculiarly firm manner in which they are held together, dislo- normal, and equal on the two sides. The appetite is now cation is also comparatively rare. Cases illustrating any points good, and he feels that his inability to walk is the only cause connected with such injuries must therefore possess certain complaint. intrinsic merits entitling them to be recorded. A very slight forDecember lst.-He is now (seven weeks after the accident) injury to one of the vertebra may produce disastrous results to much better in general health; but the power of locomotion the patient, and a small piece of bone broken off, and pressing has very little increased for the last fortnight. He walks with on the spinal cord, may be the cause of death immediately or crutches easily enough; and, when sitting on a chair, moves remotely; the quickness with which the fatal result supervenes the legs about quite readily, and in every direction, but he varying according as the injury is more or less near to the head. cannot stand alone. The legs and buttocks are very much When we compare the results produced by disease of, and wasted, and he walks with the knees bent outwards, in a accidental injury to, the vertebral column, it seems that there peculiar bowed position, the upper part of the vertebral cois one remarkable difference between them. In cases of caries lumn bent forwards, and the toes only touching the ground. of the vertebre, the form and capacity of the canal may be The urine is now passed quite naturally, no catheter having greatly altered, and yet the cord, by gradually accommodating been used for the last fourteen days. He has also much more itself to its altered relations, be very little affected as regards control over the defecation. Discharged. its functional capacities. There may be produced thereby Swnmary.-There was, in this case, an injury to the spine at its lower extremity, the effect of which was an impairment some impairment of the mobility of the lower extremities, and in many cases there is complete paraplegia, but it would appear of the motor power of the lower limbs, and paralysis of the that there is no relation between the amount of distortion of sphincters ofthe bladder and rectum. It was not at first perthe spine in angular curvature, and the extent and intensity of ceived that the power of moving the lower extremities was the paraplegia. When, however, the vertebral column has re- much affected, as the patient could draw his legs up in the ceived an accidental and sudden injury, producing, perhapsf bed. When, however, the pelvis had sufficiently recovered only a trifling alteration of the relation of the vertebrae to each the effect of the bruising it had sustained to allow the patient other and to the contained cord, the functions of the cord to get out of bed, it was found that paraplegia to a certain below the seat of injury may be very seriously interfered with. extent was present. The diagnosis made, was that of conThese facts have a certain importance, when the diagnosis of cussion of the spinal cord; but it could not, of course, be cer. the nature of the lesion the cord has sustained in a particular tainly determined that this decision was correct. The sphincinstance has to be decided on. One of the following cases, in ters of the bladder and rectum, which were at first quite which the cord was pressed upon but slightly, owing to the paralysed, gradually recovered their power, although the altered relations of the bones around it, and in which the para- ability of moving the lower extremities was still very incomplegia produced finally resulted in death, is an instance of the plete when the man was discharged. The nux vomica admi. truth of these remarks. nistered in this case seemed to have a beneficial effect. (To be concluded.) Concnssion of the Spinal C01’d; Paraplegia incomplete. are

will help,

CASE I.-C. M-, aged thirty, a well-made man, by occupation a builder’s labourer, was admitted into St. Mary’s Hospital on the 10th of October, 1854, under Mr. Coulson. On the day of admission, he had been working on a scaffold, at a height of thirty feet from the ground. In passing from one part of the scaffold to the other, he fell backwards, and was picked up insensible. When admitted, there was found to be a contusion of the lower part of the back, over the sacral region, and he had evidently fallen on this part of the body. There was no distortion of the spine, and no other injury excepting a slight wound of the lower lip, produced by the teeth. He was, at the time of admission, unable to answer questions, which was in part accounted for, as it was found that just before the accident happened he had been drinking. The catheter was used to evacuate the bladder, and he was cupped over the loins. Ordered, mixture of sulphate of magnesia, with tartrate of antimony, three times a day; and two grains of calomel, and one grain of opium powder, every four hours. October 13th, (three days after admission.)-The catheter has been used twice every day, as he is unable to pass urine naturally. He is able to move the legs up in the bed slowly; complains of great pain in the lower part of the back; is unable to move the pelvis, apparently on account of the pain any motion produces. The urine escaped last night involuntarily. The gums are affected by the calomel; the tongue red at the edges, and brown at the centre; there is considerable thirst; the bowels

are

open, but he has

no

control

over

the motion.

ON

BANDAGING THE ABDOMEN DURING AND AFTER DELIVERY. BY HENRY HANKS, ESQ., M.R.C.S. ENG. THE controversy now extant amongst obstetricians respecting the utility of the binder, safeguard, or roller, claims ample consideration, lest the testimony of those who advise that its

should be abandoned should supersede the important directions of the highest authorities of the present day. Writers of established reputation, whose sentiments are confirmed by practice, including Drs. Bums, Reid, Ramsbotham, Rigby, Murphy, Waller, Hardy, M’Clintock, agree in asserting the efficiency of this simple expedient subsequent to the completion of labour; although others (Ley and Denman) not less eminent than the above denied its advantages, opposed its application, and maintained that it was unnecessary and in. jurious immediately after delivery; nevertheless, the latter did not entirely reject the abdominal bandage, but deferred its employment " till five or six days after delivery," when he acknowledged it might be applied with some advantage. The inquiry of a correspondent, which I have condensed, "whether the practice of bandaging the abdomen, and tighten. ing it firmly at each recurrence of the pains, is sanctioned by approval ?" deserves notice. use