OCR Text |
Show FBACTURE or THE SPINE. ing of the bones hurts the soft substance of the spinal marrow, although it appeared entire, being covered with its tougher sheath. I believe that the force which fractures the bone will at the same time destroy the spinal marrow, and the effect will be paralysis of the lower extremity, and in the end death. The substance or bodies of the vertebrae may be said to be fractured when a bullet lodges there. Gun-shot fracture is a desperate and generally fatal case; for if the ball has entered from before, it must. have passed through the viscera of the thorax or abdomen, and if from behind it must .lvlizisbuw " have injured the spinal marrow. If it has entered by the side into the bodies of the lumbar vertebrae, it may lodge there without being fatal, and may drop from its place at ter inflammation and suppnration have reduced the patient; but the chance is, that by the concussion of the spinal marrow or breaking up the tube of the spine into splinters, the injury will prove quickly fatal. If the spinal marrow be cut through by a bullet, a man may live a longer or shorter time, according as the divi- sion has been made in the loins or higher, as in the neck. It the division has happened in the loins, there may be only paralysis of the lower extremities, and insensibility of the bladder and rectum. If higher up, the bowels will suffer more by distension. If the division has been made high in the neck, the patient will die suddenly from the supply of ' nerves to the muscles of respiration being cut off. "‘ "ur Besides fracture of the bodies of the vertebra, and frao aw 3. r .... a ,_ "'""" "3" "Is-ru'm'.. fw‘ r"" i 95 "serum: or THE SPIKE. 91: ture by gun-shot, there may be fracture of the arch of the vertebra, which forms the tube for the spinal marrow. A man falling backward and having his spine curved and projecting, may, by hitting a stone, fracture and beat in the arch of bone; or, supposing that he is driving a carriage under a gateway, stooping, thinking to avoid the arch, but does not, he strikes the same part of the chain of spinous processes against the arch, then the blow breaks the tube of the vertebrae and forces in the tube and spinous process, so that he becomes paralytic in all the lower part of the body. In whatever way the vertebrae are broken, the danger of moving the body must be apparent, since in every change of posture, or turn of the body, the broken bones may be thrust against the spinal marrow. Looking to the anatomy as our only guide, we see no reason why in fracture and depression of the tube of the spine, the surgeon should not make an incision, and draw out the fractured portions, and el- evate the arch ! But when we turn our attention to the real circumstances of the case as it has actually presented itself in practice, we find the bones have been crushed, the swelling general, and the paralysis complete. If this paralysis proved that a piece of bone stuck in the spinal marrow, then we might proceed to operation. But as a blow less than sufficient to crush the spine will by concussion produce the p21- ralysis, we are tempted to wait and hope. But if the bones are evidently crushed in upon the spinal marrow, then raising the bone will not remove the injury to its substance. In short, the uncertainty of the circumstances of the case, joined to the little probability that the operation would do good, supposing that the bone has been crushed upon the spinal marrow, or has entered its substance, deters us from laying open the canal, the more especially as we have the chance of doing more mischief than good. When called to a patient in this situation the surgeon carries a catheter with him to draw off the urine, because he knows that the sensibility of the bladder is destroyed, and that there will be in a short time, an accumulation of urine. There will come flatulent distension of the abdomen too, and vomiting or hiccup, for which (in this case) terrible symptoms we have only to palliate by ordering very stimulating clysters, and frequent friction of the belly. If the patient survives the first shock, the insensibility of the hips and lower extremities will allow him to lie pressing the hips and nates till they mortify. This mortification and ulceration on the sacrum may be accelerated by the insensible discharge |