J. G. Willmore, M. Douglas
1925 BMJ (Clinical Research Edition)  
IMDXCALJORAL Most authorlities are agreed that operation is rarely inidicated in cases of spinal injury with complete transverse lesion of the cord, unless the injury is below the first lumbar vertebra. One would not go so far as to extend this limit ilpwards by a vertebra, as a general rule, on the strenigth of the case described; for although early and complete reduction was obtained, the patient is still, and is likely to remain, very much of an invalid; inasmuch as a return of sl)hincteric
more » ... rn of sl)hincteric control is not to be expected. The presence of .cystitis, moreover, which persists to some degree in spite of tr eatment, is a constant menace to the integrity of his kidneys. Nevertheless, the measure of recovery which has taken place is very encouraging. It is largely to bo attribuited to the optimistic ouitlook of the patient, and the skill with which he has been nursed. The chief point of interest is the extreme rarity of sIIch1 a lesion. Dislocations of the spine without fracture occur alImost entirely in the cervical region-about 98 per cenit. The remainder occur in the dorsal region. I have inot been able to find any previous record of a dorso-lumbar dislocation. I am indebted to Dr. A. Rayner, honorary radiologist to the Inifirmary, for the excellent radiographs. IN a leading article in the BRITISH MEDICAL JOURNAL of September 20th, 1924, the questioni is raised as to what miglit occur in the event of damage to the cells of the reticulo-endothelial system. Commenit is made as to the lack of clinical evidence on this subject, anid the need for further investigation regarding the effects on digestion and metabolism of a diminished formation of bile. A case recently under the care of olne of us may possibly supply the answers to at least some of the problems thus postulated, and we think that a fairly full ieport of it m11av be of scientific interest. X. Y. Z., aged 31, first seen on April 22nd, 1924, compla'ined of diarrhoea and vomiting. The date of onset was uncertain, but probably not earlier than July, 1923. He had served in France, Salonika, and with the Egyptian Expeditionary Force from 1915 to 1919. He had " enteric " in 1916, but no other serious illness. Family history unimportant. Height 5 ft. 5j in.; weight 8 st. 4 lb. 4 oz. On admission he was pale, and his general condition poor. His tongue was raw and red, with (later) small, sore, sprue-like ulcers on its right lateral surface near the tip. The teeth were in order. There was no pigmentation of skin, and no icterus. The central nervous system was normal, but he stammered. The abdomen was distended, tympanitic, and rigid. There was tenderness in the right hypochondrium, where the patient complained of constant severe pain during the whole of his illness. o mass was palpable (confirmed by several observers). The liver was diminished in size (percussion and x rays). No abnormality was detected in the spleen, heart, or lungs. The urine was acid; specific gravity 1010; there was a faint trace of albumin; no sugar. (N.B.-Glycosuria had been found previous to admission.) No acetone or diacetic acid was present. Diastase: 24 -J$ = 20 units-that is, witlhin normal limits. Microscopicallv, hyaline casts and polymorphonuclear cells were found. Cammidge's reaction was positive. The blood Wassermann reaction was negative on repeated examination both before and after provocative neosalvarsan. Blood pressure 196/130. A blood count showed: red cells 5,530,000; haemoglobin 80 per cent.; colour index 0.7; white cells 15,500polymorphonuclears 64 er cent., eosinophils 1 per cent., large mononuclears 4 per cen ., lymphocytes 31 per cent.; no abnormal cells were present. (On Auigust 8th the red cells numbered 6,000,000; haemoglobin 80 per cent.; white cells 22,700 polymorphonuclears 70 per cent., eosino ihils 1 per cent., large mononuclears 9 per cent., lymphocytes 20 per cent.) Urea, 0.015 per cent.; cholesterol, 0.145 per cent. Van den Bergh's test showed no direct reaction, but a very weak positive indirect (mere trace).
doi:10.1136/bmj.1.3340.16 fatcat:glqn7wh2c5ganmqm4jaj7z6sea