Reports of Societies

1893 BMJ (Clinical Research Edition)  
and a degree of hyper-sensitiveness on applying a hot sponge. The bladder was empty, the sphincter ani was relaxed but contracted round thie finger when introduced. The patient was a teetotaller. Absolutely no change as regards the paraplegia and anaesthesia took place. On one occasion the patient said he felt as though his ankles were touching, and complained of a tingling jumping sensation down his back. The priapism gradually subsided during the first week. All the reflexes remained
more » ... s remained abolished with the exception of the plantar reflex, which reappeared on October 9th, increased, and again disappeared by October 28th. For the first five weeks there was retention of urine, followed by incontinence. In spite of regular and frequent cath eterism and irrigation from the first, cystitis set in at the end of the first week, and continued more or less till death. At times, and especially latterly, there was blood in the urine. The bowels varied between obstinate constipation and diarrhcea. With every precaution it was impossible to prevent bedsores on the sacrum and legs, which eventually exposed the bones. The temperature throughout was very erratic. Faradic Irritability was diminished about the third week, and the reaction of degeneration was obtained. The patient, except at intervals, slept and ate fairly well. He gradually sank, and died of exhaustion on January 2nd, 1893. A limited post-mortem examination was performed sixteen hours after death. On exposing the spine in the cervical and upper dorsal region the lamina of the sixth cervical vertebra was seen to have been fractured close to the articular process on the right side; this had united, and callus was present. The articular process and transverse process had apparently been involved, but this was not so clear. On sawing through the laminae a quantity of dark fluid blood escaped from the spinal canal. The cord on exposure did not show any sign of intrameningeal haemorrhage. On passing the finger along it a distinct sulcus, inVolving the whole thickness, was felt under the membranes as it lay over the body of the sixth cervical vertebra. On cutting through the nerve roots between the fifth and sixth vertebrae a few drops of flocculent fluid escaped from under the membranes. About 3 inches of the cord was then removed, and it was seen that the body of the sixth cervical vertebra presented at the lower border of the posterior surface two sharp nodules of bone, one on either side of the middle line of the vertebra, which exactly corresponded to the sulcus in the cord above noted. When the bodies of the sixth and seventh cervical vertebrae were removed it was found that the intervertebral discs between the fifth and sixth, and sixth and seventh were almost destroyed. The body of the sixth was split into two almost equal parts in a vertical direction, so that the blade of a fine scalpel could be passed down between them. It was also crushed in a downward and forward direction, so that the depth of the anterior surface of the body measured only ,4 inch as against y9 inch for the posterior. On the anterior surface two prominent bosses of bone were thrown forward corresponding in position to the two sharper nodules on the posterior surface. There did not seem to be any maikel narrowing of the lumen of the canal. On dissecting the membranes from the segment of cord removed, on the anterior surface of the cord and just above the origin of the sevrenth nerve root a deep depression was seen corresponding to a much shallower indentation on the posterior surface. The depth of these two sulci combined would about equal two-thirds of the normal thickness of the cord. At one side of the sulcus, and for a limited extent, the membranes were firmly adherent to the cord. REMARKS.-I think this case may be worth recording chiefly on account of the length of time the patient lived (93 days 9 hours) after such serious injury so high up. It is remarkable that to the last no lung complications appeared beyond now and then a slight cough, which gave no trouble of any moment. Happily, too, it is a rare accident for the football field, especially to have occurred in the manner it did, and during a game which, as the coroner remarked, showed an utter absence of any rough play. All the tests for sugar in common use depended upon its reducing action; thus in Fehling's test the quantity of sugar was gauged by the amount of cupric oxide reduced by a known volume of the solution. All human urines--normal as well as pathological-exerted some reducing action upon cupric salts in boiling alkaline solutions. Insufficient familiarity with this fact not infrequently led to the conclusion that sugar was present in a sample of urine simply,because a certain amount of cupric oxide had been reducedthereby. Non-saccharine urines of high specific gravity were especially liable to be pronounced saccharine because such urines, being highly concentrated, were richer than usual in the normal reducing agents. The object of the author was to indicate the nature of these normal reducing agents. The chemical details of the author's experiments in connection with this subject were published in the Proceedings of the Royal Society, vol. xliii. The author agreed with Dr. Pavy in attributing one-fourth of the reducing action of normal human urine to the uric acid which it contained. He was, however, of opinion that normal human urines were absolutely non-saccharine, and in proof of this he described his method of separating the kreatinin of urine from that secretion, which differed from all methods hitherto described in effecting a complete removal of that base from tle unconcentrated secretion by fractional precipitation with mercuric chloride. The properties of the kreatinin thus isolated were different from those of any base hitherfo described, and this difference was especially remarkable when its reducing action was compared with that of other kreatinins. These differences in properties between bases having the same empirical formula were attributed to differences in atomic arrangement-isomerism. Although the method adopted-precipitation by mercuric chloride-could not remove sugar from solution in the urine, the filtrate from the mercurial salt of kreatinin was found in normal urines to be destitute of reducing action, and the determination of the quantity of kreatinin present (by weighing its mercury salt) conjoined with a careful estimation of the reducing action of the kreatinin itself,proved that the entire reducing action of a normal urine might be accounted for by the uric and kreatinin which it contained, one-fourth of the whole reduction being due to uric acid and the remaining three-fourths to the kreatinin. A beautifully crystallised specimen of the reducing. kreatinin of urine was exhibited. In confirmation of the. author's conclusion that normal human urine was non-sac-charine, C. Schwartz had described' a very delicate test for sugar which gave negative results with normal human urine. The author exhibited this test during the meeting. The urine was completely precipitated with lead acetate and filtered. The filtrate was rendered alkaline with potash, and a solution ol phenylhydrazine was added. The mixturewas well shaken and boiled. An orange colour was developed, which was followed by an orange precipitate when excess of acetic acid was added if sugar was present. Schwartz stated, and the author had confirmed his statement, that normal urines gave a negative result with this test. The conclusion was that sugar was absent from normal urine. Dr. WILLIAM HUNTER mentioned that besides uric acid and kreatinin there were carbohydrate substances, some of which were undoubtedly allied to sugar, in normal urine, whichwere capable of reducing the copper in Fehling's or Pavy's tests. He referred to two tests for carbohydrates in urine which had been recently introduced, and which had undoubtedly the power of showing very faint traces tf these bodies in the urine. The first test, known as the benzoylchloride test, could be easily applied. In a sample of urine. 1Pharm. Zeit., xxxiii, 4t.
doi:10.1136/bmj.1.1677.351 fatcat:6tj2rrq3djbsjgu4f3htp43uka