University College Hospital
1858
BMJ (Clinical Research Edition)
Under the care of CysSR HAWKINS, Esq. EDWARD M., aged 35, a labourer, was admitted on April 16th, 1858, under the care of Mr. Caesar Hawkins. It appeared that, twenty-one weeks before admission, while at work on a tunnel in France, he fell a height of about twenty feet on a large stone, and a large mass of earth (said to weigh a ton) came down from the same height on his back, striking the lumbar region. Since the accident, he had had no sensation or power of motion in his back or lower
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... ies, nor any power over the bladder or sphincter ani. Large bed-sores had formed on the back and buttocks, exposing the spines of the sacrum and the right tuber ischii. There were also smaller sores on the right trochanter, on both heels, and on the right foot. He bad been lying on a mattress all the time he was in France. At length, his desire to return home became uncontrollable, and he was carried on board ship in a covered couch, in which he was brought up to the Hospital from the docks. He was put upon a water-bed, and ordered good diet with porter. The bed-sores were dressed with a solution of nitrate of silver, and covered with calamine cerate. The catheter was also passed daily, but only a very small quantity of urine was ever found in the bladder, as its irritability kept it constantly emptv. The uirine was very faetid and ammoniacal. His lungs were much loaded, and bronchial rales were heard all over. On this account, expectorant medicines were given. He continued to improve for some time; the sores rapidly assumed a healthy appearance, and began to contract. At the end of the month, it is noted that sensation, which had been entirely absent above Poupart's ligament, had returned in both thighs as low as the knee, although it was still extremely imperfect. The cough also was better, but the irritability of the bladder persisted. During the month of May, the couigh diminished considerably; the sores went on healing; and he appeared in a fair way of recovery. The bladder was now injected every morning with acidulated water (one drop of nitric acid to the ounce); squills and morphia were given at night, and mineral acids administered. The irritability of the bladder now diminished; and it is noted on May 27th, that " he is doing well in every way". On June 1st, however, while eating a hearty dinner, he died so suddenly that no one was aware of the seizure until he was dead. He had not been ailing in any respect previously, except that he had complained that morning of slight pain in the right side. On post mortem examination, twenty-four hours after death, the body was found emaciated, and there were bed-sores on the back and heels; but these were quite superficial. The brain was watery; otherwise, both it and the medulla oblongata were quite healthy. The heart was large and flabby; all its cavities were empty of blood. The microscope showed considerable fatty degeneration of the muscular fibres. There were marks of old pleurisy on the left side. The bronchial tubes of both lungs were loaded with serum; otherwise, the lungs were healthy. The larynx was healthy. The stomach was full of food. There was a small abscess in the cortical structure of the right kidney, the pelvis of which was highly inflamed. The bladder was inflamed, fasciculated, and much contracted. The mucous membrane of the intestines was healthy. The upper part of the spinal column and cord were quite natural. There was a fracture in the lumbar region, running behind through the laminw of the first two lumbar vertebren on the left side, in the form of a fissure, which showed no trace of union. There was no displacement of the spinoils processes. The fracture in front ran through the bodies of the last dorsal and two upper lumbar vertebrae, and there was considerable displacemenit both in the lateral and antero-posterior directions. A piece of bone had here been driven backwards, and projected into the spinial canal on the riaht side of the median line, below the termination of the cord, among the nerves of the cauda equina, none of which, however, were divided. The lower part of the cord appeared somewhat softer than the rest (though this was obscure), and there was a little purulent fluid in the theca vertebralis. UNIVERSITY COLLEGE HOSPITAL. INJURY TO THE SPINE. Under the care of J. E. ERICHSEN, Esq. [From Nots by F. B. JESSETT, ESQ., House-Surgeon.j WILUAM C., aged 45, a labourer, was admitted on July 10th, 1857, under the care of Mr. Erichsen. It seemed that, ten days before admission, he fell from a ladder to the ground, a height of five or six feet. He was not at all stunned by the fall, but immediately lost all power of moving the limbs. He was carried home and put to bed, and it was then found that he had lost sensation over his whole body. A bottle of water was put to his feet, so hot as to blister them, without his being conscious of it. He passed water, however, voluntarily that day, and still retained power over the fteces up to the time of his admission. Since the accident, he had suffered much pain in the limbs and trunk. His mental faculties had been always quite clear, and he had no ditficulty in swallowing or articulating. On admission, there were no external marks of injury in the back; but a slight prominence was observed at the lower part of the cervical region-not, however, more than would be accounted for by ani unusually projecting vertebra Frominens. He complained of much pain in the limbs, especially the arms. This was occasional, and radiated from between the shoulders. When his head was moved (which he could do himself, although imperfectly), he complaine(d of pain in the back and shoulders. He had not the slightest power over his arms or hands; he could draw up his legs a little, enough to cross them when lying on his back. Sensation was about normal all over the body, but accompanied by slight numbness. His respiration was generally entirely diaphragmatic, but he could expand his chest on taking a deep inspiration. He spoke well and rationally. His appetite and digestion were good. R Hydrarg. bichlor. gr. 1-12; decocti cinchon. j. M. Fiat haustus ter die sumendus. July 14th. His arms were still quite capable of motion. He moved his head a little more easily, and with less pain; and said that he thouight he had more power over his legs. July 16th. On the urine being examined, it was found to contain diabetic sugar. July 2.7th. He continued as before; he had rather more power in the lower limbs, and was almost able to turn himself over by the muscles of the back and shoul(ders. Pulse 64, regular, tolerably full, and incompressible. He was ordered to have half a grain of extract of nux vomica three times a day. July 31st. To-day, for the first time, power of motion was observed in his hands and arms. He sat up about half an hour. The extract of nux vomica was increased to one grain. August 28th. He lhas now sat up for some hours daily, and complained of little pain, except in his hands and arms, which, from the little power he had over them, were obliged to hang more or less, and consequently became congested and painful. He was ordered to leave off all medicine. September 22nd. By the help of the nurse, he was now able to move about the ward. October 1st. Since leaving off the DUx vomica, he had continued to make as much if not more progress thian while taking it. He was now able to walk about the ward without even the aid of a stick, although his gait was still very uncertain. He had also recovered some use of his arms, which he could now raise nearly as high as his shoulders. His health was apparently very good, he having increased in weight considerably. He still complained, however, of a pain in his shoulders and limbs, and also of a degree of numbness in the latter. October 14th. He still continued to improve, gaining greater strength in his limbs. He was ordered to begin again with a grain of nux vomica. October 20th. He was discharged in much the same state, it being thought that he would improve more rapidly in the country.
doi:10.1136/bmj.s4-1.78.513-a
fatcat:oqxvwe2jinai5hrtbesyl4ejfq