SPINE, Concussion and Injuries of.
Injuries of the spinal cord and spinal column must not be confounded with each other. The weight of pathological evidence is decidedly against the assumption that the functions of the spinal marrow can be arrested without some structural change—contusion, laceration, hemor rhage, or the secondary formation of cylindrical cavities, having taken place in the nerve tissue.
The treatment will consist in immediate resort to bed in the horizontal position till the symptoms pass off. The same measure is clearly indicated in gross lesions of the cord and in sprains and injuries of the spinal column. Pain may be so severe as to demand injections of Morphine or Cocaine, and when painful spasms occur a lumbar puncture should he performed and Eucaine, Stovainc or Novocain-Suprarenin injected into the spinal canal. The fluid obtained by lumbar puncture is a valuable diagnostic element; the fluid extracted relieves tension, and in addition one or other of the drugs mentioned may he introduced.
Ire to the spine may be employed for the relief of pain, or hot fomenta tions and cataplasms if these give better results. Owing to the danger of
haemorrhage having occurred, the application of heat is, however, a doubtful agent to employ. Where there is evidence of haemorrhage, if spinal puncture does not afford relief, a resort to laminectomy will be necessary when compression symptoms are severe, but this procedure is generally useless in intra-medullary• bleeding (luematomyelia). In the chronic stage of cord and column lesions, counter-irritation, blistering and the application of the actual cautery may be resorted to. The bladder in most cases will require scrupulously aseptic catheterisation, and where asepsis cannot be guaranteed, suprapubic drainage may be employed or the method of applying abdominal pressure, practised by some American surgeons in the last year of the war. Failure to keep the bladder empty will ultimately lead to ureteral dilatation, and if infective cystitis coexist, to suppurative pyelo-nephritis and death.