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Alfred Master n describes the unusual case of a fractured spine caused by a sud-
den muscular strain. A clerk, aged 47, was helping unload some heavy bags of money
from a taxi outside his office one morning in April 1932. While lifting a particularly
heavy bag from ground, he suddenly felt something snap in his back and coUapsed
on the floor. At the time he felt " the use go out of his limbs" below the waist for a
few moments, but this passed off, though he still complained of severe pain in the
lumbar region of the spine. After resting for a little while in the office he was able
to travel home in bus unattended, having fastened his belt firmly round his waist. He
continued in bed for three weeks, and after another month's convalescence he returned
to duty. He continued his office work for twelve months, apparently in good health,
except for occasional pain in the lumbar region and a jarring sensation down the spine
on walking downhill. Owing to the persistence of the pain he sought medical advice,
and the X-ray examination revealed an ununited fracture of the body of the third
lumbar vertebra.

Concussion of the Spine.—This condition may occur without any
evidence of an external injury to the spinal column. It may follow a severe

blow on the back, or a jar, or a fall
from a height. This is the most com-
mon form of injury met with in rail-
way and motor car collisions, and is
known as " railway spine ".

The symptoms may develop imme-
diately or may be delayed for a few
hours or days. The patient complains
of headache, restlessness, giddiness
and sleeplessness. He is excitable and
emotional and generally suffers from
nerve prostration or neurasthenia. He
is unable to concentrate his mind and
therefore has to give up his work or
business. He complains of pain and
tenderness over the spine and weak-
ness in the limbs. Hence he is unable
to walk. He also complains of amnesia,
loss of sexual power, irritability of the
bladder and derangement of the spe-
cial senses. These symptoms are
exaggerated very much by any kind
of mental excitement, e.g. during the
time of medical examination. Most of
the symptoms being subjective, it is
difficult for a medical practitioner to
determine whether the patient is
feigning or not. It has often happened
that the symptoms have abated imme-
diately after a civil suit for damages
brought by the patient against his
employer or a railway company has been decided in court.

Being well protected by anatomical structures, incised or punctured
wounds of the spinal cord are rare except between the first and third
cervical vertebrae, where they are more exposed owing to the narrowness
of the laminae. A punctured wound caused in this region even *by a small
needle proves almost instantaneously fatal, as it injures the medulla and
the upper part of the cord which contain the respiratory and other vital
centres. The process of killing in this manner is called pithing and the
wound caused is so very small, that it may be overlooked altogether if tlte
weapon is thrust obliquely.

Fig.   127,—Cervical   vertebrae   showing
fracture of the 4th Cervical vertebra.

11.   Brit. Med. Jour., Nov. 24, 1934, p. 976.