SPIKE AND SPBSTAL CORD 263 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.