A fatal case of concussion of the spinal cord / by Seymour J. Starkey.

  • Sharkey, Seymour John (Sir)
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: A fatal case of concussion of the spinal cord / by Seymour J. Starkey. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    rectum should have been directly injured, when at the post- mortem examination not the slightest damage to other parts could be discovered; and it would be still more incredible that a precisely symmetrical lesion should have affected the perineal nerves. The only reasonable explanation of the exact symmetry of the acute bedsores in the perineum, which were situated on parts not exposed to pressure, is that the cord was diseased at the spot in the lumbar region where the perineal nerves approach or meet each other. And this would equally explain the affection of the bladder and rectum. But it may be objected that no disease of the spinal cord was actually found. To this we answer, that physiological reasoning in this case is of more value than arguments based on our inability to find pathological changes, and that for two reasons: 1. Because it is impossible to examine more than a small portion of the cord microscopically. And although such scant examination shows us the anatomical changes of disease when extensive, yet our not finding alterations in the few sections we examine is no proof of the absence of a small focus of disease. In the present instance the focus must have been very limited in extent. 2. It is legitimate to suppose, that if we had had an oppor- tunity of examining the cord a week or so after the injury we might have found disease; and yet that six weeks after the accident all morbid changes, except the few doubtful ones recorded, might have cleared up. For the bedsores had long been healing, and death was the result not of progressive cord disease, but of an unfortunate cystitis and suppurative nephritis which early accompanied the paralysis of bladder. It seems then that the only reasonable conclusion is, that owing to the concussion of the spinal cord produced by the force of the accident a small focus of disease resulted, which would probably have ended in the recovery of the patient, had not secondary disease of bladder and kidneys unfortunately proved fatal. Satisfactorily proved cases of concussion of the spinal cord are undoubtedly rare ; but we must remember, that in order to prove them we require a post-mortem examination. This case at least suggests what other considerations would render pro- bable, that in severe accidents small focal lesions may result from concussion, and although they may cause very obscure and annoying symptoms, yet as they are small in extent and have not damaged vital parts they terminate in recovery, and leave us to argue as to the cause ol the clinical phenomena we * observe, without giving us the opportunity of proving whether our conclusions are correct.