. Modern surgery, general and operative. idity exists, we may be sure that the cord Prognosis of Fractures and Dislocations of the Spine 963 is not completely divided. When the cord is compFetely divided the symptomsare immediate, there are absolute flaccid motor paralysis and complete sen-sory paralysis (loss of appreciation of pain, touch, and temperature). Theline of anesthesia is definite and suddenly terminates (Walton). The bladderand rectum are paralyzed and there may be priapism. All the reflexes, su-perficial and deep, except, perhaps, the plantar have disappeared. There ispain, there
. Modern surgery, general and operative. idity exists, we may be sure that the cord Prognosis of Fractures and Dislocations of the Spine 963 is not completely divided. When the cord is compFetely divided the symptomsare immediate, there are absolute flaccid motor paralysis and complete sen-sory paralysis (loss of appreciation of pain, touch, and temperature). Theline of anesthesia is definite and suddenly terminates (Walton). The bladderand rectum are paralyzed and there may be priapism. All the reflexes, su-perficial and deep, except, perhaps, the plantar have disappeared. There ispain, there are no muscular spasms, there is vasomotor paralysis with sweatingof the paralyzed parts, and the symptoms persist and do not vary (J. J. Thomas,in Boston City Hospital Med. and Surg. Reports). There is usuallytympanites (Walton). If this latter symptom-group is due to shock, it willusually be temporary, but occasionally, even when so caused, it persists someconsiderable time. It is also probable that concussion of the cord may in some. Fig. 611.—Fracture of the odontoid process of the second vertebra and dislocation betweenthe first and second vertebra a number of years after injury. (From X-ray Dept. of JeffersonHospital.) cases simulate complete division. As Walton says, no symptoms prove a hope-less crush of the cord: it is the persistence of the symptoms which does proveit (Jour. Nervous and Mental Diseases, Jan., 1902); I would add, the per-sistence of and lack of change in the symptoms prove it. A. J. McCosh (Jour. Amer. Med. Assoc, Aug. 31 and Sept. 7, 1901)points out that definite pressure is indicated by marked symptoms and ab-sence of reflexes. When there is not definite pressure the symptoms areirregular; there is incomplete palsy, or muscles of the same group show differ-ent degrees of paralysis; anesthesia is partial; signs of irritation are not dis-tinct, and there are patches of hypereslJiesia and zones of paresthesia. If indoubt at the end of twelve hours, p
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