Nervous and mental diseases . flexes are not en-countered. Complete and permanent lossof rectal and bladder reflexes points to in-volvement of the cord. In lesions of the cauda, therefore, we have anatomically coextensivesensory, motor, trophic, and reflex symptoms, corresponding to the dis-tribution of the roots making up the sacral and lumbar plexuses or apart of them. The disturbance always affects the lowest portion andceases at some definite upper level. Most cord lesions, on the otherhand, are limited in vertical extent, and the reflex and trophic disordersare confined to the correspondi
Nervous and mental diseases . flexes are not en-countered. Complete and permanent lossof rectal and bladder reflexes points to in-volvement of the cord. In lesions of the cauda, therefore, we have anatomically coextensivesensory, motor, trophic, and reflex symptoms, corresponding to the dis-tribution of the roots making up the sacral and lumbar plexuses or apart of them. The disturbance always affects the lowest portion andceases at some definite upper level. Most cord lesions, on the otherhand, are limited in vertical extent, and the reflex and trophic disordersare confined to the corresponding body segments. The usual lesions which affect the cauda are vertebral fractures anddislocations, new growths, penetrating wounds, and hemorrhage. Intabes and multiple neuritis, which are sometimes confounded withcaudal disease, symptoms are present at higher levels, as in the upperextremities, and in the pupillary reflexes. Injury to the plexuses withinthe pelvis usually—at least, at first—produces unilateral Fig. 129.—Area of anesthesia ina lesion of the cauda, affecting allthe sacral roots. 352 DISEASES OF THE CORD PROPER. CHAPTER CORD LESIONS. TRAUMATIC LESIONS OF THE CORD SUBSTANCE. The spinal cord is sometimes reached by penetrating wounds madeby knife, bullet, or other foreign object. It is injured more frequentlyby the displacement of vertebrae, and this is almost invariably attendedby both fracture and dislocation. With the surgical conditions we shallnot deal. It is to be noted that vertebral fracture-dislocations are fre-quently devoid of any external signs of displacement, even when it isfound postmortem that the vertebral bodies have been so completelydisplaced as to actually shear the cord in two. Restitution to a practi-cally normal position may occur at once, either spontaneously or due tothe lifting eiforts of those who first attend the injured person. Thesecases all furnish a history of trauma, and usually present local evi
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