38 SURGERY. 



compress and a pasteboard splint, retained by a suitable bandage, 

 will retain the parts in apposition ; and the patient is to be fed by 

 gruels and soups, through the interstices of the teeth. The union is 

 rapid, and there is usually but little deformity. 



FRACTURE OF THE SPINE. 



This is attended with serious injury to the spinal cord, from com- 

 pression, laceration, bruising, concussion, or from subsequent in- 

 flammation and softening. When it occurs above the fourth cervical 

 vertebra, death is almost certain, on account of the origin of the 

 phrenic nerve which supplies the diaphragm. 



When the lumbar region has suffered, the symptoms are paralysis 

 of the lower limbs, involuntary discharge of faeces, retention of 

 urine, and frequently priapism. 



When the injury is in the upper dorsal or lower cervical region, 

 there is, in addition to these symptoms, paralysis of the arms, diffi- 

 culty of breathing, sluggishness of the bowels, and distention of the 

 abdomen. In all fractures of the spine, the kidneys suffer, and bed- 

 sores are apt to follow. 



Treatment. — Absolute rest upon a mattrass, low diet, and anti- 

 phlogistic means, to prevent the formation of pus, and thickening 

 of the membranes. The discharges of the bowels must be regu- 

 lated, and the bladder relieved by the catheter; counter-irritation 

 and frictions will be useful in the latter stages of the case. The use 

 of the trephine in this injury has not met with success, and will pro- 

 bably do more harm than good. 



FRACTURE OF THE PELVIS. 



Fracture of the bones of the pelvis can only be produced by the 

 greatest violence. There is but little displacement, although great 

 danger results from injury to the parts within. 



Treatment. — All that can be done is to place the patient at rest 

 in an easy position, keep a catheter in the bladder, and make inci- 

 sions, if urine or pus is extravasated in the perineum. The appli- 

 cation of a broad bandage around the hips, will assist in preventing 

 motion. 



When the crest of the ilium or the anterior superior spinous pro- 

 cess is knocked off*, the fragment is displaced inwards, and can be 

 readjusted by the fingers. Fracture of the sacrum is longitudinal 

 usually, and there is no displacement. The coccyx may be frac- 

 tured by a kick, and is displaced inwardly : readjustment may be 

 effected by the finger in the rectum. The acetabulum may be split, 

 and injury of the neck of the femur may be simulated, though there 

 is no shortening of the limb, and crepitus is felt by the finger in the 

 rectum, when the pelvis is moved. 



