148 THE SURGICAL PHYSIOLOGY 



segments below the injury, and either from the first 

 or after the lapse of a little time they lose their reflex 

 functions, the bladder and rectum and their sphincters 

 become paralysed, and the effect is much the same 

 as it would have been if the isolated portion of the 

 cord had been removed in toto. In animals, the 

 reflex functions persist. 



Considerable difficulty may be experienced for a 

 day or two in deciding whether a patient is suffering 

 from a complete division of the cord due to the nip 

 at the moment of fracturing the spine, or whether 

 the symptoms are due merely to concussion. In 

 the latter case a few days' rest will effect a cure. 

 Sometimes one can get a hint earlier. If the distri- 

 bution of the paralysis does not correspond with 

 the distribution of the anaesthesia, and if the sym- 

 ptoms are asymmetrical, it is probable that they are 

 due partly at least to concussion. In either case it 

 is very seldom that any useful purpose will be served 

 by operating, unless the injury involves the cervical 

 region or the cauda equina. 



When the cord is involved, but has not suffered 

 a functional transection, the paralysis will probably 

 be spastic in nature, and operation is more hopeful 

 because there may be something exercising injurious 

 pressure which can be removed. 



Haemorrhage into the spinal membranes produces 

 pain and spasm by involving the issuing nerve roots. 

 In addition, there will probably be some evidence of 

 pressure on the cord, producing spastic paralysis and 

 some anaesthesia below the lesion. 



Haemorrhage into the centre -of the cord sometimes 



