Chap, xxiv.] THE SPINE. 559 



patient being conscious of the act or being capable of 

 inhibiting it. 



In some injuries to the cervical cord the patient 

 has suffered from severe vomiting for some time after 

 the accident, or has exhibited a remarkable alteration 

 in the action of his heart. Mr. Erichsen, for example, 

 reports the case of a man who, after a severe blow 

 upon the cervical spine, continued to vomit daily for 

 several months. In the other category, instances 

 have been recorded when the pulse has sunk as low 

 as 48, or even as 36, and 20, after lesions to the 

 column in the neck. 



These changes are supposed to be due to dis- 

 turbance of the vagus, and it is further suggested 

 that the morbid influence is conveyed to the vagus by 

 the spinal accessory nerve with which it is so freely 

 associated. 



It should be remembered that the spinal accessory 

 trunk has origin from the cord as low down as the 

 sixth or seventh cervical nerves. 



Operations upon the cord. Mr. Victor 

 Horsley and others have cut down upon the spine and 

 removed a tumour from the spinal cord with perfect 

 success, and with relief to the symptoms from which 

 the patient was suffering. The spinal canal has also 

 been exposed in certain cases where callus in an old 

 fracture of the spine was pressing upon the cord, or 

 where a small osseous growth was encroaching on the 

 sanal. 



