DISLOCATION OF NERVES.
A few of the nerve trunks may be displaced by injury in such a way that they are liable to subsequent redislocation. The condition is recognized by the mobility of the nerve trunk under the skin, by peculiar sensations when the trunk is irritated, and often by tingling sensations referred to its distribution. The condition is most common in connection with the ulnar nerve, just behind the inner condyle. Should nothing else give relief the trunk should be cut down upon and retained in place by suture or by fixation of other structures around it.
WOUNDS OF THE SPINE AND CORD.
Penetrating Wounds.
—Penetrating wounds of the spine occur both in military and in civil practice. Sometimes the vertebræ alone are injured; occasionally the spinal canal will be opened, with little injury to the bone, only the cartilage suffering. All such injuries are serious in proportion as the cord itself may be injured. Such injuries may be direct or indirect. Should a large vessel have been divided the cord may suffer from pressure of clot, and should this injury occur high in the spine, death may be caused by pressure. The severity of such an injury is generally estimated by phenomena pertaining to the nerve supply of parts below the wound. Should anything indicate partial or complete division of the cord, or that a single nerve trunk has been divided, then an operation is indicated for relief of symptoms, and for nerve or cord suture except in those instances where destruction seems to be too complete to warrant it.
Gunshot Injuries.
—Gunshot injuries vary from small punctures and penetrating wounds to extensive laceration. The lower the injury the lower the mortality, other things being equal. Such injury to the cervical region generally proves quickly fatal. The symptoms here are not essentially different, save that the bullet may have done still more harm by passing beyond the cord, and that to the signs of a penetrating wound may be added those of a traumatic hemothorax or some other serious complication. It is necessary to distinguish between mere stiffness of the back and disinclination to use certain groups of muscles and absolute loss of motility. The former may indicate contusion and the latter severance or pressure. After some perforations cerebrospinal fluid will escape. In one instance I opened a spinal canal for perforating gunshot wound with complete paralysis, and found not only that the bullet had divided the cord but had passed through the vertebra into the lung beyond. A very curious phenomenon presented in this case is that when the passage was well opened air passed backward and forward through the spinal wound, the patient thus partly breathing through his back.
PLATE XLVI
Intraspinal Hemorrhage, mostly Subdural, with Minute Subpial Ecchymoses.