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PHILLIP'S EMULSION.

Pancreatized.

THE CHAS. H. PHILLIPS CHEMICAL CO., 128 PEARL ST., New York.

The location of fractures of the spine may be anywhere in its extent. They occur more frequently in the cervical region, and are more serious here than at any other site; although, as is well known, prognosis of a fracture of the spine is never good. These fractures may be produced either by a direct or an indirect force. The direct force producing them usually fractures the spinous processes and the arches of the vertebræ. However, when the force is of sufficient intensity, further injury may be done at the same time to the bones. When an indirect force produces a fracture, it is capable not only of injuring the spinous processes, the transverse processes, and the arches, but frequently produces crushing of the bodies of the bones. Accompanying any *Read at Meeting of Nashville Academy of Medicine, November 22, 1904.

fracture there may or may not be a diclocation of the vertebræ, complete or incomplete, but such dislocation is not an uncommon complication.

We are all aware that the nerves given off from the spinal cord arise from the cord higher up than their point of exit from the canal. The lower down the nerve the longer the distance traversed by it within the canal. Therefore, in determining what vertebra is injured, we must always take into consideration the fact that the nerve showing the symptoms arises from a point above its exit, as stated above. The eight cervical nerves come from points within the cord between the first and the sixth cervical vertebræ. The first six dorsal nerves come from the cord between the seventh cervical and the fourth dorsal vertebræ. The remaining dorsal nerves arise between the fourth and the tenth dorsal vertebræ, while the lumbar and sacral nerves arise between the tenth dorsal and the second lumbar vertebræ. After having thus arisen, these nerves travel down along the cord within the canal to their respective points of exit.

A fracture or a fracture with dislocation produces its symptoms not by the traumatism that may have been done to the bones and soft parts, constituting and surrounding the spinal column, but to the fact that the lesion has been produced in the cord, or in the nerve proceeding from the cord, either within the canal or at the point of exit, or to the fact that this injury has produced a condition which causes the pressure on these structures. The injury may be a complete laceration or transverse section of the cord produced by the bony structures under pressure, or it may be a partial laceration of the cord produced in a like manner, or again there may be no visible crushing of the cord at all, and yet a sufficient pressure produced upon it to suspend its function. Furthermore, pressure may be brought about by hemorrhage within the dura, or secondarily by inflammation, which causes swelling around the cord. The point I wish to make clear is, that the function of the cord, although it is not always completely destroyed, yet may be so destroyed that it is impossible to determine whether we have a complete lesion, a partial lesion, or simple pressure of a marked degree on the cord.