DOI: 10.7925/drs1.ucdlib_280666
title: Luxation and fracture of spine

description: Watercolour medical illustration depicting spinal injury. It has the alternative reference number 1418, P15A and 19 on the front. There is no Richmond Hospital Museum reference. The handwritten note in the bottom left reads 'Mary Anne Earle aet 28'. The following are indicated on the illustration 'Luxation' and 'Fracture'. The typescript and handwritten notes on the back begin 'Case book p. 252. M.A. Earle aet 28 was admitted into the Richmond Hospital on the 28th of August, 1838'.
description: Scope and content: The typescript and handwritten notes on the back read 'Case book p. 252. M.A. Earle aet 28 was admitted into the Richmond Hospital on the 28th of August, 1838. She fell, or was thrown, into an area, a depth of ten feet. The back part of her head came first to the ground, and her body seemed to have been doubled to violently flexed, giving her (as she reported) the sensation that her neck was driven into her chest. Having been lifted up, she observed that her body, below her neck, was nearly devoid of all feeling, and that she could not move her limbs. She stated that she perceived a grating or cringing at the lower part of her neck, as id some bone were broken, and that occasionally a numb tingling feeling (particularly on any motion of her neck) passed through her limbs. From the time of the accident till her admission into hospital at 2 o'clock, P.M., on the following day, she had passed no water, and on introducing the catheter about three pints of urine were drawn off. On examining the neck a depression was observed behind, at the lower part of this region; and, on introducing the finger back through the mouth, a projection was felt in the pharynx; "this projection seemed neither abrupt nor sharp; but smooth, though bony". There was no difficulty in swallowing, but great pain along the cervical vertebrae. Her respiration was laborious, and performed entirely by the diaphragm and abdominal muscles. Her ribs were motionless; her pulse 90, small and compressible; her stomach very irritable, rejecting everything, so that she was afraid to drink, though very thirsty. In no position was her head easy for more than a few minutes. She frequently had it moved and supported on each side. Her thirst, and the irritability of her stomach, kept her from sleeping, although anodyne enemata were administered. The following notes were taken on August 31st, four days after the accident: She lay upon her neck; her abdomen was much distended and tympanitic; her whole body below her neck was devoid of feeling, it's temperature of a normal standard; her lower extremities quite paralysed; if raised, or left unsupported, falling down as if lifeless, and lying in whatever position they are placed. However the upper extremities were not so completely powerless, as she could move the fore-arm a little, and support it for a moment or two; here also she felt an occasional numb tingling sensation. Her respiration was 22, and performed by the diaphragm; the pulse 80, regular. The use of the catheter was necessary, and the bowels remained unmoved, except by aperient enemata. She got no sleep, except a short doze; still teased by thirst; there was frequently a convulsive working of the mouth. Her intellect was perfect; her manner calm, collected, and resigned, throughout the whole of the case. She had a weak kind of vomiting, or rather gulping up of the contents of the stomach. On each successive day she became gradually worse. The dejections were involuntary; the vomiting ceased; her respiration rose to 32; her pulse was 90; the upper extremities now became utterly powerless, as well as the lower limbs, which had been so from the first. She lived for one week longer, surviving till the twelfth day from the occurrence of the accident. [] intervertebral substance had disappeared. The only ligaments ruptured were the capsular ligaments of the oblique processes and the ligaments subflava. The anterior and posterior common ligaments of the spine remained unbroken, so that although a very decided luxation existed so far as the articulating processes and bodies of the vertebrae, the absolute displacement of the bones as to each other only consisted in a slight advance of the fifth vertebra on the sixth. The longi colli muscles in front were perfect, and these, as well as the posterior muscles, prevented the bones from further displacement than that just mentioned. The displacement of the vertebrae, where the fracture existed inferiorly through the body of the fifth dorsal vertebra, was much greater than the displacement of the bones in the cervical region, where the luxation existed. The anterior and posterior ligaments were unbroken: here, also, all the articular processes remained in situ. Medulla Spinalis- On opening the bony canal, some extravasated blood of a black colour was found at the seat superiorly of the luxation and inferiorly of the fracture. The spinal marrow and its theca were then removed, and the latter opened. The pia mater corresponding to the lower injury (the fracture) was found to be of a yellowish-brown colour; and though it maintained its continuity at this place, there was a complete and perfect interruption of the substance of the medulla spinalis. Corresponding to the seat of the cervical lesion in the bones, that is, the luxation, the medulla spinalis externally exhibited but little alteration in its appearance from that which is normal, except that it had a slight tinge of yellow colour; but when a longitudinal section of the medulla was made, it was found that ramollissement of this portion of the nervous system had occurred. The medulla was remarkably soft, almost diffluent, for the extent of three and four inches, presenting a mottled appearance, from the different shades of colour–yellow, red, and brown-which were observable in it. On a former occasion Mr Adams had shown to the Society the medulla spinalis when exhibiting other specimens of injuries of this portion of the nervous system, but at that time was not aware of the true lesion the bones had suffered. It was Mr Robert W. Smith who discovered that in the cervical region a true luxation had occurred. -March 29, 1845. Museum, Richmond Hospital. Luxation & Fracture of Spine.'
description: Numbering/sequence: Original reference number: 1418.