DOI: 10.7925/drs1.ucdlib_280661
title: Softening of the spinal marrow fracture of the vertebrae

description: Watercolour medical illustration depicting spinal injury. It has the alternative reference number 1435, P15A and 22 on the front. The Richmond Hospital Museum reference is D.a.3. The entry for this in P263/1 pg. 16 reads 'Softening of Spinal Marrow from injury of spine. Dr Hutton'. The handwritten note in the bottom right corner reads 'six [?], one [?]'. The typescript and handwritten notes on the back begin 'Softening of the Spinal Marrow. 2. Fracture of the Vertebrae'.
description: Scope and content: The full typescript and handwritten notes on the back read 'Softening of the Spinal Marrow. 2. Fracture of the Vertebrae- Dr Hutton exhibited a specimen of fracture of the vertebrae and softening of the spinal marrow. The subject of the case was a stout, muscular man, who was admitted into the Richmond Hospital on the 4th of March, for a severe injury of the loins received the day before, in consequence of a wall, under which he was digging, having fallen on him. Both bones of the right leg were also broken. On admission, there was a large patch of ecchymosis covering the whole of the lower part of the dorsal and the upper part of the lumbar region. He suffered great pain when pressure was made in this situation, and the least motion caused excruciating agony. Between the first lumbar and the last dorsal vertebrae, there was a larger and more distinct interval than usual, and on moving the first lumbar vertebrae, by means of its spinous process, a crepitus was produced. He had loss of power of the lower extremities, and impaired sensation in them, the external parts of the limbs being quite insensible, the internal still retaining a considerable share of sensibility. He had also retention of urine and faeces, having passed neither from the time of the accident. He stated, also, that he had been complaining of his chest before the accident occurred, and on examination, Dr Hutton discovered pneumonia and bronchitis of the left lung. There was something, however, in his breathing not to be accounted for by the amount of pulmonary disease. His respiration, which was about twenty-eight in a minute, was laborious and heaving, with fluttering motions at the epigastrium, so that a person observing him would be disposed to think, that the diaphragm was acting without the intercostals. Dr Hutton said, however, that he himself could not observe this phenomenon, although it had been noticed by others. On the eight day, the urine, which had been drawn off night and morning with a catheter, was found to be ammoniacal, and about the same time an eschar began to form on the left buttock. Dr Hutton observed, that this coincidence was remarkable, and thought that, perhaps, both effects might be attributed to diminished nervous influence. It was also a curious fact, that the bones of the leg united favourably, and that the patient had not the startings of the limb so common in case of fracture. The treatment pursued was antiphlogistic, and the patient was put under the influence of mercury. The pulse, which at first was 154, fell to 100, but afterwards rose to 120; the respiration also fell to 20. The temperature of the lower extremities was at first about 62, and lower than the surrounding medium, but afterwards rose to 95. The patient ultimately sunk. On examination, Dr Hutton discovered a fracture of the body of the first lumbar vertebra, running obliquely through it, so as to give the lower fragment a wedge shape. The body of the vertebra was pushed backwards, so as to narrow the spinal canal, and press upon the cord. At this spot there was a quantity of matter in the spinal sheath, and the cord itself was soft and pulpy; the whole of the cauda equina was bathed in pus, and greatly discoloured. The bladder was contracted, and its coat's presented numerous traces of ulceration. The patient had passed for some time before death purulent matter mixed with the ammoniacal urine. The duration of the disease was six weeks'.
description: Numbering/sequence: Original reference number: 1435.
description: Date details: This illustration is undated, approximate dates are given based on dates for the entire collection.