DOI: 10.7925/drs1.ucdlib_280556
title: Luxation of spine

description: Watercolour medical illustration depicting dislocation of spine. It has the alternative reference number 1419 and P19c on the front. The Richmond Hospital Museum reference is C.b.84. The entry for this in P263/1 pg. 23 reads 'Dislocation of spine. Mich.l Dowdle aet 35'. The artist's name is in the bottom right corner 'J. Connolly fec.t' and in the left corner 'Case of Mich.l Dowdle Aet 35'. The handwritten note above the artist's name reads 'Luxation of the spine between 5th & 6th cervical vertebrae'. The typescript note on the back begins 'Dislocation of the Spine'. This illustration relates to P263/558 portfolio 9.2.
description: Scope and content: The full handwritten note above the artist's name reads 'Luxation of the spine between 5th & 6th cervical vertebrae'. The typescript note on the back reads 'Dislocation of the Spine – Dr Hutton exhibited a well-marked example of this rare form of injury, taken from the body of man about thirty-five years of age, who, while driving home late on last Saturday night in a taxcart, was thrown into a ditch; he fell upon his head, his neck being doubled under him. He was carried home in a state of insensibility, but next morning he became quite collected; but the lower extremities and the body, as far up as the axilliae, were paralyzed; thee was also some impairment of motion and sensibility of the upper extremities; the fingers were flexed and could not be extended, neither could he extend the forearm; he lay flat upon his back and made no complaint, except of pain in the lower part of the neck whenever he was moved. The bladder was distended, the respiration was completely diaphragmatic, and, during each act of inspiration, the capacity of the thorax, although enlarged in the vertical direction, was diminished in its transverse diameter, in consequence of the paralyzed condition of the intercostal muscles. His pulse remained at 62 throughout; his breathing became gradually more embarrassed, from his inability to expectorate the mucus which was collecting in the bronchial tubes. On Tuesday he began to vomit a greenish matter, and died on Wednesday. Autopsy – Upon removing the muscles from the vertebral grooves, a space was observed between the fifth and sixth cervical vertebrae, through which the theca vertebralis could be seen; the superior articular processes of the sixth vertebra were also exposed, the fifth having apparently been drawn upwards and forwards, during the forcible and violent flexion of the neck at the time of the accident; the intervertebral substance was torn through, but there was no fracture of the boy of either vertebra; the right transverse process of the sixth was fractured, but the lesion had all the appearance of having been caused during the removal of the spinal column. The injury was, beyond any question, a true luxation or diastasis. The theca and posterior vaginal ligament were uninjured, but a small clot of blood existed between them. The external aspect of the cord was normal, but at the seat of injury it felt soft and pulpy, and when a longitudinal section was made of it, a coagulum was found in its centre, and the medullary tissue was softened around it and discoloured. Before concluding, Dr Hutton alluded to the striking resemblance which this specimen bore to that exhibited upon a former occasion by Mr Adams, in which, besides a fracture of the body of the sixth dorsal vertebra, there was a true luxation between the fifth and sixth cervical [March 29, 1848]. In this instance, also, the cord exhibited externally but little alteration in its appearance from that which is normal, but when a section of it was made, corresponding to the seat of the displacement, ramollissement of the medullary structure was found to have occurred. Dr Hutton finally alluded to the cases of the injury in question recorded by Lawrence [Medico-Chirurgical Transactions, vol. xv], Dupuytren [Lecons Orales], Samuel Cooper [Surgical Dictionary], Lasalle [Gazette Medicale, 1841], Liston [Lancet, 1837], Norris [American Journal of Medical Science, 1841], and Miller [Practice of Surgery] and also to that recently published by Mr Butcher [Dublin Quarterly Journal, 1853]. – March 25, 1854'.
description: Numbering/sequence: Original reference number: 1419.