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which situation it now is fixed, and by its pressure from beneath causes a hypertrophy of the integ- ument : besides, there is a painful neuralgia through com- pression of the nerves. It is clearly apparent that the practical loss of the posterior arch as a means of support must occasion a weakness in the segment of the verte- bral column, and leave Levofloxacin Levaquin a permanent " wry neck," orrre- quire a prothetic adjustment to maintain the head in' an •* upright position. Fig. 9. I I Case V. — Double Fracture oj Posterior Arch of Fourth Ceri'ical Vertebra. — Fig. 9 is a diagram of a spinal injury. This resulted from a fall of twenty feet, the patient, a young man, striking on his neck and back of his head. The case ended mortally on the seventh day. As is seen in the cut there was no displacement found on autopsy ; but without doubt the fragments had been driven in on the cord, for it was reduced to a pulp underneath. There was a large, bloody extravasate into the spinal canal, with evidences of advanced inflammatory changes in the meninges. This is another example yet of the uselessness of operation in many of those fractures which are Cheap Levaquin limited to the cervical segment 500 Mg Levaquin of the spine. October 2S, 189^ MEDICAL RECORD. 557 Case VI. — Fig. 10, with a few notes on the case, I am permitted to report by the kindness of Dr. J. W.. Wright, of Bridgeport, Conn., under whose care he was. The patient, a young man, aged nineteen, was injured on January 19, 1S80, by a fall from a trapeze horizontal bar. He fell, striking on the back Levaquin Buy of his head, a dis- tance of about seven feet. He was instantly paralyzed from the shoulders down, though consciousness was in no way affected. There were no external marks of vio- lence. No special line of treatment for a time was tried, as it was thought recovery would be impossible. But he gradually recovered sufficiently to walk, with the aid of crutches and a support, one year after the injury. How- ever, he always remained an invalid, though living eleven years, when he died of a bladder affection. On inspection of the cervical vertebrae it was found that the fifth and sixth had been Levaquin Levofloxacin fractured through their arches and bodies ; that they had been partly tele- scoped into each other ; a sort of impacted fracture had occurred. The precise point of medullary compression had been just opposite the sixth vertebra (Fig. 11). Dr. G. M. Ham- mond, of New York, made a microscopical section of the cord. At the point of compression it measured one eighth of an inch in its antero-posterior diameter, and three- eighths of an inch transversely. The cord had been in strong alcohol and Levaquin 750 Mg MuUer's fluid three months when these measurements were made. As the crushing was so low down in this case, we can understand why it was that there were no symptoms of asphyxia at any time. It was maintained by some of the speakers at a meeting of the Neurological Section of the New York Academy Buy Levaquin of Medicine, before which this case was first reported, that an operation might have saved the patient by relieving the cord- pressure. But how in the world an impaction and telescoping of the bodies could be dealt with safely in this situation it would be interesting to know. In- deed, surgical intervention in the presence of such an ex- tensive disorganization of tissue must have been promptly mortal in its consequences. As a consecutive measure after ossification was complete, it might have effected some relief. Fracture of Fifth Cervical Vertebra. — Mr. D. Living- ston Davies (M.R.C.S.E.), of Nottingham (Borough Asylum), in the issue of the London Lancet for June 22, 1893, submits a remarkably interesting case of cervical fracture of the spinal column in a healthy male lunatic, of twenty-nine years of age. It appears that on the 2ist of January, in the morning, he was suddenly seized with a suicidal tendency, and pushed his head through a square of thick glass ; however, without inflicting much damage to his head. The same night he was under the continuous supervision of an attendant. Shortly after lying down he jumped up, and with great violence jammed his head against the wall of his compartment. After his second plunge he fell helplessly to the floor. He was temporarily stunned by the fall, but in a few moments fully recovered consciousness, complained of pain in his neck, and said that he thought he was para- lyzed. No deformity could be detected. Motor power and sensation were wholly lost for three inches above the nipple line ; respiration was wholly diaphragmatic ; knee-jerk Levaquin Online was absent. Twelve hours after the injury his temperature suddenly went up to 102° F. January 22d, temperature 103° F. in the morning; Levofloxacin 500 Mg at i p.m. it was 104° F. ; at Levofloxacin 500 5 p.m. temperature 104.6° F. ; at 7 p.m. temperature in right axilla was 104.8° F., in the left 103° F. ; at II Buy Levofloxacin Online p.m. temperature was 104.2° F. January 23d, I A.M., temperature was 105.2° F. Levaquin 500 ; at 3 a.m. 105.3° ^■ Patient was conscious until an hour before his death, when he became delirious, and died at Levaquin Mg 4.15 a.m. Death took place apparently by asphyxia. Temperature ten minutes and thirty minutes after death was 106.6° and 106.2", 105.8°, F. Qyx post mortem examination, twenty-nine hours after death, no fracture of the skull was detected, nor evidence of trauma of the brain. A T-shaped fracture of the body Levaquin 500 Mg of the fifth cervical vertebra was discovered, splitting the body into three parts with a V-shaped fracture through the posterior lamina, near the junction with the trans- verse processes. No displacement of the fragments was noticeable. ' On opening the vertebral canal, the meninges bulged out, and on incising these a large amount of dark blood es- caped, being sufficient in amount to cause some compres- sion of the cord. As it was decided to preserve the body specimen the cord was not e.xamined. Remarking on this spinal injury the author says " that it is interesting to note, i, the manner in which the ver- tebra was fractured, by butting the head, without Purchase Levaquin injur- ing it, in a room six by ten feet; 2, the short period of unconsciousness ; 3, total absence of the knee-jerk, with limitation of perspiration to the sensible parts of the body, and difference of thermal state in the a-xill^e." The post-mortem showed that no good would have re- sulted from trephining, the performance of which had been under consideration. I have quoted this short but valuable report, with comments, almost verbatim, and find that it presents so many highly interesting and practical features that it will bear a further analysis and review with advantage. Etiologically the case is a puzzle; for how a man could fracture the cervical segment of the column without battering in his cranium first, by any sort of butting, is quite incomprehensible, and is utterly incompatible with all laws of physici. It would seem more probable that he must have dove off the bed, head foremost, on to the floor, thereby projecting his whole body against the head and the cervical isthmus. Clinically the case is a typical one of serious spinal- cord lesion. He was immediately paralyzed. That meant that the cord was mortally crushed ; which is al- ways a grave symptom. His temperature shot up sud- denly and kept on mounting even after he was dead. That is an invariable phenomenon when acute menin- geal inflammation develops after a traumatism of the cord. He died asphyxiated ; ascending meningeal in- flammation, as soon as it reached the roots of the phrenics and respiratory nerves of Bell, inducing, simul- taneously, respiratory inhibition, medullary hyperemia, and cerebral congestion, with thermal and mental de- rangement. Pathologically, though no minute examination of the cord was made, it was specially interesting, for here we ' Italics mice. 558 MEDICAL RECORD. [October 28, 1893 had a fracture completely smashing through both planes of the column, and yet there was no displacement. He had free intra-dural hemorrhage. I have always maintained that primary intra-dural hemorrhage never occurs after a traumatism of the column unless there has been a fracture or structural disorganization of other parts. Therapeutically it supports my position, too, that Levaquin 750 there are no definite symptoms connected with vertebral fracture ; that there rarely is depression of the fragments, and that when there is, the cord is generally irreparably destroyed. I have taken pains to investigate the dime- museum case of "the man with the broken neck," Barney Baldwin. Going there I found a large, hea\y, middle-aged man, with his head Levaquin Cheap in a cage, which had a brace attachment. There was no cervical deformity visible. He refused to Buy Cheap Levofloxacin permit me to carry my hand over the spinous process, or indeed to touch his neck at all. I offered to pay him liberally to call at my office and per- mit me to make an examination and report a full descrip- tion of his case to the profession. This he would not do. I have written to physicians in Birmingham, Ala., some of whom have been there all their lives, yet none have any knowledge of him. Buy Levofloxacin To my mind the case is one on a par with the usual dime-museum exhibits. This is all the more evident when we read Baldwin's own story in his book, a copy of which I secured. He says ' ' the accident was caused by an engine becoming unmanageable, which was push- ing a train of cars, when I was knocked off" the caboose, and was run over by the engine and si.\ cars." It said that Barney had his neck broken, together with his right arm, both legs, and five ribs. His watch was crushed out of sight " into his bowels, and an iron bolt was lost sight of in his collar-bone." The arm was made good by a new silver joint. Besides all this, the fourth, fifth, and sixth cervical vertebra were smashed, etc. I would not have noticed this piece of imposture as one of extensive cer- vical fracture of the column, were it not that it has been chronicled by some of our medical journals as " one of the marvels of our time." " Barney Baldwin, the Broken- neck Wonder." Summary and General Conclusions in Cervical Le- sions of the Spinal Column Attended with Fracture.^ The general conclusions arrived at after a study of cervical fracture in man and experimental observations on animals

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