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total loss of motion in both lower extremities. Sensation was completely absent in the right leg and thigh and up to a level about two inches above the anterior superior spine of the ilium. Sensation was also absent from the greater part of the left lower limb-a small surface of the upper and internal part of the thigh being the only part of it which retained sensation. The cremasteric reflex on the right side was absent, but slightly present on the left side. His bladder was paralysed. He was put on a water bed and the condition of his bladder and bowels carefully looked after, his urine being drawn off twice or thrice a day and aperients given when necessary, as constipation was well marked. On the occasions when his bowels were very loose the patient had no control over his sphincter ani. The urine became alkaline on the 6th July and soon after other signs of cystitis set in. Benzoates were given and the bladder washed out every six hours with different antiseptic solutions, but never- theless its condition slowly became worse. The man's general condition also got worse, the lower extremities wasting considerably, while he was evidently getting weaker in those parts of the body over which he still had control.” Galvanism of the lower extremities was commenced on the 14th of July. The conditions of motion and sensation remained as on admission and bed-sores were now forming in the upper gluteal region. As it was evident that the man was getting much worse and that there was probably some pressure on the cord in the region of the first or second lumbar vertebræ-extensive destruction of the cord being negatived by the fact that the bodies of the vertebræ were not, and probably had not been, displaced-it was resolved to cut down and see if anything could be done to improve matters at the site of the injury.

On the 20th July, therefore, Dr. ATKINSON, with antiseptic precautions, cut down on the cord over the fractured spinous processes. After dissecting the muscles back on either side, he proceeded to remove the spinous processes and laminæ of the eleventh and twelfth dorsal vertebræ and also that of the first lumbar. The spinous processes of the twelfth dorsal and first lumbar vertebræ had got fairly firmly fixed. That of the second lumbar, which was comparatively loose, was also removed and there was found to be a depression of the lamina of that vertebra. On getting freer access to the depression it was found that an oblong piece of the bone about the size of a finger-nail was deeply embedded in the substance of the cord, the larger part of it pressing over the left half of the cord. This was seized and dissected off the dura mater which did not at this time show much sign of injury. Examination did not show any further apparent injury, and the wound was closed by deep and superficial stitches and dressed with iodoform, a small drainage tube being inserted at the bottom of the wound. A gum

elastic catheter was tied in the bladder.

21st July, wound dressed, looking well, but considerable discharge through tube.

22nd, wound again dressed, very little discharge, some induration at upper end, drainage tube removed, patient feeling out of sorts still.

23rd, wound dressed-practically, no discharge. The induration at top of wound not so marked. The bladder is improving as the urine does not smell so bad and is clearer. There is, however, a considerable amount of ropy mucus still washed out by the corrosive sublimate solution. Patient expresses himself as being much better, no pain in the back at all.

The left cremasteric reflex is more evident than it was, the right is totally absent. The line of sensation on the right side is the same. Sensation on the left side is considerably improved as to-day he feels pin pricks all over the front of his leg and calf. No movement is yet observable when he tries to move any of the muscles of his lower extremities. He remarks that the washing out of the bladder Low gives him pain.

The solution now

24th, the bladder was only washed out once yesterday, and the same to-day. comes out quite clear with only a few flakes of mucus. Sensation in the limbs is practically the same as yesterday, but on being told to move the left leg, there is evident contraction of the Sartorius and some of the fibres of the Quadriceps Extensor, but movement of the limb is nil.

25th, wound healed except one inch in the middle of the incision. In spite of the apparent slight local improvement, the patient does not improve generally as he is getting more asthenic every day. The bed-sores on his buttocks are no worse.

August 24th, there continues to be improvement in the left leg. All the muscles of the thigh now contract when he is asked to move his leg; and the patella can be moved about quite freely. He cannot raise the leg off the bed, but he can rotate it fairly freely and there is slight motion of the

There is slight contraction of the muscles of the right thigh, moving the patella to some extent, but sensation is still totally absent on the right side. The sensation of the left leg is considerably improved, in fact is very good. The patient says he is much weaker, and to-day, there is some pus welling up from the part of the wound which did not heal by first intention.

The patient had a slight rise of temperature on the 6th August, and after this, it went up almost every afternoon to 102° or 103° F., he gradually got more asthenic and died on August 23rd.

A post mortem examination unfortunately could not be obtained, a fact much to be regretted in this case.

From the fact that motion in both thighs, sensation in the left leg, and the condition of the bladder improved as they did, it was evident that to a certain extent the pressure on the cord must have been relieved. The fact that sensation in the right leg did not return at all showed that the injury to the posterior columns of the left half of the cord must have been destructive in the first instance.

J. A. LowSON.