siderable risk of infection, unless the most rigid precautions are
adopted. Hypostatic pneumonia is liable to develop. Great care in
nursing is necessary to prevent trophic sores occurring over parts
subjected to pressure, such as the sacrum, the scapulae, the heels, and
the elbows.

_Later symptoms_ are the result of descending degeneration taking
place in the antero-lateral columns of the cord. There are often
violent and painful jerkings of the muscles of the limbs; the muscles
become rigid and the limbs flexed.

_Treatment._--When the cord is completely divided, no benefit can
follow operative interference, and treatment is directed towards the
prevention of infective complications from cystitis and bed-sores.

#Injuries of the Cord at Different Levels.#--_Cervical
Region._--Complete lesions of the _first four cervical segments_--that
is, above the level of the disc between the third and fourth cervical
vertebrae--are always rapidly, if not instantaneously, fatal, as
respiration is at once arrested by the destruction of the fibres
which go to form the phrenic nerve. It is from this cause that death
results in judicial hanging.

In lesions between the _fifth cervical and first thoracic segments
inclusive_, all four limbs are paralysed. Sensation is lost below the
second intercostal space. The parts above this level retain sensation,
as they are supplied by the supra-clavicular nerves which are derived
from the fourth cervical segment (Fig. 205). Recession of the
eyeballs, narrowing of the palpebral fissures, and contraction of the
pupils result from paralysis of the cervical sympathetic. Respiration
is almost exclusively carried on by the diaphragm, and hiccup is
often persistent. There is at first retention of urine, followed by
dribbling from overflow, and sugar is sometimes found in the urine.
Priapism is common. The pulse is slow (40 to 50) and full; and the
temperature often rises very high--a symptom which is always of grave
omen.

[Illustration: FIG. 205.--Distribution of the Segments of the Spinal
Cord.

(After Kocher.)]

When the lesion is confined to the _sixth cervical segment_, the arms
assume a characteristic attitude as a result of the contraction of the
muscles supplied from the higher segments. The upper arm is abducted
and rotated out, the elbow is sharply flexed, and the hand supinated
and flexed (Fig. 206). Sensation is retained along the radial side of
the limb.

[Illustration: FIG. 20