6.--Attitude of Upper Extremities in Traumatic
Lesions of the Sixth Cervical Segment. The prominence of the abdomen
is due to gaseous distension of the bowel.]

Total lesions of the lower cervical segments are usually fatal in from
two to three days to as many weeks, from embarrassment of respiration
and hypostatic pneumonia.

When the lesion is confined to _the first thoracic segment_, the
attitude of the arms is usually that of slight abduction at the
shoulder and flexion at the elbow, the forearms lie semi-pronated on
the chest or belly, and there is slight flexion of the fingers. There
is complete anaesthesia as high as the level of the second interspace,
and along the distribution of the ulnar nerve (Fig. 205); the
respiration is entirely diaphragmatic; and the ocular changes
depending on paralysis of the cervical sympathetic are present.

_Thoracic Region._--In injuries of the thoracic region--second to
eleventh thoracic segments inclusive--the anaesthesia below the level
of the lesion is complete and its upper limit runs horizontally round
the body, and not parallel with the intercostal nerves. Above the
anaesthetic area there is a zone of hyperaesthesia, and the patient
complains of a sensation as if a band were tightly tied round the
body--"girdle-pain."

The motor paralysis and the anaesthesia are co-extensive. The
intercostal muscles below the seat of the lesion and the abdominal
muscles are paralysed. The respiratory movements are thus impeded,
and, as the patient is unable to cough, mucus gathers in the
air-passages and there is a tendency to broncho-pneumonia. As the
patient is unable to aid defecation or to expel flatus by straining,
the bowel is liable to become distended with faeces and gas, and the
meteorism which results adds to the embarrassment of respiration by
pressing on the diaphragm. There is retention of urine followed by
dribbling from overflow. As the reflex arc is intact there may be
involuntary and unconscious micturition whenever the bladder fills.

If infection of the bladder and the formation of bed-sores are
prevented, the patient may live for months or even for years. At any
time, however, infection of the bladder may occur and spread to the
kidneys, setting up a pyelo-nephritis; or the patient may develop an
ascending myelitis, and these conditions are the most common causes of
death.

_Lumbo-sacral Region._--All the spinal segments representing the
lumbar, sacral, and coccyg