he tearing of the cord persist.

The _prognosis_ is generally favourable, but must be guarded, as
permanent organic changes in the cord may take place, causing a
spastic condition of the muscles. When recovery is taking place the
first signs are the return of the knee-jerks, and a gradual change in
the limbs from the flaccid to the spastic condition. Sensibility
returns in the order--touch, pain, temperature, and the parts supplied
by the lowest sacral segments usually become sentient first. Voluntary
power returns earlier in the flexors than in the extensors, and
flexion of the toes is almost invariably the earliest voluntary
movement possible. Infection from bed-sores or from the urinary tract
is the most common cause of death in cases that terminate fatally.

The _treatment_ is carried out on the same lines as for total lesions.
Laminectomy, however, is indicated when there is reason to believe
that the pressure is due to some cause, such as a blood-clot or a
displaced fragment of bone, which is capable of being removed.

In practice when a person has lost the power of the lower extremities
as the result of an accident, there are three conditions requiring
ultimate differentiation--a concussion of the cord alone, a total
transverse lesion and a partial lesion of the cord together with
concussion. It must again be emphasised that it may not be possible to
differentiate between these immediately after the accident. Two or
three days may elapse before it is possible to give a definite
opinion.

"#Railway Spine.#"--This term is employed to indicate a disturbance of
the nervous system which may develop in persons who have been in
railway accidents, but a similar group of symptoms is met with in men
engaged in laborious occupations such as coal-miners, who, after an
injury to the back, develop symptoms referable to the nervous system
on account of which they claim compensation not infrequently in the
law-courts. It is a remarkable fact that it seldom occurs in railway
employees, or in passengers who sustain gross injuries, such as
fractures or lacerated wounds.

_Clinical Features._--The patient usually gives a history of having
been forcibly thrown backwards and forwards across the carriage at the
time of the accident. He is dazed for a moment and suffers from shock
or, it may be, is little the worse at the time, and is able to
continue his journey. On reaching his destination, however, he feels
weak and nervous, an