Treatment.  What to do First.—­Put the patient to bed without any pillow, and put around his body hot water bottles or bags, suitably covered.  He should be kept quiet and free from excitement, and sleep should be encouraged.  Hot water or ice water, when awake, as is most agreeable to the patient, may be given.  Aromatic spirit of ammonia, during the shock is better for the patient to take than alcohol, for alcohol excites the brain; dose, one-half to two drams; the former can be given every ten minutes in a little water for about three doses.  Surgical treatment may be necessary at any time.

Injuries of the spinal cord.  Concussion of the Spine.—­A severe jarring of the body followed by a group of spinal symptoms supposed to be due to some minute changes in the cord, of an unknown nature.

Causes.—­Severe concussion may result from railway accidents or violent bending of the body, fall from a house, blow on the back, jumping, etc.

Symptoms.—­May come on suddenly, when it is due to a jar of the brain as well as the cord.  Loss of consciousness, complete paralysis, small pulse, collapse, and within a few hours death may follow.  In other cases improvement, though very slow, follows.  Walking is difficult and the upper extremities are weak in these cases.  There are pain and tenderness along the spine.  Brain symptoms, such as headache, dizziness and fainting, may be present or absent.

Treatment.—­Absolute rest from the beginning, stimulants if necessary, electricity is useful.

Traumatism of the cord. (Blows, etc.).—­(Fractures and dislocations, gunshot and stab wounds, etc.).

Symptoms.—­They differ according to the place where the cord is injured.  The motion and feeling power may be disturbed.  There may be sudden complete paralysis of the upper and lower extremities depending on how severely the cord is injured, and how high up the injury is.  The bladder and rectum may not act properly.  The contents may be retained or “run-away.”  Death follows sooner or later if the injury is extensive.  In some cases the symptoms are slight in the beginning, but increase in a few days, or they may suddenly increase a few months afterwards.  In other cases, bad symptoms at first may gradually abate which is due to the blood clot having been absorbed.

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Recovery depends upon the extent of the injury and the constitution of the patient.  It is always well to be careful about expressing an opinion about this injury.

Treatment.  Immediate.—­Surgical treatment is necessary.  Absolute rest is a necessity, and must be had for weeks according to the severity of the case.  It may seem long and become tedious, but the case must have rest for a long time.

Organic diseases of the spinal cord.  Caisson Disease; Divers’ Paralysis.  Causes.—­This affection occurs in divers, bridge builders, and others who are subject to increased atmospheric pressure.  The symptoms develop on coming suddenly to the surface when the atmospheric pressure is greatly lessened.