In the preparation of this brief report of a series of seventeen cases of shell fracture of the spine as observed at the Walter Reed General Hospital, the subject was approached with a full realization of the period of time that necessarily elapsed between the inflicting of the wound and our first clinical view, connoting the transition from the primary stage of spinal shock with depression and retention to the succeeding stages usually characterized as the stages of: (1) paradoxical, or passive incontinence; (2) periodic reflex micturition, or active incontinence, and (3) paralytic or complete incontinence, in which latter phase evacuation of the urinary bladder is continuous, automatic and complete.
It was in these later stages, with their bewildering array of signs and symptoms, that the cases first came to our attention, and it is on these phases only that we feel entitled to make comment, our primary approach having
PLAGGEMEYER HW. SHELL FRACTURES OF THE SPINEWITH OBSERVATIONS ON KIDNEY AND BLADDER FUNCTION. JAMA. 1919;73(21):1599-1606. doi:10.1001/jama.1919.02610470035011