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May 28, 1910


JAMA. 1910;LIV(22):1783. doi:10.1001/jama.1910.92550480001001k

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Because of the rather unusual character of the injury I am constrained to report this case.

History of Injury.  —In a scuffle between two women on a porch one was thrown, striking the back of her neck against the baluster rail. The rail gave way and she fell some four feet to the ground on her head. She was picked up helpless and carried to her room. A couple of hours afterward I saw her.

Examination.  —Total paralysis existed below a line extending from the top of the shoulders across the chest about two inches below the clavicle. She could move her head from side to side, forward and backward movement being somewhat impaired. She could elevate the shoulders and clavicle only slightly. There was slight tenderness on pressure over the region of the fourth cervical vertebra. Otherwise the patient had no pain anywhere. No fracture or dislocation of the vertebrö could

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