A Case of Broken Neck, 
WITH AUTOPSY. 
BY 
EDWARD O. OTIS, M.D. 
Reprinted from the Boston Medical and Surgical Journal of 
September 15, 1892. 
BOSTON: 
DAMRELL & UPHAM, PUBLISHERS, 
283 Washington Street. 
1892. S. J. PARKHILL & CO., PRINTERS 
BOSTON A CASE OF BROKEN NECK, WITH AUTOPSY. 
BY EDWARD O. OTIS, M.D. 
H. L. W., Jr., a student, seventeen years old, was 
attempting to do the " cut-down " in the gymnasium 
of the institution where he was at school, when he fell 
upon the underlying mattress. This accident hap- 
pened about five o'clock in the afternoon of January 
20th. The " cut-down," as it is called in gymnasium 
parlance, is a simple feat. The performer stands be- 
neath the parallel flying rings, holding them in his 
hands. He swings his feet up so as to throw them in- 
side his hands, and letting go without breaking the 
continuity of the swing, lands upon his feet. It is a 
pretty and not a difficult trick. 
Young W. when about the middle of this manoeuvre, 
fell a distance of about five feet, upon a thick mattress 
lying beneath. He fell at the point of time when his 
head was down and the superincumbent body was 
moving forward with the momentum of the swing. 
The resultant of the two motions was that he struck 
upon his head - the occipital part - and upon his 
knees and elbows. The weight of the body, then, 
bent over the cervical spine on the one hand, while 
the head resting on the mat, held it fixed, on the other. 
The boy weighed about a hundred and twenty-five or 
1 Read before the Surgical Section of the Suffolk District Medical 
Society, May 4, 1892. 2 
thirty pounds, and had a long, slender neck. The 
weight of the body, not the force of the fall, did the 
mischief. 
As one can readily see, no more perfect way of 
breaking one's neck could be devised ; and yet in a 
considerable gymnasium experience I have never seen 
or heard of this or any accident happening in the per- 
formance of this common trick, although it possesses 
this awful possibility. There is no evidence to show 
that the fall was accompanied with any great amount 
of pain. Paralysis was immediate, the patient finding 
it impossible to extricate himself from the peculiar 
position in which he had fallen. He was seen by his 
attending physician, Dr. Nute, of Exeter, N. IL, who 
had him very carefully transported to his room, near 
by, on a stretcher. 
I saw him, together with Dr. G. W. Gay, of this 
city, the next forenoon, seventeen hours after the ac- 
cident. There was complete paralysis below a line 
drawn two or three inches above the nipples. He 
could flex the forearm upon the arm, but could not 
extend it, or make any other movement of arm or 
hand. Respiration was diaphragmatic. There was 
paralysis of bladder and intestines. He could rotate 
the head, but any antero-posterior movement gave 
him pain. There was a tender spot, painful on pres- 
sure, between the fourth and sixth vertebrae. There 
was no sensation in the paralyzed portion of the body. 
He could swallow perfectly well, but could not clear 
his throat. An attempt was made by extension, coun- 3 
ter-extension and manipulation to reduce whatever 
displacement might exist from dislocation or fracture. 
This gave him much pain and was apparently without 
result. Operative interference was not advised. 
I saw him again the next forenoon, January 22d, 
and thenceforward constantly until the end, and made 
another attempt with his attending physician to reduce 
whatever displacement there might be. Extension 
and counter-extension with rotation was tried, and 
twice we heard something snap, which was also 
noticed by the patient, but no results followed. We 
then applied permanent extension from the occiput 
and chin, with a weight of from seven to twelve 
pounds, and counter-extension by elevating the head 
of the bed. This seemed to give him relief and when 
it was discontinued from time to time he often asked 
to have it re-applied. He was given simple liquid 
nourishment, catheterized regularly, and the tympa- 
nites was relieved by a rectal tube kept in situ. An 
ice-bag was placed at the back of his neck. The tem- 
perature was about a degree above normal, the pulse 
62, and the respiration 24. His mind was remarkably 
clear and he was perfectly self-possessed, although he 
realized the gravity of his condition. His fortitude 
for one so young was remarkable ; he expressed him- 
self as having no fear, and showed the greatest care 
and consideration for all about him. Not the slightest 
thing escaped his notice, and he frequently suggested 
little devices for his Own comfort. 
On Saturday, January 23d, the third day after the 4 
accident, breathing became difficult from the accumu- 
lation of mucus. This was removed from the throat 
and larynx by a pair of long placental forceps with 
cotton. Then nitro-glycerine, one-fiftieth of a grain, 
was given, which had a most marvellous effect in 
clearing the lungs with great rapidity. The adminis- 
tration of this drug was continued every three or four 
hours up to the time of his death. Brandy and aro- 
matic spirits of ammonia were also given from time to 
time. On Saturday afternoon dissolution seemed im- 
minent, but the heroic determination of the patient to 
live until his mother arrived from the West, together 
with the happy effect of the nitro-glycerine, seemed to 
be the factors in averting imminent death. On Sun- 
day, January 24th, the fourth day after the accident, 
the temperature arose to 102°, the pulse to 96, and 
the respiration to 40. By trying to breathe as gently 
and quietly as possible he seemed to keep the collection 
of mucus at a minimum. He would sleep an hour or 
two at a time. Now and then for a moment he would 
be delirious. On Monday, the fifth day, the tempera- 
ture went up to 104° in the afternoon, the respiration 
varied from 40 to 44, and the pulse from 98 to 112, 
and at times would become very weak. Death took 
place early Tuesday morning, the sixth day after the 
accident. 
An examination was made of the spine in the 
cervical region, nine or ten hours after death. Drs. 
W. T. Bull of New York, Symington of Sante Fe, 
New Mexico, Perry and Nute of Exeter, N. H., being 5 
present. The space between the atlas and atloid 
seemed to be unusually wide, but the ligaments were 
not torn. Neither did there appear to be any rupture 
of the various ligaments anywhere in the part of the 
spinal column examined. A fracture of the lamina of 
the fifth or sixth cervical vertebrae was found, but no 
displacement. Neither was there a dislocation any- 
where. On opening the spinal canal over the seat of 
fracture the dura was moderately injected and the 
spinal cord was found to be soft and diffluent. The 
bodies of the vertebrae were in place. If a dislocation 
or displacement occurred at the time of the accident it 
is probable that it immediately righted itself. The 
cord, however, was probably crushed and irretrievably 
damaged at the moment of the accident, remembering 
that the paralysis was immediate. In the light of the 
autopsy no operation could have accomplished any- 
thing, thus verifying Moullin's statement2 that " in 
cases of fracture by indirect violence, the operation of 
trephining offers little or no hope. It is probable that 
in the majority of cases the cord is only subjected to 
momentary compression, but yet it is so reduced to a 
pulp that recovery of function very rarely follows." 
Such a case as this, however, is a most trying and 
unpleasant one for the surgeon, for, as Dr. Gay re- 
marked, his inclination is to attempt some operative 
interference, but his judgment opposes it. The length 
of time the patient survived such an injury is remark- 
able and unusual I think. Operation in case of injury 
2 Treatise on Surgery, 1891, p. 661. 6 
of the spine has been recommended since the time of 
Ambrose Par6, and lias been not infrequently done in 
suitable cases, not, however, with great success. I will 
only refer the reader to the most exhaustive review 
and discussion of the subject I am aware of, by Dr. J. 
William White, in a paper read before the American 
Surgical Association, last Septenber, in Washington, 
and published as a reprint from the Therapeutic Ga- 
zette of October 15, 1891. In the American Journal 
of the Medical Sciences for April, 1892, p. 395, Church 
and Eisendrath of Chicago report cases of spinal cord 
surgery.  THE BOSTON 
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