About 680 AD
English translation: The Seven Books of Paulus Aegineta, translated from the Greek, with a commentary
London: Sydenham Society, 1844–1847
Volume 2 of 3, pages 455-456
BOOK 6, SECTION 98. ON THE VERTEBRAE, SPINE OF THE BACK, AND OS SACRUM.
The round bodies of the vertebrae may sometimes be crushed, but rarely undergo fracture, in which cases the membranes of the spinal marrow or the marrow itself being compressed, sympathetic nervous affections take place, and death speedily follows, more particularly if the vertebrae of the neck be affected. Wherefore, having first given warning of the danger, we must, if possible, attempt to extract by an incision the compressing bone, or if not we must soothe the part by the anti-inflammatory treatment. But if any of the processes of the vertebrae, of which the spine, as it is called, consists, be broken off, it will readily be felt upon examination with the finger, the broken piece yielding and returning again to its position, and, there fore, we must make an incision of the skin externally and extract it, and having united the wound with sutures, pursue the treatment for recent wounds.
When the os sacrum is fractured the index-finger of the left hand is to be introduced into the anus, while with the other we manage as we best can the fractured bone; or if we feel any piece broken off, we make an incision and lay hold of it, and apply bandages and suitable treatment.
Commentary by Adams
Celsus remarks that when a piece of one of' the vertebrae is broken off a hollow is felt in the place, it is attended with pain, and the person is compelled to bend inwards. The treatment is to be conducted upon general principles, as explained under fractures of the scapula.
Albucasis lays it down as a rule that when a fracture of the cervical vertebrae produces paralysis and insensibility of the arms, the case may be abandoned as hopeless. When, after a fracture of the dorsal vertebrae, it is remarked that there is paralysis and insensibility of the lower extremities, and that the alvine and urinary discharges are passed unconsciously, he, in like manner, pronounces the case to be desperate. When a piece of bone is broken off and occasions great irritation, he recommends us, like our author, to make an incision and take it out.
Hally Abbas and Avicenna borrow everything from Paulus.
Rhases gives many curious remarks upon injuries of the spine, but several of them are borrowed from Galen. (De Locis Affectis.) Galen relates many cases to show that retention of the urine and faeces is a common effect of an injury of the spine. He also mentions that loss of speech is sometimes the consequence of the upper part of the spine being injured. Rhases relates the case of a man who lost the sensibility of his arms from an injury of the last vertebra of the neck, produced by a fall from a horse. He states, that when the injury is below the neck the respiration is never affected. He inculcates that whenever there is paralysis of the limbs, or of any part after a fall, it arises from some injury of the spine. (Cont. i.)
When the sacrum or os coccygis is fractured, he directs us to replace the parts by introducing the finger per anum. (Cont. xxix.)