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Am J Psychiatry 1942;98:533-537.
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1. The considerable percentage of vertebral fractures in the middorsal region during metrazol convulsions can be reduced to a great extent by appropriate chemical or, better, simple mechanical means.2. Reexamination of eight patients who had severe multiple fractures two years ago, showed no orthopedic or neurological signs of progressive pathology.3. In electric shock therapy, even without precautions, these fractures are considerably less frequent. By applying an improved technique of extreme hyperextension, they can be avoided as was shown in 60 cases.4. Seizures in epilepsy do not produce vertebral fractures in the middorsal region as demonstrated by a series of 42 epileptic patients. Fractures in other regions of the spine occur occasionally but they are of a different type and not comparable to the fractures in convulsive treatment.5. Vertebral fractures in tetanus have the same localization, about the same frequency and multiplicity as those sustained in metrazol convulsive therapy done without precautions.6. The varying frequency of vertebral fractures in the various convulsive conditions is explained by differences in the onset of the convulsion.7. No contraindication against shock treatment can be seen in these fractures which can be largely avoided and which, if they do occur, have no clinical importance.

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