按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！
There are several instances on record of tolerance of foreign bodies in the skin and muscles of the back for an extended period。 Gay speaks of a curious case in which the point of a sheath…knife remained in the back of an individual for nine years。 Bush reported to Sir Astley Cooper the history of a man who； as he supposed； received a wound in the back by canister shot while serving on a Tartar privateer in 1779。 There was no ship…surgeon on board； and in about a month the wound healed without surgical assistance。 The man suffered little inconvenience and performed his duties as a seaman； and was impressed into the Royal Navy。 In August； 1810； he complained of pain in the lumbar region。 He was submitted to an examination； and a cicatrix of this region was noticed； and an extraneous body about 1/2 inch under the integument was felt。 An incision was made down it； and a rusty blade of a seaman's clasp…knife extracted from near the 3d lumbar vertebra。 The man had carried this knife for thirty years。 The wound healed in a few days and there was no more inconvenience。
Fracture of the lower part of the spine is not always fatal； and notwithstanding the lay…idea that a broken back means certain death； patients with well…authenticated cases of vertebral fracture have recovered。 Warren records the case of a woman of sixty who； while carrying a clothes…basket； made a misstep and fell 14 feet； the basket of wet clothes striking the right shoulder； chest； and neck。 There was fracture of the 4th dorsal vertebra at the transverse processes。 By seizing the spinous process it could be bent backward and forward； with the peculiar crepitus of fractured bone。 The clavicle was fractured two inches from the acromial end； and the sternal end was driven high up into the muscles of the neck。 The arm and hand were paralyzed； and the woman suffered great dyspnea。 There was at first a grave emphysematous condition due to the laceration of several broken ribs。 There was also suffusion and ecchymosis about the neck and shoulder。 Although complicated with tertiary syphilis； the woman made a fair recovery； and eight weeks later she walked into a doctor's office。 Many similar and equally wonderful injuries to the spine are on record。
The results sometimes following the operation of laminectomy for fracture of the vertebrae are often marvelous。 One of the most successful on record is that reported by Dundore。 The patient was a single man who lived in Mahanoy； Pa。； and was admitted to the State Hospital for Injured Persons； Ashland； Pa。； June 17； 1889； suffering from a partial dislocation of the 9th dorsal vertebra。 The report is as follows〃He had been a laborer in the mines； and while working was injured March 18； 1889； by a fall of top rock； and from this date to that of his admission had been under the care of a local physician without any sign of improvement。 At the time of his admission he weighed but 98 pounds； his weight previous to the injury being 145。 He exhibited entire loss of motion in the lower extremities； with the exception of very slight movement in the toes of the left foot； sensation was almost nil up to the hips； above which it was normal； he had complete retention of urine； with a severe cystitis。 His tongue was heavily coated； the bowels constipated； and there was marked anorexia； with considerable anemia。 His temperature varied from 99 degrees to 100 degrees in the morning； and from 101 degrees to 103 degrees in the evening。 The time which had elapsed since the accident precluded any attempt at reduction； and his anemic condition would not warrant a more radical method。
〃He was put on light； nourishing diet； iron and strychnin were given internally； and electricity was applied to the lower extremities every other day； the cystitis was treated by irrigating the bladder each day with Thiersch's solution。 By August his appetite and general condition were much improved； and his weight had increased to 125 pounds； his temperature being 99 degrees or less each morning； and seldom as high as 100 degrees at night。 The cystitis had entirely disappeared； and he was able； with some effort； to pass his urine without the aid of a catheter。 Sensation in both extremities had slightly improved； and he was able to slightly move the toes of the right foot。 This being his condition； an operation was proposed as the only means of further and permanent improvement； and to this he eagerly consented； and； accordingly； on the 25th of August； the 9th dorsal vertebra was trephined。
〃The cord was found to be compressed and greatly congested； but there was no evidence of laceration。 The laminae and spinous processes of the 8th and 9th dorsal vertebrae were cut away； thus relieving all pressure on the cord； the wound was drained and sutured； and a plaster…of…Paris jacket applied； a hole being cut out over the wound for the purpose of changing the dressing when necessary。 By September 1st union was perfect； and for the next month the patient remained in excellent condition； but without any sign of improvement as to sensation and motion。 Early in October he was able to slightly move both legs； and had full control of urination； from this time on his paralysis rapidly improved； the battery was applied daily； with massage morning and evening； and in November the plaster…of…Paris jacket was removed； and he propelled himself about the ward in a rolling chair； and shortly after was able to get about slowly on crutches。 He was discharged December 23d； and when I saw him six months later he walked very well and without effort； he carried a cane； but this seemed more from habit than from necessity。 At present date he weighs 150 pounds； and drives a huckster wagon for a living； showing very little loss of motion in his lower extremities。〃
Although few cases show such wonderful improvement as this one； statistics prove that the results of this operation are sometimes most advantageous。 Thorburn collects statistics of 50 operations from 1814 to 1885； undertaken for relief of injuries of the spinal cord。 Lloyd has compiled what is possibly the most extensive collection of cases of spinal surgery； his cases including operations for both disease and injury。 White has collected 37 cases of recent date； and Chipault reports two cases； and collected 33 cases。 Quite a tribute to the modern treatment by antisepsis is shown in the results of laminectomy。 Of his non…antiseptic cases Lloyd reports a mortality of 65 per cent； those surviving the operation are distributed as follows： Cured； one； partially cured； seven； unknown； two； no improvement； five。 Of those cases operated upon under modern antiseptic principles； the mortality was 50 per cent； those surviving were distributed as follows： Cured； four； partially cured； 15； no improvement； 11。 The mortality in White's cases； which were all done under antiseptic precautions； was 38 per cent。 Of those surviving； there were six complete recoveries； six with benefit； and 11 without marked benefit。 Pyle collects 52 cases of spinal disease and injury； in which laminectomy was performed。 All the cases were operated upon since 1890。 Of the 52 cases there were 15 deaths （a mortality of 29。4 per cent）； 26 recoveries with benefit； and fiv