Case of fracture of the spine, in which the operation of trephining was performed : with observations / by Robert M'Donnell.

  • McDonnell, Robert, 1828-1889.
Date:
1865
Catalogue details

Licence: Public Domain Mark

Credit: Case of fracture of the spine, in which the operation of trephining was performed : with observations / by Robert M'Donnell. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    made after the operation. In Oldknows’ case, and indeed in Hol- scher’s, the dura mater was thickened, and the pia mater of the cord vascular; in Meyer’s case the spinal marrow was softened; as how- ever, in my own limited experience, I have seen three patients, not operated on, carried off in great suffering by suppurative meningitis, the whole cord being bathed in pus; I must rather incline to the opinion that trephining tends more to prevent meningitis than to cause it. Those surgeons who are opposed to the operation of trephining the spine are of course anxious to show that cases of fracture of the spine are not in all instances fatal; and it is obvious that before any surgeon Avould be willing to incur the weighty responsibility of recommending this operation to his patient, the very first thing he will do will be to inquire what may be the probable chances for life in cases left without operative interference. We have not, unfortunately, anything like accurate statistical information on the subject. It is well known, however, that recovery under such circumstances is extremely rare: as Jones observes, in common par- lance, when it is said that a man has broken his back it is generally regarded as synonymous with his having met his death. Mr. Shaw mentions two cases of recovery: the first is that of a patient who recovered (with paralysis remaining) from fracture in the dorsal region, and Avho was seen by him in perfect health otherwise, more than twelve years after the accident. The second is that of a man who had fracture and paralysis in his youth,- who shortly after- .wards recovered sensation, and the power of motion in his limbs, so as to be able to follow an active occupation, who, after a period of seventeen years, had a return of the paraplegia, and lingering for five years in that condition, died under the observation of Mr. Shaw, who had the opportunity of examining the body. He narrates also a very remarkable case communicated to him by Mr. Page, of Carlisle, in which a gentleman, twenty-six years of age, survived, for nearly fifteen months, an injury of the fifth (or fourth ?) cervical vertebra, the body of which was broken, almost severing the spinal marrow. Cases such as that detailed by Mr. Hilton, in which a patient with fracture of the cervical vertebrae, accompanied by complete paralysis of the arms, legs, bladder, and rectum survived for fourteen years; or Mr. Phillips’® well-known case of fracture of the “ Medico-Chirurgical Transactions, Vol. xx., p. 78.