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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    from a careful consideration of the details of Collins’ case, and inspection of the injured parts; I have obtained his permission to make the following statement:— The operation was performed on June 3rd, two months after the accident, and in the same region as in my case. I now write on July 22nd. Just seven weeks, therefore, have elapsed since the operation. Of the wound not so much as half-an-inch in length remains unhealed; a minute portion of bone (weighing nearly two grains) came away; no abscess formed; in fact Mr. Shaw’s appalling predictions have not been realized. Motion is in an appreciable degree restored in the lower limbs; sensation has improved; a bed sore which had formed on the back, not larger than half-a-crown, is well; the urine which before the operation was alkaline, containing blood, and copious muco-purulent deposit, and very offensive, is now almost natural in colour, and has been for the last month per- sistently acid; power over the bladder is restored. The patient’s appearance is much improved, and his appetite is good. Mr. Harman, one of the resident clinical clerks in the Whitworth Hospital, has copied from his note book the following, showing the condition of the urine and bladder succeeding the operation:— Fourth day after operation.—Urine became acid. Fifth day after operation.—Urine again alkaline, scalds him in passing. Eleventh day.— Had a motion from the bowels, of the passage of which he was perfectly conscious, but unable to control. Urine since last date alkaline, drawn off with catheter. ^ Fourteenth day.—Urine when drawn off, acid, and quite free from blood. Sixteenth day.—Urine slightly alkaline, and continued neutral for three days when it became acid, and has remained so since (now a month). Twenty-sixth day.—Can eject the urine from the bladder; and since the beginning of July the power over the bladder is such as to force the water strongly against the side of the vessel in a full stream, and on one occasion to a distance of between two or three feet; urine persistently acid. The catheter is no longer necessary. Of course I need not say that as regards the life of this patient, the improvement in the urine, bladder, bed sore, and, I may add, the state of the penis, is by far more important than the return of sensation or any return of motor power.