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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    distingiiisli, Avith precision, heat and cold, and also pricking Avith a point. There is no difference in these respects between one limb and the other; in each foot sensibility is much impaired, and the sole of each is dcAmid of feeling altogether. Operation,—I operated on February 3rd, 1865. My colleagues, Drs. Hughes, Stapleton, Banon, Tyrrell, and Forrest were present. Dr. BroAvn-Sequard Avas also present, and many surgeons of Dublin. The patient Avas not removed from the ward or from the bed on Avhich he lay. This was in order, as far as possible, to avoid dis- turbing any callus Avhich might possibly have already formed. He Avas put under the influence of chloroform as he lay on his back in his accustomed position; Avhen chloroformed, the bed Avas car- ried opposite to the Avindow. The patient Avas turned over on his face; in this position the seat of the injury Avas obvious from the prominence of the last (?) dorsal vertebra. A small spot of ulceration, not so large as a sixpence, existed over the most pro- minent spinous process at this part. An incision, nearly five inches long, was made with a strong sc'alpel over the spinous processes of the vertebra3 (the last tAvo dorsal and first two lumbar) ; then, Avith a strong curved bistoury, the slips of tendon on each side of the spines Avere divided. Keeping quite close to the bone the mass of muscle Avas detached on each side, and securely held apart by broad retractors, Avell suited for the pur- pose. The spinous processes, and laminge, in fact, the back of each vertebra as far out as the articulating process were thus fairly and fully exposed. The spine of each exposed vertebra was then taken hold of in a strong pair of necrosis forceps, and cautiously but firmly shaken to try Avhether any fracture of the posterior arch, or of the processes could be detected. No such fracture existed. (This I expected, as I had reason to suppose from the nature of the injury, that if any fracture existed it Avas one of the body of the vertebra). On examination I Avas satisfied of the displacement existing in the parts Avith Avhich I had to do; it Avas as follows:—The last dorsal vertebra (?) Avas as it were tAvisted, so that on the left side the inferior articulating process was raised up, and although not com- pletely dislocated, yet it stood prominently backward from the corresponding process on the bone below; on the right side the superior articulating process of the same vertebra was in exactly the opposite predicament; it was displaced so as to be as if pushed in deeper than the process to which it corresponded on the vertebra above.