Report of clinical cases treated during the session 1859-60 in the surgical wards of the Royal Infirmary under the care of James Spence.

Date:
1861
Catalogue details

Licence: Public Domain Mark

Credit: Report of clinical cases treated during the session 1859-60 in the surgical wards of the Royal Infirmary under the care of James Spence. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    S , we have an instance of such a lesion, with considerable dis- placement, terminating successfully. Judging from the train of symptoms observed, although the displacement and crepitus on movement, left no doubt as to the nature of the injury, it neverthe- less seems pretty clear, that the medulla spinalis must have escaped direct lesion ; for the complete paralysis and other symptoms, at first urgent, gradually passed off, so that after some hours all the formid- able symptoms had disappeared, and in a few days the patient felt so little uneasiness or inconvenience, that it was difficult to make him believe the serious nature of his injury, or get him to keep quiet in bed, and avoid moving his head. It is probable, therefore, that the original urgent symptoms were due either to severe concussion of the cord, or perhaps to a certain amount of direct compression without laceration, the compression being relieved when the patient was placed in bed, with the head supported. For my own part, I incline to the former view, and for this, among other reasons, that there never seemed to be any apparent alteration of the displaced bones, the shortening and bulging forward of the front of the neck, and the irregular depression and prominence felt posteriorly, being as marked, after the bad symptoms had passed off, as they were before. The interest of this case, however, does not terminate with the cure of the primary injury, for, contrary to my wish, he left the hospital on the twenty-fifth day after the accident, saying he felt quite well, and would be very careful of himself at home. I sub- sequently heard he had returned to his work, and on the 11th of March he applied to be i’e-admitted, on account of gradually in- creasing paralysis, which had rather suddenly supervened a few days before. The quick pulse and febrile condition of the patient, together with the difficult respiration and the paralysis affecting parts deriving their nervous supply from above the original seat of injury, led me to infer that secondary changes, the result of irrita- tion and inflammation of the cord and its membranes, were taking place, if, indeed, softening had not actually occurred, and gave me a most unfavourable opinion of the case. Under treatment, how- ever, the bad symptoms again gradually disappeared, and he was finally dismissed cured. The case, independent of other points of interest, is instructive, as encouraging to careful treatment, even in cases all but hopeless, and as showing the necessity for enforcing absolute and prolonged rest and treatment, although the patient or his friends may consider all danger as past. In regard to the fractures of the extremities, I would only re- mark, that the list recorded affords but a very imperfect idea of the number of fractures actually treated, because, except in special cir- cumstances, cases of fractures of the upper extremity are not ad- mitted into the hospital, but are treated as out-patients, and hence, though they come to the hospital, and form subjects of clinical in- struction, no regular records are kept of them.