The surgery of the spine : read before the American Surgical Association at the Congress of American Physicians and Surgeons, Washington, D.C., September 23, 1891 / by J. William White.

  • White, J. William (James William), 1850-1916.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: The surgery of the spine : read before the American Surgical Association at the Congress of American Physicians and Surgeons, Washington, D.C., September 23, 1891 / by J. William White. 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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    That these statements, at least so far as they attribute the paralysis of Pott’s disease to an external pachymeningitis rather than to direct pressure from the bones themselves, are not new ones, a few quotations will demon- strate. Hippocrates, writing of spinal cases, said,— “ The palsy of the legs and arms, the wasting of the body, and the retention of urine happen chiefly in those cases where there is no spinal deformity, nor any projecting bone forward or backward; and paralytic affections take place the least frequently in cases of gib- bous or angular projections.” Mr. Percival Pott, writing in 1720011 “The Useless process is invariably a limited one, the inflammation of the dura mater being restricted exactly to the site of the diseased vertebrae, exhibiting no tendency to extend in the membrane,—nature’s medullary protection; that the medullary surface of the dura mater is almost invariably normal. It follows, then, that the pressure lesion is sim- ply mechanical, possessing no tendency to involve the spinal cord through any inherent specific characters of the carious process—a bland mechanical lesion—and the damage it inflicts is commensurate with the pressure ex- erted. Experimental physiology gives no evidence of an in- flammatory lesion following experimental compression of the cord. A careful examination of the pathological findings of reported cases reveals to us, in the light of recent pathological knowledge, but few instances where we have reason to believe the original lesion to have been inflammatory. These were cases where the process was virulent, leading to a perforation of the dura mater, thus allowing the purulent products to come in direct contact with the cord, giving rise to a lepto-meningitis. Finally, then, Dr. Elliott concludes, our researches have led to the belief that the original lesion is, as a rule, non-infiammatory, an opinion supported by pathol- ogy and experimental physiology, and corroborated by clinical manifestations.