The operative treatment of spina bifida and hydrocephalus / by James H. Nicoll, M.B., Assistant Surgeon, Western Infirmary.

  • Nicoll, James H.
Date:
[1899]
Catalogue details

Licence: Public Domain Mark

Credit: The operative treatment of spina bifida and hydrocephalus / by James H. Nicoll, M.B., Assistant Surgeon, Western Infirmary. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    nerves which caused paralysis of one leg, which has remained permanent. “ To avoid such risk I adopted a plan which, in connection with the demonstration of several cases of cured spina bifida, 1 described to the Glasgow Medico-Chirurgical Society in November, 1897. The method is as follows: “ Flaps of skin and mesoblastic tissues are dissected up in the usual way. The sac is freed and opened. Such portions of it as are free from nerve tissue are excised. The remainder is ‘ cut into ribbons ’—by incisions made from the interior, parallel with the nerve cords incorporated with it—and thoroughly roughened with the point of knife. The ‘ slashed ’ and roughened sac is then placed in the patent spinal canal, over which the flaps are sutured in the usual way. “ In a certain number of cases—two of which have been mentioned above, and two of which (Plates IV. and V.) are described below—I have still further extended the principle and considerably modified the method of this operation, with good results. “ Plate IV.: M. D., shown to the Glasgow Medico-Chirurgical Society in April, 1898, was sent to me, at the age of 5, in 1890, by Dr. Lamont, of Chryston. “ Particulars of case.—Spina bifida tumour 8 by 9 inches across. Complete paraplegia ; constant incontinence of urine : condition of bowel in which obstinate constipation alternated with incontinence of faeces and flatus. “ At that time I operated—opened sac by incision shown in plate—found it so occupied by expanded nerve cords that excision of even small portions appeared impossible. With the knife I carefully tore such small areas as seemed free from nerve tissue, and gently, but pretty thoroughly, roughened the whole interior, including the surface of the nerve cords in many parts, and stitched up. Condition when shown in April, 1898, nearly two years after operation :—Sac replaced by a tough lobulated fibrous mass, shown in plate. This is considerably smaller 1 1 t/
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