On fractures and dislocations of the vertebral column.

  • Hulke, J. W.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: On fractures and dislocations of the vertebral column. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    34/66 (page 30)
    may not be doubted. I should not refer to so obvious a subject had I not frequently witnessed in practice, under the false security of a sujoposed strict antisepsis, such a want of exactitude of observance of details of (chemical) cleanliness as necessarily compromised the patient. In daily bed-side work the exactitude which characterises a chemical laboratory may not always, or even usually, ])e attainable, but it should, none the less, ever be our aim. Operative procedures, undertaken in the injuries we are considering, are of two kinds. One category comprises manipulations adapted to the reduction of dislocations and displacements of fragments, the other includes various cutting measures, designed for the removal of pressure conceived to be made on the spinal cord by dislocated or by displaced pieces of fractured vertebrae, either by replacing these in their normal positions, or by their complete removal. When, in any case, the signs of dislocation are obvious on inspection, or are recognisable by touch (even though the co-existence of fracture cannot be excluded), the question of attempting reduction will require instant consideration and decision. My own experience in this subject (as must be that of any single individual) is necessarily very limited. Only in a very few instances have the local circumstances appeared to me sufficiently clear to warrant an attempt at reduction^ and only in one case did this appear to be beneficial. It need scarcely be added that every such attempt sliould be conducted with the greatest gentleness, and no attempt should be under- taken without a previous clear conception of the relations of the presumably dislocated parts, and of the mechanics of the displacement; it should ever be borne in mind that the risk of inflicting additional injury on the spinal cord is very real. ^ As regards cutting procedures for the removal of