The surgery of the spine / by J. William White.

  • J. William White
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: The surgery of the spine / 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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    tumor. Horsley’s experience in the patient of Dr. Gowers is ample evidence of the unavoidable uncertainty as regards the particular vertebra or vertebrae to be attacked, but there is every prospect that these diagnoses will become more and more scientifically exact in the near future. In the meanwhile I would reler the surgeon who desires carefully to study for himself this side of his cases to the articles referred to below.1 Having arrived at a conclusion and having decided that the probability is in favor of the existence of a tumor, and having also fixed upon its probable seat, the surgeon is confronted with the important question of the advisability of operation, and of its probable result; in other words, with the question of prognosis. All the evidence which we now have points to extraordinary reparative power on the part of a cord which has simply been suffering from compression and to an almost equally remark- able tolerance to operative interference. The material for finely differentiated prognoses can hardly yet be said to exist, but in a general way it is safe to say that the diagnosis of tu- mor (if it be non-malignant) carries with it a reasonably favor- able prognosis, which is strengthened if, in addition the tumor is thought to be extra-medullary. In conclusion I desire briefly to speak of the operation itself, which has been variously described as “ formidable,” “ appalling,” “ well nigh impossible,” “desperate and blind,” and in other similar extravagant terms. In one case the pa- tient is said to have died upon the table from haemorrhage ; in another the operation was abandoned on account of the sup- posed impossibility of its completion. It has not seemed to me that these descriptions are in the least justifiable. The op- eration is, indeed, as was said by Dr. McDonnel, apt to be ’Seguin on Localization of Spinal Lesions, Pepper's System of Medicine, vol. v. p. 77. Starr on the Localization of Functions of the Spinal Cord, Am. Journ. of Neurology and Psychiology, vol. iii, 1889* Gowers, Diseases of the Nervous System, vol. i, p. 142. Thorburn, The Medical Chronicle, April 1889, p. I, and 1 he British Medical Journal, Dec. 22, 1888. Ranney, The Applied Anatomy of the Nervous System, p. 355. Ross, Diseases of the Nervous System, p. 356. Charcot, Localiza- tion of Cerebral and Spinal Disease. Bramwell, Diseases of the Spinal Lord, Mills and Lloyd, Pepper's System of Medicine, vol. v.
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