On the advantage and applicability of the prone position, in diseases and injuries of the spine, malformations of the chest, hips, &c. : Read at the Westminster Medical Society, May 21, 1836 / by Charles Verral.
- Verral, Charles, -1843.
- Date:
- 1836
Licence: Public Domain Mark
Credit: On the advantage and applicability of the prone position, in diseases and injuries of the spine, malformations of the chest, hips, &c. : Read at the Westminster Medical Society, May 21, 1836 / by Charles Verral. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
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![this case was not so favourable as I could have wished. The girl went to service, pro- bably too soon, probably in too laborious a situation. In three years she again applied to me ; the spine had given way, and a large abscess had formed in the neighbourhood, which, however, I hoped, was not connected with a diseased state of the vertebra. The result proved my opinion to be correct. I placed her again upon the couch, and opened the abscess. She seemed to be going on well, when, by one of those changes so frequently occurring, in rural districts es- pecially, so derogatory to the profession and detrimental to the poor patients themselves, the attendance of the paupers of that parish passed out of my hands into those of another medical person, who, in utter ignorance of my plans and of my motives, in utter igno- rance of the former history of the case, abruptly dismissed the couch, placed her in bed, in which I heard also she was allowed to lie pretty much as she liked ; and though she ultimately recovered her health, she was left with a considerable degree of defor- mity. But amongst the greatest triumphs of the phone position I must call your at- tention to two cases, which are at present under my care. The first is that of a poor little girl, aged about four years, the child of parents in the lowest state of poverty; the father having for many years laboured under a painful and apparently incurable disease, though he had become the progenitor of nearly a dozen children. I mention this, to account in some measure for that negligence on the part of the parents, which allowed a disease of so much importance to proceed so far, without having consulted any medical person on the subject. When I saw the child I found a posterior curvature of the dorsal vertebrae, terminating upwards in an acute angle, from whence the cervical ver- tebra advanced suddenly forwards, so that the neck seemed to be completely buried and lost, and the head to rest absolutely on the shoulders. There was paralysis of the lower extremities, excessive emaciation, a tense and tumified abdomen, great contrac- tion of the chest, cough, dyspnoea, palpita- tion of the heart, depraved appetite, extreme debility, and fever, apparently of a hectic character. This child was placed upon the couch about a year since, and a very consi- derable improvement was speedily perceived, not only in the shape of the spinal column, but also in her general health ; which im- provement has progressively advanced up to the present time, although the want of sound and sufficient nutriment, as well as of care and cleanliness, evils incidental to the poverty and the large young family of the parents, have rendered this one of the most unfavourable cases I have ever had to attend to. My other patient was more fortunate; tor though the daughter also of poor parents, she resided in the vicinity of Firle Place, the seat of Lord Gage, to whom, and to Lady Gage, the child has been indebted for the nourishment which at one time was con- sidered indispensably necessary for her sup- port. This case I did not see until it had existed a very long time ; nor until it had advanced so far as to be incapable of a per- fect cure. There had been disease of the bodies of several of the lumbar and dorsal vertebra ; abscess had formed ; matter, toge- ther with portions of bone, had made its way out at the groins, and through two or three openings in each of the thighs. She had been long under the care of the parish surgeon, who, apparently despairing of the case, had not recently thought it necessary to pursue any particular medical treatment. In spite, however, of all these unfavourable circumstances, her parents had fancied that about two or three weeks before I saw her an evident change for the belter had taken place in her health ; in which they were pro- bably not deceived, as anchylosis had begun to take place amongst the diseased bones, indicating, as I conceive, the existence of more healthy action. The distortion, how- ever, still continued to increase ; and, to use the expression of her mother, she grew shorter and shorter every day. I found her creeping about, though with much difficulty, supported upon one crutch, and that a great deal too short. She was exceedingly ema- ciated ; the body was bowed forward so as to approach to a semicircle ;—the countenance had assumed the appearance of old age ; and she was not, at eleven years of age, equal in height to many a child of five or six. On examination, I found an immense protube- rance on the middle of the back, forming at its apex a very acute angle, at least four inches without the natural line of the spinal column. In consequence, however, of the bowing forward of the head and shoulders, the whole spine seemed to be one vast lump of distortion, with this angular protuberance growing out of its centre, like the bump on the back of a camel. There was also consi- derable lateral distortion, the consequence, probably, in great part, of her being allowed to depend upon a single crutch ; and the ribs had been drawn back by the distorted spine, and were involved in, or indeed formed part of, the general deformity behind, while in front they, and even the sternum, were so sunk in, that they were almost buried from the view. This child was placed in the phone position on the 28th of March, 1835, and from it she never has been moved] exeeptflSg that for the last two months I have permitted her to stand sometimes for an hour, supported by two crutches so long that her feet can but just touch the ground. The progress of emendation has been very satisfactory. The discharge soon abated, and has long since entirely ceased. The wounds are cnmnletelv Up.,tort](https://iiif.wellcomecollection.org/image/b28524688_0007.jp2/full/800%2C/0/default.jpg)
