The hysterical element in orthopædic surgery / by Newton M. Shaffer.

  • Shaffer, Newton M. (Newton Melman), 1846-1928.
Date:
1880
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Licence: Public Domain Mark

Credit: The hysterical element in orthopædic surgery / by Newton M. Shaffer. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    I would not make extended comment had not the error in diagnosis been committed by one whose opinion in such matters is generally accepted as authoritative. 1st. It has been stated again and again by various writers that superficial tenderness over the vertebrae is in- dicative of disease of the spine—a statement which other writers contradict.'^ The truth is that this localized ten- derness does exist in many cases of true vertebral caries, but it is frequently developed by the surgeon at his examina- tion, and has no real connection with the lesion. There is this difference between the tenderness of the sub-cutaneous tissues in Pott's disease and the hyperaesthesia of neuro- mimesis. In the former it is rarely made the subject of complaint by the patient, and, as before stated, is often de- veloped by the surgeon at his examination—while in the latter condition it is one of the very first of which the pa- tient speaks. The neuromimetic fastens on any abnormal sign—often of the most trivial character and exaggerates its importance ; the victim of Pott's disease has enough to engage his attention without searching for superficial tender spots. 2d. It may be safely asserted that perfectly normal move- *For example : C. B. Radcliffe, M.D., F. R. C. P., in Reynold's System of Medicine (vol. ii, p. 718, Article, Caries of the Vertebral Column,) describes among other symptoms of this disease a feeling of undue heat, or even burn- ing in the weak and painful and prominent part, which is not felt in other parts of the spine, when a sponge soaked in moderately hot water is passed down the spine—a state of tenderness on pressure or concussion, which is equally restrict- ed to the same weak and painful and prominent part. On the other hand, Skey, in the valuable work already quoted, (p. 56), deals thus forcibly with these symptoms : Of all the fallacies that cling to professional practice, of all the false doctrines which the pardonable ignorance of a former generation has en- tailed on modern surgery, none can surpass that which affects to detect a carious disease of the body of a vertebra by drawing the fingers down the spine. Again, p. 55, he says : Fifty or sixty years ago, a provincial surgeon of some note recommended the application of a hot sponge to the spine with a view to detect disease of the bodies of the vertebra—there was some excuse for ignor- ance then—there is none now. My own experience leads me to wish that Skey's statements might find a place in every work on surgery. The frequency with which one hears the remark There is tenderness over the vertebra, proves that faith in this sympt&m as diagnostic of vertebral caries is still wide- spread. In true disease it has no significance whatever as a symptom of actual disease of the bone.