Selected Monographs.

  • New Sydenham Society.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Selected Monographs. Source: Wellcome Collection.

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

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    flattened out, and under the altering statical conditions undergo such transformation ; in one word, as the origin of the lesion, we look on an injury which does not break the bone (the lesion may be quite different), but which inflames it, softens it, and allows all that metamorphosis to take place. Now it is not true that the deformation or dislocation must be an immediate result of the fracture. It might, but by no means must be so. Indeed many a dislocation occurring after fracture is secondary, due to internal or external influence, muscular tension, strain during the process of repair, or some similar cause, the power of the fall or blow, or whatever it may be, having exhausted itself on the resistance of the bone, or a dislo- cation of the broken fragments may not happen till some time after a fracture, and we know that dislocations and deformities which would perhaps not have occurred if the cure had been left to nature, are not infrequently caused by improper bandaging. So in olisthesis the injury, or fall, causes the fracture, and then the predisposition to olisthesis, due to the weight of the body, necessitates the deformity, or rather the deformation. That from the alteration in the statical conditions or deformation, as well as in consequence of the fracture, infraction, or other injury itself, a chronic inflammatory condition of the bones does arise, and plays a certain part in the olisthesis, is self-evident, and has never been denied. But this inflammatory condition is always secondary, and therefore is not the cause of the spondyl- olisthesis, but is only a process accompanying it, and is like it, a result of the injury; the spondylolisthesis itself is therefore due to the injury. However, Herrgott himself says this chronic inflammatory condition, put forward as the controlling cause, is a result of the injury. The difference, therefore, between Herrgott's view and my own is only that he looks upon a chronic inflammatory condition of the vertebra, itself due to an injury, as that primary cause, which I find in the injury itself, for without the latter that primary chronic inflammatory condition would never have existed. It is essentially a difference in words only, for Herrgott, with whom I had an opportunity of conferring personally in Nancy not long ago about it, explained to me that in distinguishing between spondylizema and spondylolisthesis he had not intended to insist