Pottawatomie

“ The most difficult parts to dissect are the organs connected with the mouth and rostrum. It is best to remove the head and transfix it with the left-hand needle, then to scalp the head by removing the dorsal half of the chitinous carapace. A bold plunge with the right-hand needle will sometimes effect what is desired. A pull on the labium will sometimes bring out the pharynx. It must be confessed that successful dissections are often obtained more by good luck than by skilful management. The use of dilute potash solution facilitates the study of chitinous parts by jellifying the muscles. ”

“ Occasional cases are seen in which Nature has stopped the spread of the disease by walling off the morbid area with exostosis. Such cases should not be adjusted, and the disease may remain latent through a long life. When active the disease proves fatal unless checked, which is possible in the earlier stages, and becomes impossible when the vertebral bodies are too fragile to stand strong adjustments. Discernment in case-taking will avoid any fatalities under adjustment, but by no means all cases of Potts’ Disease are curable. ”

“ Percival Pott, in 1779, first described a disease of the vertebral column which is characterised by erosion and destruction of the bodies of the vertebræ. It is liable to produce an angular deformity of the spine, and to be associated with abscess formation and with nervous symptoms referable to pressure on the cord. This disease is now known to be tuberculous. It may occur at any period of life, but in at least 50 per cent. of cases it attacks children below the age of ten and rarely commences after middle life. ”

“ The pain and contracture sometimes even suggest a suboccipital Pott’s disease. This form of hysterical pseudotetanus is of sudden onset, as a rule following burial in a trench or else contusion, or a slight wound in the cervical region. Pressure on the spinous processes produces no pain, nor does a blow upon the head ”

“ This, on the whole, is the most important contribution by Pott to the surgical practice of the last century. Dr. Hamilton, the greatest American authority on the subject of fractures and dislocations, writing in 1884, says that ‘the work is distinguished for the originality and boldness of its sentiments, and was destined soon to revolutionise, especially throughout Great Britain, the old notions as to the treatment of fractures, and to establish in their stead, at least for a time, what has been called, not inappropriately, “the physiological doctrine.” ”

“ Among the various symptoms of Pott's disease of the spine, fixed pains in one side of the trunk, in one thigh, or in the upper occipital region, etc. is a sign against which the physician should always be on his guard, as it is a very early and valuable indication of the existence of an affection which requires special treatment as soon as a diagnosis can be made. ”

“ His graduation thesis on the human skeleton treated especially of the formation and development of bone, and attracted no little attention. It is noteworthy because of the breadth of view in it, for it touches on the various questions relative to osteology, from the standpoint of physics and chemistry, as well as medicine and surgery. It was sufficient to obtain for its author the place of lecturer in anatomy in the University of Bologna, besides the post of director of the teaching of anatomy in the Institute of Sciences, a subsidiary institution. ”

“ He was the first surgeon of his day, and a scientific writer remarkable for the classic purity of his style, the scrupulous precision of his definitions, and the unerring closeness of his argument.’ Pott appears to have done for surgery what Glanville did for science: he introduced a wholesome scepticism. He always professed the utmost respect for the early writers on the art of surgery, and read their voluminous works with diligence; yet in his practice he relied entirely upon his own observations, and was guided by his common sense. ”

“ On account of the increase in his practice and his impaired health, he now obtained the services of Home as his assistant at St George’s Hospital. The death of Pott in December 1788 secured to him the undisputed title of the first surgeon in England. He resigned to Home, in 1792, the delivery of his surgical lectures, in order to devote himself more fully to the completion of his Treatise on the Blood, Inflammation and Gunshot Wounds, which was published by his executors in 1794. ”

“ Now as to this, surely the most remarkable thing about the bone is that it should have remained intact—that is, unbroken—in a stratum in which, so far as I know, all other bones are reduced to rolled fragments. The femur of a Hippopotamus is not a small bone by any means, and if such animals as Rhinoceros perimensis and Hippotherium antelopinum are represented in the conglomerate only by isolated teeth and fragments of bone, how comes it that this bone alone exists unbroken? ”

“ Of the numerous bursae in the popliteal space, that _between the semi-membranosus and the medial head of the gastrocnemius_ is most frequently the seat of disease, which is usually of the nature of a simple hydrops, forming a fluctuating egg-or sausage-shaped swelling at the medial side of the popliteal space. It is flaccid in the flexed, and tense in the extended position. As a rule it causes little inconvenience, and may be left alone. Otherwise it should be dissected out, and if, as is frequently the case, there is a communication with the knee-joint, this should be closed with sutures. ”

“ The swellings tend to run together so as to form extended elevations enveloping the entire limb up to a given point, forming a great pad under the chest and abdomen, or distending the whole face or head so that it seems more like that of a hippopotamus than of a horse. ”

“ At the same time, marked symptoms of the motor nerves of the face are present, the patient’s sight is disturbed, he sees colours or sparks before his eyes; in a few cases there has been transitory blindness, in others diplopia. The pupil in nearly all the cases has been dilated, also in exceptional instances it has been contracted. The levator palpebrae superioris is paralysed, and the resulting ptosis completes the picture. Consciousness remains intact almost to death, there is excessive weakness of the muscles, perhaps from a general paresis. ”

“ The patient died on the ninth day, December 18, in a state of coma. After admission, his stupor had become more marked; there had been incontinence of urine and fæces, and the patient could be aroused only by loud tones. Difficulty in swallowing had developed; the right-sided ptosis had become more marked, and muscular twitchings had developed on the right side. When the left leg was pinched, there was twitching of the left leg and arm. There was slight spasticity of the right arm and leg. An examination upon the day of death definitely showed a lack of reaction of the pupils to light. ”

“ On the dorsal side of the cartilage there is a projecting ridge composed mainly of a bone known as the pterotic, sometimes erroneously [Pg 596] called the squamosal, and continued in front by the sphenotic. The pterotic, or the cartilaginous region corresponding to it, always supplies the articular surface for the hyomandibular.
In the floor of the skull, in the region of the pituitary body, there is formed a basisphenoid; while in the lateral parts of the wall of this part of the cranium, there is a bone known as the alisphenoid. ”

“ There are people with hyper-pituitarism who exhibit the highest mental powers. In them is an increased activity of the posterior lobe in association with enlargement and hyperfunction of the anterior, overgrowth is not so marked, and the individual is lean and mentally acute. But the ordinary giant is one in whom there is degeneration of the pituitary after too much action of the anterior and too little of the posterior glands. A tumor or disease process in the gland is most often responsible. ”

“ On May 19 the circumcorneal injection was much less; the conjunctival hyperæmia and lachrymation were still present, while the ptosis was slightly increased and tension was + 1.
At the present date—July 23, 1899—this patient has no pain. The retinal arteries are increased in size. Tension is + 1. Vision has increased from light perception to ability to count fingers at three feet. The conjunctival injection which followed the operation has disappeared; the optic nerve has a color more approaching the normal. The ptosis is less.
This was the first sympathectomy made in America for glaucoma. ”

“ In some cases of Pott’s fracture the foot will move inward instead of outward. The degree of outward displacement can be measured by the difference in the distance from the front of the ankle to the cleft between the first and second toes, as measured on the sound and injured foot. There is not always complete loss of function. In fractures of the external malleolus alone, the patient may walk quite well. ”

“ In a work of this limited size the sensibility of the various tissues cannot be fully treated but it should be borne in mind that the integument and the subcutaneous tissue, fat and muscles as well as the tendons, their sheaths, the muscles and periosteum and perichondrium covering the bones and cartilages throughout the body, are all highly sensitive to pain. It is also equally true that the bone substance, the bone marrow, and the cartilages are devoid of any of the four modalities of sensation. ”

“ Afterward the pains are in the abdomen. As the head advances there is great suffering in back, hips and groin, with a disposition to bear down.
This disposition need never be urged by attendant, nor forced by the patient. Old ladies often say, “Bear down! make an effort!” supposing that this will facilitate labor. The fact is that these attempts to assist nature are retarding instead of helpful, and are often the cause of accidents. Nature indicates all effort essential to progress.
The bag of waters consists of the membranes which enclose the fetus and liquor-amnii. ”

“ The kidneys are supported mainly by their blood vessels, so that if they sag their circulation is impaired, and this kind of ptosis is very common. Hence faulty attitudes are very important for all visceral ptoses, while he finds much to commend in the use of abdominal corsets, even for fleshy men. Elasticity of the ribs should receive attention and the author prides himself on exercises that increase the elasticity of the basal tissues which sclerosis is prone to assail. The capacities of individuals for exercise in the open air can generally lessen the need of medical supervision. ”

“ Free incision, if possible, otherwise incision, cauterizing with pure carbolic acid, and packing with iodoform gauze. Internally, large doses of iodide of potassium should be given, as this drug alone has cured many cases.
Trench Foot. This results from exposure to wet and cold in the trenches, and soldiers who were compelled to have their feet immersed in water for any length of time and were then exposed to cold, are afflicted with this condition. The symptoms are similar to frost bite and the prevention of frigorism (Trench Foot) is as follows: adequate feeding; perfect circulation ”

“ The general movements of the globe were fair, but the upper lid could not be raised. The proptosis and subconjunctival hæmorrhage cleared up.
Little further improvement occurred; six months later the patient could only count the fingers excentrically. A very extensive scotoma was present. The optic disc was much atrophied, the calibre of the arteries diminished and the veins full (Mr. Critchett) . The ptosis persisted. It was doubtful in this case whether the ptosis depended on injury to the nerve of supply, or on laceration and fixation of the levator palpebræ superioris. ”

“ He showed a liking for surgery, and on 1 Aug. 1729 he was bound for seven years an apprentice to Edward Nourse [q. v.] His mother paid 210l. as premium. Nourse, at this time an assistant-surgeon at St. Bartholomew's Hospital, gave, contrary to the practice of most of his colleagues, private lectures in anatomy at London House in Aldersgate Street, and it became Pott's duty to prepare the subjects for these demonstrations. Pott seems to have gained some professional reputation even at this early period in his career. ”

“ In the inspection of those who die after Lithotomy, it is not sufficient to look into the peritoneal cavity, to open the bladder, or to examine the state of the wound; the peritoneum lining the lower part of the abdominal muscles should be stripped off, and the source of evil will then be laid open. ”

“ He introduced valuable improvements into the treatment of hernia, of cataract, of dislocations, and other surgical diseases. He first fully described and named the growth called ‘fungus hæmatodes.’ The name of ‘Hey's operation’ is given to a mode (devised by him) of partial amputation of the foot in front of the tarso-metatarsal joint. His proofs of the transmission of venereal disease to the fœtus in utero were convincing. ”

“ After giving a table which shows the result of each kind of amputation in the two periods, he adds, “It is plain from the above table that since the employment of chloroform there has been a diminution of mortality; thus in amputations of the thigh for disease there has been 5 per cent. less death, while after accidents 17 per cent. have been restored to health, who formerly would have perished. In the pathological amputations of the leg there is a difference of 8 per cent. ”

“ The following are the symptoms of dislocation inwards, as described by him. The leg is longer than natural, the buttocks outwardly appear hollow; the knee, foot, and leg [502] are turned out; the patient cannot bend his thigh at the groin; and the head of the thigh-bone occasions a tumour in the perineum. This appears evidently to be the variety described by modern surgeons as the dislocation inwards and downwards, the head of the bone being lodged near the thyroid foramen. The symptoms described by modern authors are exactly the same as those mentioned by Hippocrates. ”