Hearing and sight were normal; throat examination was negative. He complained of headache and pain in the neck. There were no external wounds. There was diaphragmatic breathing, complete loss of tactile sensation, flaccid paralysis below level of fourth rib in front, and below a line from the fourth to the seventh rib in the axillary line (Figs. 1 and 2), loss of reflexes. No broken bones were palpable, and no deformity of spine de¬ tected. Motions of shoulders slow; arms could be drawn up to chest slowly, but not extended. Unable to put either hand on the opposite shoulder. Type of sixth cervical nerve irritation.Seen in consultation with Drs. Walton, Baldwin, and Paul, who considered the lesion to be in the region of the fifth and sixth cervical vertebra:. Operation by Dr. Samuel J. Mixter; Dr. H. M. Chase assisting.Patient on abdomen, head flexed over the end of the table; incision in median line of neck, spinous processes exposed and lamina: and spines of fourth, fifth, and sixth cervical vertebrae found fractured, depressed, and apparently lying against the cord. These were removed, exposing the dura, which looked normal. The dura was opened and cerebrospinal fluid escaped, no bloodclot under dura, small clot found under laminae. Dura not sutured, wick inserted, superficial sutures, and bandage. Good recovery from ether. Temperature gradually rose to 104.6° F.; pulse slow and good volume. June 25, 1902. No change in tactile sensation, arms are moved a little more deliberately. June 26, 1902. Tactile sensation returning slightly. June 30, 1902. Tactile sensation recovered over whole body except left hand (Figs. 3 and 4). Can locate accurately where one touches him, though sensation is not normal, as shown by the time required to locate the point of contact. Plantar reflexes, knee-jerks, and ankle clonus absent. Slight thoracic breathing. 11 Soreness" of muscles of arms. Paralysis still complete below dotted line, and of extensors of arms. July 6, 1902. Slight plantar reflex and knee-jerk. No cre¬ masteric reflex. Improvement in motion of left arm. July 15, 1902. Ankle clonus present, tactile sensation normal except in left hand. July 26, 1902. Hamstring muscles can be contracted, but not November 30, 1902. Gaining in every way; can sit up in chair without assistance; can move wheel-chair a little with right hand. Disturbances of sensation mapped out in Figs. 5 and 6 on date of August 22, 1902, have nearly disappeared, and areas are blurred and indistinct. December 12, 1902. Occasional gastric disturbance. January i, 1903. Can pass urine voluntarily, but cannot empty bladder. Good control of sphincter ani. Flexor muscles gaining faster than extensor muscles. Can feed himself with right hand. January 17, 1903. Cannot hold anything in left hand. February 18, 1903. Can use both hands to wheel himself around in chair. Urine examination finds color normal, acid, sp. gr. 1029, albumen slight trace, sugar absent. Rare hyaline cast with fatty renal cell adherent, considerable pus, few medium size and small round cells...
form a nidus for the attachment of fibrin and the laying down of a thrombus. They do this, perhaps, by liberating their thrombin just at the point where it is most useful. Both platelets and fibrinogen seem necessary for the forma¬ tion of thrombi, for if either is reduced nearly to a point of absence, bleeding from cuts is prolonged.Dr. Webb's observation that the number of platelets may be increased by passive hyperemia is interesting and impor¬ tant. Dr. McKinley and I have tried this out in tuberculous patients at Dr. Webb's suggestion, and find as he did that the count can often be increased for a number of days in this way. It offers a very simple means for increasing the platelet count artificially. The Roentgen ray may be used in animals either for increasing or reducing the count. It is possible that some therapeutic application for this may be found.
As the first President of this Society, and at this, its first meeting, it is fitting that I should say something of the reasons for its existence and the results that its founders hope to obtain.There are many medical societies, large and small, from the great American Medical Association to the small journal or dining clubs, limited to a few members, some of general scope and. some devoted to the special branches of the profession. These societies are absolutely essential to the life of the profession, stimulating intellectual competition and production, and giving their members a chance to advance new ideas and discuss old ones, as well as to encourage that personal contact and acquaintance, without which no body of men can do its best work.The American Medical Association is too large and some of the special societies are of too limited a membership to afford a chance for much necessary work, and it has been felt that a society, representing the best effort of the surgical profession of New England was necessary to help raise the standard and aid in solving many of the problems that are before us. Is it too much to expect this representative body of men to add materially to the sum of surgical knowledge and, at the same time, to educate themselves and each other, thus becoming more fitted to serve and aid their suffering and unfortunate fellow men.One qualification for membership in this society has been considered absolutely essentialthat is, that every member must be a Fellow of the American College of Surgeons. That association has endeavored to set a high standard for those who would call themselves surgeons, and though some of high rank and attainment have held aloof, its efforts arc always in the right direction, and it should be recognized and encouraged in every possible manner.In studying the problems of the present and future we must bave a knowledge of the successes and failures of the past, for both have helped us on our way up the hill whose top seems even now so far, far above us. During the period of my professional life many problems have been solved, but is there one of us who does not daily meet the seemingly unanswerable? I say "seemingly," for let us hope that as we go on the, now impossible may become possible. Mankind lias advanced from the Stone Age to the present solely through the. efforts of those optimistic souls wdio refused to recognize as impassible the barriers that blocked the way, and today many of these barriers lie behind us, and our vision, as we climb the hill and look back, has a. much wider range than our forefathers had. We begin to think that everything in the world is better today than yester-
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