Outlines of practical surgery / by Walter G. Spencer.

  • Spencer, Walter G. (Walter George)
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: Outlines of practical surgery / by Walter G. Spencer. Source: Wellcome Collection.

    677/712 (page 663)
    he nape of the neck over the head to a strap round the fore- iead. Tubercular Disease in the Cervical, Dorsal and Lumbar Regions is indicated first by stiffness of the spine and pain m pressure, or on coming down on the heels, or on tapping he head. In attempting to stoop to pick up from the floor, . child holds the spine rigid, and places one hand on the :nee to support itself. As the disease progresses, an angular urvature backwards becomes more and more marked ; the pine of one vertebra may be especially prominent, but the vhole spine may be curved where many bodies are affected. Some lateral curvature may appear secondarily from the >atient supporting himself on his elbow. Caseous matter extends forward on either side of the .nterior common ligament. If in the cervical region, it may >ulge forwards the wall of the pharynx and form a post- )haryngeal abscess. A post-pharyngeal abscess due to ubercular disease of the spine is best reached by an incision >ehind the sterno-mastoid (see p. 244). If in the dorsal region an abscess forms in the posterior nediastinum, it may burst into the pleura or lungs, or track lownwards and point in the loin, or extend into the psoas. Attempts may be made to drain the abscess without opening he pleura, by cautiously dividing the necks of two or three ibs. Psoas Abscess.—The caseous matter spreads into the iheath of the psoas. It may bulge backwards in the lumbar egion, extend down within the sheath of the psoas muscle, ind form a swelling in the inguinal region above Poupart's igament. It may spread to the iliacus, and fill the hollow )f the ilium. It may pass under Poupart's ligament and behind the vessels, and point on the inner side over the esser trochanter. Beyond this the pus has extended down he leg to the heel. If not treated, a psoas abscess sooner or later bursts either externally or internally into the intestine or urinary tract, rhe result is secondary septic infection, added to the tuber- cular process; the patient gradually sinks from septic exhaus- ion. Only rarely, after a sequestrum has been discharged