British and Foreign Medical Review, 1842, Vol. 13
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Produktbeschreibung
Excerpt from British and Foreign Medical Review, 1842, Vol. 13: Or Quarterly Journal of Practical Medicine and Surgery In the introduction, Dieffenbach yields to Stromeyer the exclusive merit of the discovery of "subcutaneous orthopædy," naming him its "inventor and founder," and awards to Guerin well-merited censure for seeking to appropriate to himself the greatest share of the credit, if not the entire discovery of the method. He justly disabuses his readers of the too prevalent idea that the simple operation of division of a tendon can alone restore a distorted limb. "It is an erroneous conception of the nature of tenotomy to suppose it an operation which without further difficulty is capable of removing every distortion and contraction, in the manner that an incarcerated hernia is relieved by division of the structured parts; more especially to imagine that an advanced degree of club-foot can be cured by division of the tendo achillis alone. The section of the contracted tendons does not remove the distortion of the limb, but prepares it for a well-adjusted mechanical treatment. In many contractions, on the contrary, the section of the tendon is the chief point, the mechanical after-treatment being but an incidental part of the cure, e.g. in wry-neck where the vertebrae have not become displaced, or in simple pes equinus," [the author might also have added in simple cases of angular knee contraction.] "Orthopædic operations are attended by the most brilliant success in cases where the unnatural contraction of particular muscles overpowers other muscles, the energy of which was previously normal. The result is less favorable when, in consequence of paralysis of certain muscles, their natural antagonists have so completely obtained the preponderance, that they are permanently contracted. In this case the section of the contracted tendons often induces merely an amelioration in the state of the limb; nevertheless the apparently paralytic state of the muscles is frequently removed by their restoration to activity through the cessation of the preponderance of the contracted muscles, resulting from their division. In this form of contraction, mechanical orthopædy is not simply inefficient, but aggravates the paralytic-like condition of the muscles; and the feeble limb is rendered completely unserviceable. Mechanical means are, as Stromeyer also states, equally ineffectual in spasmodic contractions. Nothing but the section of the contracted tendons and the deposition of a small intermediate tissue is capable of removing spastic contraction (habitueller krampf), precisely as in permanent contractions the normal form of the part is restored by elongation of the tendon." (p. 11.) In the following important observations, Dieffenbach corroborates the opinions of Stromeyer: "In the subcutaneous division of a large tendon, the achilles for example, the sheath of the tendon, contrary to what might be expected, is not divided, but in consequence of its size and laxity escapes the edge of the knife. Strempel has assured me that on the examination of subjects after death in which he had divided the tendo achillis, he invariably found one or at most two small openings in the sheath opposite to each other, and never a complete division: I have confirmed this by experiment; and the probability exists that the same result takes place in the living subject. This non-solution of continuity of the sheath is unquestionably of the utmost advantage, as it prevents extensive diffusion of blood in the adjacent cellular membrane. The promptitude with which mobility of the tendon is restored after cicatrization of the wound demonstrates that in consequence of its section, no firm adhesion of the external surface of the sheath has ensued." (p. 12.) About the Publisher Forgotten Boo
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