DEVELOPMENT IN NINETEENTH CENTURY 363 



which formerly was not resorted to unless in extreme cases. The 

 intervention of operative measures has not only reduced the mor- 

 tality to a very small percentage by preventing an infective process, 

 but it also has eliminated the various nervous phenomena, such as 

 headache, ataxia, epilepsy, insanity, and other like conditions. 

 I have treated many hundred cases of compound fractures of the 

 skull, and at one time collected a series of 116 cases of my own, a 

 reference to which may give an idea of what modem surgery has 

 achieved in the past few years in the management of this class of 

 serious cases. Of these 116 cases of compound fractures of the 

 skull, excluding those deaths from shock within 48 hours, in accord- 

 ance with all statisticians, because these deaths were not the re- 

 sult of any special plan of treatment, there are two deaths which 

 may be ascribed to sepsis. Perfection has been almost reached in 

 the technic of the operation of trephining; but as yet there are 

 circumstances which are not controlled by the practical surgeon, 

 and in the study of these causes future scientific surgery must be 

 employed. In these 116 cases of compound fractures of the skull, 

 there were two deaths due to sepsis, which give a mortality of less 

 than 5%. 



Traumatism of the vertebral column and the spinal cord have been 

 treated by Sayre's plaster-of-paris jacket. The utter helplessness, 

 the intense suffering, the absolute hopelessness, the wretched dis- 

 comfort, the living death make these patients objects of pity to 

 all under whose care they come. On the other hand, the recent 

 advances in the science of neurology, the precision of topographic 

 anatomy, the modern researches in physiology, the introduction of 

 anesthetics and antiseptics, the wonderful inventions in mechanical 

 art present a most vivid picture to the modern surgeon of what 

 surgery has accomplished by this new method of treatment. The 

 expectant plan terminates in death, the application of well-recog- 

 nized surgical principle to this peculiar class of hitherto neglected 

 cases, has demonstrated the possibility of salvation in at least a 

 limited number. The treatment of all these different varieties of 

 traumatism of the spine and cord by the plaster-of-paris jacket has 

 met with brilliant results. Before the employment of the jacket, 

 these patients were doomed to unalleviated suffering and death. 

 There is no reason why the same brilliant results should not follow 

 the application of the jacket when used in connection with spinal 

 meningitis or myelitis secondary to traumatism. Some time ago 

 I collected thirty-three cases of recovery after unmistakable fracture 

 of the spine, and to this list many others an be added of recent 

 date. Cases have been eliminated in which improvement only was 

 noted. This list is sufficiently large to attract the attention of sur- 

 geons and to induce them to employ this method of treatment in 



