REPORT CXII. OBSERVATIONS ON THE PHYSIOLOGY OF THE FEMALE GENITAL ORGANS
Authors: W. B. Bell, P. Hick
Journal: BMJ (1909)

5Iit consists in simple laminectomy, opening the theca, and washing out the theca with a mercurial lotion.Here we enter at once on the general and interesting question of notable benefit attending the free opening of the so-called serous spaces and washing out with some antiseptic, because I suggest the parallel of this surgical treatment -of spinal meningitis is the well*known surgical procedure .ofopening the abdomen to cure tuberculous peritonitis.I believe there is no risk in washing out the theca with strong solutions of mercury, even up to 1 in 500 strength, though I have only used that strength once or twice.Still, I should not have any hesitation in using it at any -time where there was much exudation in the arachnoid, following it up with 1 in 2,000, and leaving in some of this strength when closing the wound.'The skin wound, 1 think, should be completely closed, not drained.I used to sew up the theca, my object being to arrest the escape -of cerebro-spinal fluid into the wound.I have now given that practice up in almost all cases, because in the first place I found wounds healed as quickly, and there is as a rule no greater escape of cerebro-spinal fluid, so that that reason for suturing was not a very important one.Undoubtedly, too, there is less discomfort to the patient afterwards-namely, less tendency to headache and less tendency to the temporary pyrexia and tachycardia which taminectomy cases not infrequently show.But I have also .come to believe that allowing the escape of the cerebro- .-spinalfluid into the wound cavity for a time, for a few days at any rate, secures a valuable new state of things, for it 4must get away.It does not necessarily get away through -your suture opening, which remains as dry as when closed; therefore it must drain away through the lymphatics of the walls of the wound.If we can thus establish an artificial exit for the cerebro-spinal fluid by means of the lymphatics in and among the muscles surrounding the spine, then, of course, we have established a fistulous association for the carrying on of the circulation of the cerebro-spinal fluid exactly analogous to Senn's and -Cushing's methods of treating hydrocephalus.Non- suturing of the theea in the operation, therefore, has a possible advantage.It is difficult to prove that this circu- lation exists to the degree one believes, but at any rate mnost of the fluid escapes in that way necessarily because it does not flow out between the stitches of the closely sutured wound.Aft%r the wound is completely healed, free mercurial inunction of the spine should be ordered, especially over the scar, on the idea that having arrested the disease an attempt should be made to secure active " absorption " and a complete restoration to health.In concluding this sketch of an imperfectly understood chronic condition I would express the view that probably many cases of so-called acute myelitis are really meningeal in origin, and that a laminectomy and free drainage of the subdural space might arrest the whole' process and the subsequent fatal injury which the cord sustains in such -conditions.