If the dura is distended with blood, its color will be purplish; yellow, if pus be present. The presence of a tumor can usually be determined by touch.
If the cause for which the spinal canal was opened has not been satisfactorily removed, the dura should now be opened.
If a tumor be present, it should be moved if possible, but it may infiltrate the cord so as to be inoperable. Blood clots, fragments of bone, etc., should, of course, be removed when the cord is lacerated. Efforts to suture the cord have so far been unsuccessful. The dura should be closed with fine sutures unless for some reason pressure on the cord is not desired. The skin incision may or may not be drained, the dependent posi tion of the cut favoring the escape of fluid. If a drainage-tube is employed, it should be removed in twenty-four hours. A plaster-of-Paris bandage out side all the dressings is advisable in al most all cases—certainly in those for Pott's disease and in fracture.
Seventeen laminectomy operations per formed. Of 7 acute traumatic cases, 3 of which were in the cervical region, no shock followed operation, and even in 10 rapidly-fatal cases a temporary im provement followed intervention. Those injured in the upper part of the cord died, with sudden and marked elevation of temperature. Two dorsal cases lived for several months, neither injured nor benefited by the operation. Autopsy in three cases showed complete crush and softening of the cord. Of 4 chronic trau matic cases, 1, a fracture dislocation of the second cervical, was markedly ha proved in the paralysis of the upper ex tremity and in the motions of the head; a second, operated upon during a second ary acute affection of the cord, was not benefited by interference, but died in a few hours with high temperature. A
third middorsal case, and almost hope less from the start, was relieved of the athetosis, but gradually succumbed to sepsis. A fourth, upper lumbar, though paraplegic and typhoidal at time of oper ation, made a complete recovery, so that she could earn her living at general housework at the end of eight months. Of 2 adults with paralysis from caries, 1, upper cervical, was perhaps slightly benefited; the other, one of 10 earlier cases, died of acute peritonitis, probably from being placed in the prone position after operation,—a position that has proved not only useless, but at times dangerous. Of 2 cases of syringomyelia, both were markedly benefited by opera tion, and though ultimately the disease is fatal, yet the relief justifies the simple operation of opening the spine and dura. Two cases of sarcoma were operated upon,—one a diffuse growth, the other melanotic; but very little, if any, benefit resulted. In operating, a single median incision is recommended; hwmostasis by gauze packing; removal of the laminm by special forceps, without chisel or tre phine; the dorsal position after an oper ation that should not last over half an hour. J. C. Warren (Boston Med. and Surg. Jour., May IS, '99).