The writer’s professional work among this class has long been along the line here noted. He has extended confidence—very rarely has it been broken; he has asked for confidence, and the general result can be truly and tersely stated—increasing satisfaction and success.
And now, gentlemen, what are the conclusions of this whole matter? These.
Reason and right alike demand a more rational and correct idea as to the origin of the toxic neurosis we have noted.
This demand complied with—regarding such patients, with certain exceptions, as creatures of conditions beyond control, and so no more culpable than the subjects of other functional disorder—will be most helpful against the protective temptation to untruth.
The medico-legal status of such cases will then be more in keeping with advanced forensic medicine.
The medical care of these cases will tend to a more humane method, with a larger promise of good results, both near and remote.
It will, too, be likely to lessen the increase of habitués, and the number now existing, for a more correct idea as to the genesis of this disorder will prompt medical men to greater care in avoiding the cause, while many a patient—who now shrinks from disclosing his misfortune—feeling he is not denied the charity his case deserves, and that he can command resources both helpful and humane, will be impelled to avail himself of the aid that scientific treatment can surely extend.
Presented to the Brooklyn Pathological Society, April 12, 1888.
On September 25th, 1888, was called to attend Mrs. H. in confinement. Patient was a primipara about twenty years of age, and a native of Mexico. Both she and her husband were free from any deformity, and had always enjoyed excellent health. Duration of pregnancy about nine months. Upon examination, I found the breech presenting. Labor progressed favorably, and nothing occurred worthy of special note, except that about half an hour before delivery, while making a digital examination, I discovered over the sacrum of the child a loose flap or fold of tissue, the nature of which at that time I was unable to satisfactorily determine.
After delivery I found the following condition: Over the lumbosacral region were two flaps, each two inches and a half long and about an inch wide; the outer borders were free, the middle portions of the inner borders were attached over the spinal column, and at this point of attachment there was an opening which communicated with the spinal canal. This opening was about large enough to admit the tip of the little finger. The anterior surface of the flaps was simply a continuation of the integument, the posterior surface was a continuation and expansion of the membranes of the spinal cord. The edges of these folds were straight and showed no signs whatever of having been torn or lacerated. There was atrophy and complete paralysis of both lower limbs. No other deformities existed. Flaps were placed in close apposition over the opening into the spinal canal, and upon them was put a thick compress, held in place by a wide bandage. The child continued to do well until the morning of the fourth day, when convulsions developed, and death took place in a few hours.