Rootless Century

Abstract

The tendency of children to improve coordination and function with increasing age must be distinguished from the effect of treatment.'' R.S. Paine 1 With reference search to 1888, Professor Otfrid Foerster read his extensive review ''On the Indications and Results of the Excision of Posterior Spinal Nerve Roots in Men'' 2 before the Third Clinical Congress of Surgeons in North America, New York City, November 2, 1912. Why women were excluded from the benefits of this procedure was not explained; the figures include 25 photographs of posed naked boys. Foerster defined 3 purposes for the procedure: ''The first indication for the excision of the posterior spinal nerve roots is based upon the physiological function of the same, as conductors of the sensibility, and is formed by violent neuralgic pains, which defy other methods of relief.. .. .'' Results: Successful, 12 cases; failures, 23 cases; result unknown, 3 cases.. .. The second indication for resection of posterior spinal nerve roots is the visceral, especially the gastric, crises in tabes.. .. The third indication for resection of posterior roots is spasticity and spastic paralysis due to a disease of the corticospinal path, especially the pyramidal tract. I will not here recur to the physiological point of view and the pathologico-anatomical ''facts which have led me to propose the resection of posterior roots for the relief of spasticity.. . .'' ''Mortality of 8.8%. The mortality appears still less when considering the results of a single operator like Küttner, who had only two deaths among 31 cases operated for spasticity. Both were children with severe epilepsy; an epileptic attack followed the first stage of the operation.. .. I counted 88 cases of congenital spastic paralysis treated by resection of posterior lumbar and sacral roots, with 6 deaths. In a large majority the results have been satisfactory, part even excellent. The causes of failure will be discussed later on.. .. I should like to demonstrate to you, in pictures, the extent of the improvement in some cases operated by Küttner and treated by me.. .. Case 1. Boy, age 7. Severest rigidity of the limbs (Fig. 7); unable to make the slightest voluntary movement