Preparatory and after treatment in operative cases . Fig. 279.—Retraction of Flap Following Thoracoplasty, (von Bergmann.) of the corest. In all cases the general tone of the patient shouldbe brought to as high a level as is feasible by attention to diet, theadministration of tonics, creosote and fat emulsions. The admin-istration of iodin seems to be of benefit. A mixture of syrup ofthe iodid of iron in an emulsion of the mixed fats has proven ofapparent benefit. The causative factor which produced the con-dition calling for operative relief is, of course, the most determin-ing prognostic ele
Preparatory and after treatment in operative cases . Fig. 279.—Retraction of Flap Following Thoracoplasty, (von Bergmann.) of the corest. In all cases the general tone of the patient shouldbe brought to as high a level as is feasible by attention to diet, theadministration of tonics, creosote and fat emulsions. The admin-istration of iodin seems to be of benefit. A mixture of syrup ofthe iodid of iron in an emulsion of the mixed fats has proven ofapparent benefit. The causative factor which produced the con-dition calling for operative relief is, of course, the most determin-ing prognostic element. However, even in tuberculous processes,a favorable ultimate outcome will not infrequently prove sequen-tial to painstaking attention to details in the after-treatment. THE DEFORMITY 415 Following thoracoplasty by the flap method the cavity leftbeneath the flap, not having any osseous wall, contracts and bulgeswith deep respiration or coughing. This has been regarded asthe outcome of distention or collapse of the lung (Figs. 279 and280).. Fig. 280.—Bulging of Flap Following Thoracoplasty, (von Bergmann.) The entrance and expulsion of air is, however, not the causa-tive factor in this regard. The bulging may be produced bykeeping the glottis open and making pressure upon the abdominalwall in an upward direction. The phenomenon need not be regarded as rendering exerciseof the respiratory function dangerous. During muscular exer-tion the patient may best be protected from unnecessary strainupon the weakened thoracic wall by wearing a firm pad over thesite of the thoracotomy. The retraction of the flap is, perhaps,of minor importance, and it is probable that if any unfavorableoutcome is to be apprehended, it is from the bulging. The pre-caution mentioned has a tendency to obviate these contingencies. CHAPTER XXOPERATIONS ON THE SPINAL COLUMN Laminectomy—Tuberculosis osteomyelitis of the spine. LAMINECTOMY Laminectomy, or perhaps more properly stated, resection ofthe vert
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