Jean-François Bouley (Bouley jeune). Pioneer investigator in intermittent claudication.

Reports of pathologic investigations as to the cause of intermittent claudication in horses were made in France in October, 1831, by veterinarian Jean-François Bouley. Obstructive clots in the femoral arteries were found to be responsible for the muscular changes causing limping. Bouley's work in the horse was used by Charcot in 1858 to understand the mechanism of claudication in the case of a soldier with gunshot wound in whom a traumatic aneurysm, clotting, and ischemia of the legs developed. This was not, however, the first medically reported case of human claudication from vascular occlusive disease; the one reported by Barth in 1835 seems to be the first. According to Dejerine in 1911, the disease in the horse appeared to be due to invasion of the vessels by a parasitic round worm; earlier he had ascribed some cases of human claudication to impaired circulation of the spinal cord. It was not until 1949, however, that Verbiest elaborated the concept of spinal stenosis to explain one type of human claudication.

Dorcas Hager Padget: artist and embryologist.

Dorcas Hager Padget (1906-1973), a largely self-taught illustrator, became a more polished artist under Max Brödel at Johns Hopkins Hospital, before going to work for neurosurgeon Walter Dandy. In search of more information on vascular anatomy, she became an expert neuroembryologist, first in the development of arteries and veins and later chiefly involved with anomalies of neural tube development. She was able to clarify the development of the Arnold-Chiari and Dandy-Walker syndromes.

Victor Horsley, John Marshall, nerve stretching, and the nervi nervorum.

In his early professional life, Victor Horsley was registrar and assistant to Mr. John Marshall, anatomist, surgeon, and president of the Royal College of Surgeons. In helping with the research for the Bradshaw Lecture on Nerve Stretching given by Marshall in 1883, Horsley demonstrated changes in nerve fibers due to mechanical stretching of the sciatic nerve, and he also demonstrated small nerve fibers in the sheaths of peripheral nerves--the so-called nervi nervorum. Marshall attributed the benefits of nerve stretching in sciatica to the interference with these nervi nervorum hitherto considered to exist only in the sheath of the optic nerve.

Nonoperative versus operative intervention in low back disorders.

Examination of the patient is necessary to rule out those numerous causes of lumbosacral backache that need not involve the neurosurgeon. A variety of nonoperative treatments (rest, injection of tender pressure points, extradural injections, traction in which the pelvis is fixed and the chest and upper spine can be pulled from the pelvis, and manipulations of the spine) can be used with proper precautions. Injections of enzymes to dissolve the disc have had declining use among neurosurgeons because of actual or feared complications. Operations range from percutaneous disc excision or laminotomy with decompression of nerve roots, to disc excision with interbody fusion. Selection of proper operative treatment to be undertaken when an adequate period of conservative (nonoperative) therapy has been fruitless is controversial. Probably the simplest way of excising a disc with small incisions and minimal disruption of normal anatomic relationships is preferred.

How the sacrum got its name.

The os sacrum (sacred bone) was so named by the Romans as a direct translation from the older Greek hieron osteon. Explanations of the attribute "sacred" or "holy" in the past have included misinterpretation of the Greek word hieron, use of the bone in sacrificial rites, the role of the bone in protecting the genitalia (themselves considered sacred), and the necessity for the intactness of this bone as a nidus for resurrection at the Day of Judgment. A more plausible explanation may be that the holiness of the sacral bone was an attribute borrowed from the ancient Egyptians, who considered this bone sacred to Osiris, the god of resurrection and of agriculture.

Charles Lasègue and his 'Considerations on Sciatica'.

The eponym Lasègue sign has been applied to the increase in sciatic pain caused by flexing the extended lower extremity on the abdomen. The sign was never put into writing by Lasègue but by his pupils. He did not describe the test in the usual reference, "Considerations on Sciatica," in 1864. That article has to do with his analysis of then-current theories of sciatica and his own clinical observations. Sciatica was divided into a benign and a serious form, and two examples of each were described. Emphasis was laid on the constant, fixed sciatic pain, as contrasted with the irregular, largely nocturnal, episodes of lancinating pain. Atrophy of leg muscles was not to be explained on the basis of disuse but by a disorder of the nerve, which also was responsible for the typical neuralgia, unlike that of any other part of the body except possibly neuralgia of the brachial plexus. Treatments currently available (cupping, vesicants, and injections of atropine solution) were unavailing. The steps are unknown by which Lasègue came to modify his 1864 views that any sort of flexion or extension of the lower extremity did not exacerbate the pain; in the 1881 thesis of his pupil, Forst, that straight-leg raising sign is described and illustrated and ascribed to his teacher, Professor Lasègue.