A historical perspective on the problem of the retained surgical sponge: Have we really come that far?

Retained surgical items, particularly surgical sponges, are a considered a "never event." Unfortunately, they continued to be reported despite significant efforts to reduce them. Our goal was to identify some of the earliest reports of surgical items, particularly surgical sponges, to see how it was presented in the literature as well as any insights into contributing factors and processes to mitigate the event. We progress forward in time to look at how this issue has been addresses or changed as we enter the 21st century. After this review, it appears that our advances are not as significant as those efforts proposed over 100 years ago. We view this as a call to action for significant change in our operative safety processes and to incorporate available technology.

Cuidados oftalmológicos en la Guerra de Vietnam, medio siglo después. Datos obtenidos del Ejército Estadounidense / Ophthalmic care in the Vietnam War, half a century later. Data obtained from United States Army

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Subcutaneous packing in royal Egyptian mummies dated from 18th to 20th dynasties.

OBJECTIVE: It has been widely disseminated in the literature that subcutaneous packing, as part of mummification, was not usually done until the 21st dynasty. We aimed to study by computed tomography (CT) if subcutaneous packing was part of mummification of royal Egyptians dated to 18th to 20th dynasties. MATERIALS AND METHODS: We analyzed the 2- and 3-dimensional CT images of 13 royal mummies dated to circa 1550 to 1153 BC for presence of subcutaneous embalming materials. Among the studied mummies were Amenhotep III, Tutankhamun, Seti I, and Ramesses II. We reported the CT characters of any detected subcutaneous embalming materials and noted their impact on the morphology of the involved body part. We correlated the CT findings with the archeological literature. RESULTS: Computed tomographic images showed subcutaneous packing in 12 (92.3%) mummies; whereas the mummy that was previously known as "Thutmose I" showed no such evidence. Subcutaneous packing involved the faces (n = 11), necks (n = 4), torsos (n = 5), and/or extremities (n = 4) of the mummies. Subcutaneous filling materials showed variation in homogeneity and CT densities and they were likely composed of resin, bits of linen with resin, or other substances. Subcutaneous packing procedure succeeded in providing uniform full contour of the involved body regions without causing significant tissue damages. CONCLUSIONS: Subcutaneous packing procedure was used as part of mummification of royal Ancient Egyptians dated to 18th to 20th dynasties earlier than what was believed in archaeology. The Ancient Egyptian embalmers must have been skilled in dissection and possessed surgical tools that enabled them to perform this fine procedure.

Face to face with Phineas Gage.

We present here a reproduction of a daguerreotype of Phineas Gage that came into our possession more than 30 years ago. It is, as far as we know, the only image of this famous patient. We describe how we identified the subject in the image, describe how daguerreotypes are made and set out our comparisons of the image with the Phineas Gage life mask and tamping iron held in the Warren Anatomical Museum, Francis A. Countway Library of Medicine.

Unusual foreign metallic object (nail) in the dentition of a skull from the anthropological collection of Rudolf Virchow (Berlin).

Foreign bodies in the dentition of present day patients are frequently diagnosed. They are more rare in mediaeval and anthropological specimens. Rudolf Virchow, the doyen of pathology in Germany formed a huge collection of anthropological specimens in the 19th century. Among these specimens one skull from Tiflis (Tbilisi, Georgia) found its way into the collection of Virchow in 1881. The skull is that of a prisoner of war who died in 1877 due to dysentery. The skull is remarkable in that a metallic nail was adapted around the second right maxillary molar. Both radiological and clinical findings indicate that the nail was adapted to the tooth while the individual was still alive. In particular, erosion of the cortical bone plate in the affected area and osseous healing between the first and second maxillary molar may be taken as proof of adaptation of the nail in vivo. The reasons why the nail was applied, however, are difficult to explain. The authors assume that the nail was applied not by the individual himself. Probably, the nail was adapted as an amulet to protect the individual from injury or death.

James Platt White, MD (1811-1881): his interesting and remarkable accident.

James Platt White, MD (1811-1881), one of the founders and leading figures of the Buffalo Medical College and a pioneer in American obstetrics and gynecology, suffered an interesting and remarkable accident to his neck at the age of 26 while traveling in a stagecoach in Western New York. He was confined to bed until after 45 days, a piece of bone was discharged into his pharynx and then expectorated. The segment of bone proved to be the anterior arch of his atlas (C1) vertebra. He recovered completely from this injury except for permanent loss of rotation of his head and neck. However, he was without functional disability until his death, 44 years later, at the age of 70. This case documents the clinical result during a 44-year period after traumatic loss of the anterior arch of C1. Such cases have been reported only rarely in the literature. Only limited information is available regarding the long-term clinical significance of a Jefferson fracture with exfoliation of the anterior arch of C1. My analysis suggests that White suffered an open Jefferson's fracture that became infected. The anterior arch of C1 became a sequestrum and was discharged spontaneously into his pharynx and then expectorated. This case report with decades of followup should be of interest to all who care for patients with cervical spine injuries and those who are interested in the history of medicine in Western New York.