Second memoir on excision of the knee-joint : to which is appended a remarkable example of the power of operative surgery in saving the same articulation / by Richard G.H. Butcher.

  • Butcher, Richard G. H., 1819-1891.
Date:
1857
Catalogue details

Licence: Public Domain Mark

Credit: Second memoir on excision of the knee-joint : to which is appended a remarkable example of the power of operative surgery in saving the same articulation / by Richard G.H. Butcher. Source: Wellcome Collection.

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    a few days after his admission by an exploratory puncture, Mr. Cutler opened the joint, at first by a small, but afterwards by a free incision, as that appeared insufficient; no acute symptoms followed the opening of the joint, but the pain was only slightly relieved, and the suppuration continued abundant. Under these circumstances, after the joint had been allowed to remain open for nearly three months, it was determined to excise the knee, or at least to lay its cavity freely open, and remove so much of the bone as should be found diseased. This was accordingly done, on the 17th April, by a curved incision, running parallel to the lower border of the patella, which bone was turned back, and the joint opened ; the synovial membrane and the soft parts in the neighbourhood were found very much thickened, but the bones were found only secondarily affected; accordingly, the end of the femur was only removed, which was softened in its whole texture, and carious on the surface. The surfaces of the tibia and patella each presented a small spot of caries, which was gouged out. The relief from the pain in the knee was complete; the cavity of the abscess, however, did not seem inclined to contract, but continued to discharge serous pus. About two months after the operation, during which the boy’s strength was gradually declining, it was thought ad¬ visable to try country air ; he went to Margate, but derived no benefit from the change, and died shortly after a month in London. No post-mortem instituteda. Case XXIV. Mr. Marett, of Jersey, assisted by Mr. Jones, excised the knee-joint of a young woman, aged 19, April 17, 1856. The articular surfaces of the femur and tibia were re¬ moved, likewise the patella; the limb is stated to have been placed in Liston’s splint, and suspended. The semilunar inci¬ sion was adopted, and it is reported “ that at the end of one month the wound was cicatrized, with the exception of about the size of a sixpenny piece.'' “ She then had an attack of erysipelas affecting the knee, extending to the leg and exter¬ nal portion of the thigh ;” an abscess formed in the latter situation, which required to be opened; an abundant quantity of matter flowed from it, and still a slight serous discharge oozes from it. On the 29th of November, the report which I have received, through the kindness of Mr. Jones, states, “ she is now able to walk writh ease, with the help of a person to support her on one side, and the assistance of a stick. ’ Case XXV.—Mr. P. Price, of the Metropolitan Infirmary, at Margate, excised the knee-joint of a girl aged 15, on the a Lancet, 1856, vol. ii. p. 281.