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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    was raised up, an abscess was discharged; it was near the pa¬ tella, but had no connexion with that bone; an inch of the femur was sawn off in a curved direction, from behind for¬ wards, and a thin layer of the tibia was removed horizontally, with a view to the easy discharge of pus afterwards; a seton was passed backwards near the outer hamstring; the section of the edges of the bones appeared sound; only a few fragments of cartilage remained on the pieces removed, and they were soft and gray; the exposed bone was highly vascular and rough; the small remnants of synovial membrane were likewise vascular and pulpy. Mr. Quain, who has most politely for¬ warded to me the above details, states, December 30, 1856:—- “From the time of the operation the case went on in all re¬ spects well for several days; healthy suppuration was estab¬ lished; but on the 16th an unfavourable change was manifest: the wound was dry, suppuration was stopped, and the patient became excited, at a later period even delirious; and he died thirteen days after the operation.” The dissection is most in¬ teresting:—“A sinus was formed under the vastus internus muscle, invading the crureus, and reaching nearly half-way up the thigh; the lower end of the adductor magnus was pale, and small deposits of pus were found disseminated among its fibres; there was another short sinus behind the femur, and a third, likewise a short one, at the outer side of the leg; both bones were soft at their truncated ends; about an inch of the thigh¬ bone was scraped away before the natural resistance of the os¬ seous structure was met with. By microscopic examination some fat, but no pus, was distinguished in the softened bone; among the bloodvessels there was no purulent deposit any¬ where. The puncture of the seton, which, it should be said, had been removed in a couple of days after the operation, was seen to be between the popliteal vessels and the outer ham¬ string ; the condensation around it was well defined; in the viscera there was nothing worth noticing.” Case LX.—Mr. William Nichols, Surgeon to the Norwich Hospital, excised the knee-joint from a young woman, aged 19J years, October 11, 1856. About two years ago she was a sftfferer from subacute inflammation of the synovial membrane of the left knee-joint; this was treated, but with little behefit, and about six months ago the joint became more swollen, ex¬ quisitely painful from every movement, and her general health began to decline from the local mischief; and, under these cir¬ cumstances, the joint was removed upon the above date. The semilunar incision was adopted ; the condyles of the femur and