Observations on some of the more recent methods of treating wounds; and, On excision of the knee-joint / by Edward Lund.

  • Lund, Edward.
Date:
[1870]
Catalogue details

Licence: Public Domain Mark

Credit: Observations on some of the more recent methods of treating wounds; and, On excision of the knee-joint / by Edward Lund. Source: Wellcome Collection.

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    possible, with the syringe, so as to keep the exposed surfaces perfectly wet, and protected from the air. The whole of the interior of the knee was found to be completely disorganized; the upper chamber of the joint, where the synovial membrane extends above the line of the patella, was entirely filled with pulpy matter. One of the crucial ligaments, the posterior, was quite destroyed by ulceration, and the other was partially affected in the same way. The cartilage was abraded from one half of the surface of the patella, and the same condition was observed on the con¬ dyles of the femur on their more convex portion, and also upon the head of the tibia. The semilunar cartilages were not much diseased. I removed with the saw about one inch and a half of the femur, and nearly one inch of the tibia ; indeed, in the case of the femur, as it was necessary to cut off three successive pieces, the aggregate length of bone taken away may have been rather more than what I have just stated. The first portion sliced off from the femur was about five eighths of an inch in thickness, and this exposed a small localised abscess in the can¬ cellated structure. As soon as this was opened another made its appearance, and after this a third, each about the size of a small hazel nut, until it was evident that the end of the femur was the seat of many of these depots of matter. I had, therefore, to gouge out, with great perseverance, almost the whole of the lower part of the cancellated portion to a considerable depth, leaving, as it were, a mere shell of peculiarly hard compact bone forming the outline of the condyles. In the tibia I had only to remove one slice rather more than three fourths of an inch in its thickest part before I came down to healthy bone. During the whole time in which I was engaged in gouging out the diseased bone and clearing the abscesses, a stream of the antiseptic fluid was con¬ stantly poured over the surface, or projected forcibly upon it and into recesses in the bone, by means of the syringe. Only three small arteries required ligature, and they were situated in the neighbourhood of the lateral ligaments of the joint. For this pur¬ pose I used antiseptic ligatures, made by steeping ordinary den¬ tist’s silk in wax mixed with a tenth part of carbolic acid. The liga¬ tures were cut off short, and the ends left in the wound. To protect