On excision of the wrist-joint / by James F. West.

  • West, James F., 1833-1883.
Date:
1870
Catalogue details

Licence: Public Domain Mark

Credit: On excision of the wrist-joint / by James F. West. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    great febrile excitement; an abscess formed up the forearm on the radial side, and many of the old sinuses began to discharge afresh. On August 24th he was re-admitted to the hospital; several sinuses were laid open, and some of them which communicated with each other were connected by Chassaignac’s drainage tubes, riiese were introduced by our excellent house surgeon. Dr. Jolly, who throughout has taken great interest in the case, and to whose careful dressing the favourable result is in no small degree to be attributed. The drainage tubes were ordered to be syringed out Avith the permanganate of potash lotion every night and morning. He Avas also ordered a chop, beef-tea, milk, and four ounces of sherry daily, and to take tAvo grains of quinine, Avith 5i- of tincture of hop, and five drops of dilute sulphuric acid three times a day. Under this treatment he soon improved; the discharge diminished, so that at the end of a fortnight the drainage tubes Avere removed; the fistulous openings began to close, and the only inconvenient symptom Avas a great amount of soft swelling over the loAver end of the radius. To obviate this he Avas ordered to have the arm more firmly bandaged, and to have pressure kept up by means of some thin sheet-lead applied round the lower part of the forearm. ToAvards the end of October, the short splint, leaving the fingers quite free, was resumed, and free movement of the fingers Avas made by Dr. Jolly every day; the sheet-lead Avas still used, as the SAvelling Avas gradually decreasing under its use; his health Avas again good, and he Avas alloAved to go out of the hospital for a Avalk every day. During November the sinuses gradually healed ; the puffy swelling Avcnt doAvn, and in its place could be felt firm fibrinous deposit at the site of the excised bone. The poAver of flexion and extension of the fingers returned to a great extent, so that he could pick up a book, or hold a pen. At the present time all the fistulas are healed. The parts can be handled Avithout causing him pain, and they feel firm and compact; the styloid process of the ulna projects in rather an unsightly manner, but, Avith that exception, the appearance of the joint is admirable (Plate II., Figs. 1 & 2), and his poAver of using it, and also of flexing or extending the fingers, is so perfect that he is, and has been, able, ever since he left the hospital, to carry on his employment as porter in a large drapery establishment Avithout any difficulty. I give a fac-simile of his handwriting; and, I may also add, that he can lift a heavy Aveight.