Cases in surgery occurring in the practice of P.D. Handyside / reported by John Struthers.

  • Handyside, P. D. (Peter David), 1808-1881.
Date:
[1845]
Catalogue details

Licence: Public Domain Mark

Credit: Cases in surgery occurring in the practice of P.D. Handyside / reported by John Struthers. Source: Wellcome Collection.

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    Case 2. Complicated Fracture of the Os Femoris folio iced by Ne¬ crosis, ivith Protrusion:—.Recovery after Amputation. Andrew Firdayson, aged 18, farm servant, was admitted into the Doyal Infirmary, under Dr Handyside, late in the evening of April 19, 1844, having, whilst intoxicated, been knocked over by a cart, the wheel of which had passed over, and injured the right thigh and knee-joint. On examination, the right knee and the lower third of the thigh were found much swollen and discoloured, A nearly transverse fracture of the os femoris was easily recognised, a few inches above the condyles, there being great displacement, and marked deformity. No fracture through the condyles or into the knee-joint could be discovered. The latter, however, was immensely swollen, and the seat of severe burning heat, and much pain. Two contused and lacerated wounds were visible on the outside of the joint; but they did not communicate with its cavity. The accident happened in the afternoon, and the patient had been driven to the hospital in a cart, from a distance of ten miles. On his arrival there was no collapse, the skin being moderately warm all over, the pulse 100, and inclining to be full. The fracture was immediately reduced. The broken ends, on being brought into accurate coaptation, were retained so, by the limb being placed on a double inclined plane, and one roller ap¬ plied from the toes upwards to the knee, while another reached from the middle of the thigh downwards, over the seat of fracture. The limb was restored to its proper length. The knee-joint being thus left exposed and free from traction, twenty-four leeches were applied over it, and hot fomentations ordered to be continued during the night. An opiate also was ad¬ ministered. The bowels had been previously opened, and the tongue was clean. 20th. Doing well; pain, heat, and swelling of the joint dimi¬ nished.—To be kept on low diet. 21 st. Swelling, pain, and heat of the joint increased; tongue white; skin hot, and dry; bowels opened by enema; pulse 120, full, bounding, and incompressible. He was now bled from the arm to 14 ounces, which nearly in¬ duced syncope, after which the pulse fell to 100, and became soft and compressible. An opiate was then given, and repeated some hours afterwards, to meet the moderate reaction which ensued. An ounce of the following mixture was ordered to be taken every second hour:—B. tartratis antimonii, gr. ii, bitart, potassw 7>ij, aquas %xxiv. Solve. 2A<th. Pain and swelling decreased. Continue fomentations and the antimonial solution. 2*1 th. One of the wounds on the outer aspect of the joint now discharges much dark-coloured glairy serum, which appears to flow from the cavity of the articulation.