Case of suicide in which death resulted from a wound in the neck by an earthenware jug: with remarks / [Robert Spittal].

  • Spittal, Robert, 1804-1852.
Date:
[1842]
Catalogue details

Licence: Public Domain Mark

Credit: Case of suicide in which death resulted from a wound in the neck by an earthenware jug: with remarks / [Robert Spittal]. Source: Wellcome Collection.

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    gradually increased; and of late he has experienced considerable uneasiness, from the frequent pain in it, and the deprivation of sleep thus occasioned. As amputation was the only method by which the patient’s life could be saved, or, at least, prolonged,—and as the bone appeared to be affected at the trochanteric region also, as indicated by its apparent enlargement there, and by that region being the seat of stinging pain,—it was resolved that the limb should be removed by Amputation at the Hip-joint. Accordingly, on the 30th June, the patient having had a good night’s rest, and his bowels having been freely opened, the opera¬ tion was performed by Dr Handyside, at noon, in the following manner :—The patient- was secured on his back, on the operation- table, with the nates resting on its edge. The right limb was held aside by one assistant, and the left extended by a second. The femoral artery was then compressed against the pubes, by the fingers of a third assistant, and the knife was introduced rather above midway between the anterior superior spine of the ilium and the trochanter major. It was then carried downwards, forwards, and inwards, passing close over, and grazing the capsular liga¬ ment and the neck of the thigh-bone; and the point of it was brought out at about two inches and a half from the anus. The anterior flap was then rapidly formed, being about from three and a half to four inches in length. This flap was then seized by the left hand of the third assistant, who thus more effectually prevented hemorrhage from the divided vessels, and who, at the same time, elevated and retracted the flap thus made. As the knife entered, the second assistant (he to whom was committed the charge of the limb) held it midway between abduction and adduction, then slight flexion was made by him, and subsequently, complete rotation inwards, as the knife advanced. On the completion of this anterior flap, the limb was immediately rotated outwards, by which movement the capsular ligament was fully exposed, and rendered quite tense, at its thinnest part, where it was struck by the knife, so as to pene¬ trate the cartilage covering the head of the bone. At the same moment, the limb was abducted and depressed, which made the ball of the os femoris start forwards from the acetabulum. The teres ligament, thus rendered tense, was divided by the point of the knife. The operator, then, grasping with his left hand the head of the bone, and maintaining it on a transverse plane with the neck and trochanter major, passed the blade of the knife behind these parts, dividing thus the remaining portion of the capsular ligament; while, at the same time, he completed the separation of the limb, by rapidly forming the posterior flap, which was of greater length than the anterior one. A small portion of the tumour, which was observed to remain on the divided surface of the posterior flap, was now carefully and completely removed. The hemorrhage from the sciatic and < htu-