Surgery in Bengal : an address to the Bengal branch of the British Medical Association / by J. Fayrer.

  • Fayrer, Sir Joseph, 1824-1907.
Date:
[1865]
Catalogue details

Licence: Public Domain Mark

Credit: Surgery in Bengal : an address to the Bengal branch of the British Medical Association / by J. Fayrer. 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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    appears to be to cause the visceral changes I have alluded to, and not the more superficial deposits of pus. Early amputation, or re-amputation, therefore, is the re- medy which offers the best chance of success, and it should be, not in the continuity of the affected bone, but either at the next joint, or through the next segment of the limb. In M. Roux’s hands disarticulation has had the most marked success. It has been with him not only curative, but prophylactic. Prophylactic, because knowing the tendency of bone to take on this disease when its cancellated tissue is opened or injured, he avoided this by amputating at the joint. The proper time for amputation (or removal of the affected bone) in Osteo-Myelitis is not difficult to determine, for it should be as soon as possible after having ascertained that the bone is so affected, and, as I have said, the diagnosis is made by the constitutional and local symptoms, and by passing a probe into the medulla of the bone. Should it impinge, on healthy bleeding medulla, near the surface you may, if the constitutional symptoms are not urgent, wait and see if nature will limit the suppuration and throw off a ring of diseased bone; such expectations are, in my experience rarely realized, and the doubt is generally resolved, not in favor of the bone. However, this is one of the nice points of discrimination in the treatment, and for which no absolute rules can be laid down. The constitutional signs, the state of the pulse, respiration, and temperature, would be important indications of the patient’s condition, and they cannot be too carefully studied. A pulse exceeding 120, persistent temper- ature above 104, bronchial rales, hurried respiration, tender- ness over the hypochondria, are symptoms that should cause the greatest anxiety on their first appearance, and very speedily decide the fate of the patient or of his limb. I will, with your permission, read the outlines of two cases, one fatal, in which the symptoms during life and the patho- logical changes after death were well marked. The other successful, in which recovery took place after the symptoms of blood poisoning had supervened on Osteo-Myelitis. Amputa- tion on the hip-joint in this case proved perfectly successful. I have had the bones in each case placed on the table for your inspection, and though the appearances are much changed by