Volume 2

The Hunterian oration, presidential addresses, and pathological and surgical writings.

  • Hawkins, Caesar Henry, 1798-1884.
Date:
1874
Catalogue details

Licence: Public Domain Mark

Credit: The Hunterian oration, presidential addresses, and pathological and surgical writings. Source: Wellcome Collection.

Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.

    440/468 (page 428)
    deal of iniJammation in the lower part of the femur, which you can feel enlarged and tender (or rather the periosteum is so), for some inches above the joint. But from the degree and kind of swelling which still remains, it is by no means certain, I am afraid, that suppuration may not take place, if it has not done so already, as it did in Mr. Keate's case. If so, the result is of course very doubtful, and he wiU have a great deal to go through, even if he recovers at all; otherwise we shall have to look to the time when the present line of treatment can be left ofE, and the disease becomes sufficiently confined to be treated as iilceration of the cartilages alone by an issue. At all events, the case well deserves your watching it to its termination. [Since the lecture was given, the patient has improved a good deal, having continued the calomel and opium.—Aug. 6.] \_Medical Gazette, vol. xii., p. 652, August 10th, 1833. CLINICAL REMARKS ON WOUNDS OF JOINTS. June lUTi, 1847. PUNCTUEED wounds, independent of haemorrhage, do not always heal well, and are attended with points of interest. There is a little boy in Winchester Ward, Thomas PragneU, set. 15, who was admitted on May 10th, with abscess over the inner side of the knee-joint, and there is a discharge of thin fluid like synovia, mixed with pus. There is considerable fulness and redness over the inner side of the joint. It was caused by the point of a lead pencU sticking into it four days ago. He has had rigors for the last day or two. The abscess was laid freely open; it does not appear to be connected with the joint, but is quite subcutaneous. This case illustrates two points connected with the treatment. It was simply an instance of punctured wound not healing, because, as the notes afterwards inform us, there was a small piece of cedar remaining in it. But there is also a note of the oozing of a fluid like synovia from the opening. When an appearance of this sort takes place, you must not at once conclude that it is a proof of an opening into the joint existing. The fat in the Uving body is in a fluid state, and when its cells are ruptured it runs out; and when mixed with serum, or blood, appears veiy like the oily fluid you see escape from a wounded joint. This was probably what took place in our patient. I was obliged to lay the abscess open for a second cii'cumstance. When an abscess is situated near the knee, although the opening in the skin may be free, yet the projection of the patella, or convexity of the head of the tibia, may interfere with the ready escape of the pus, and a few drops thus confined may cause an abscess to extend all round the limb. This is to be