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CASE OF SWELLING AROUND THE KNEE-JOINT.
492
it has been who devotes the
thought of by Dr. Epps, profits of this extremely interesting piece of biography to the most
but
much no
pain
and uneasiness, and there
was
doubt, from the existing symptoms, that
chronic inflammation had commenced on the external ligamentary structure of the kneevirtuous of purposes. joint, and an effusion of lymph had taken Leaving, then, untouched, ninety-nine place, producing the tumefaction and keep. out of every hundred pages of the volume, ing up a source of much irritation. Ulcer. ation had in all probability commenced in we cordially recommend our readers to the neighbouring parts from the pain occa. share the meed of benevolence with the sioned by motion, and from the necessity for author of the work. We have transferred the reclining posture, giving, in conjunction to our pages some account of a man who was with the other marked symptoms, an ap. closely connected with the history of a par- pearance of a diseased action in progress. ticular branch of medicine,-have said The constitutional symptoms were-loss of in a great degree, with much de. enough to show that his life is worth atten- appetite and wasting of the animal frame, bility tion,-and now avoid spoiling the curiosity occasional flushes of the cheeks, without of our readers, by closing our observations perspirations. The general health being concerning the work, expressing a hope that very delicate, my first attention was di. the directorship of the Royal Jennerian and rected to ameliorate the state of the consti. London Vaccine Institutions may for ages tution, to which end tonic medicines were administered three times a day, with the nud successors equally worthy with the late use of occasional sedatives to allay the irri. Dr. Walker to fill the important office tation of the system. Nourishing diet was which was vacated by his lamented death. also prescribed ; and as soon as the case would admit, wine, ale, &c., were freely taken with the most decided benefit. Per. fect rest was enjoined, and with regard CASE OF to local treatment, cold evaporating lotions were first used, with much success, to abate SWELLING AROUND THE the inflammation and swelling, followed by KNEE-JOINT. the application of a poultice to accelerate By FRED. S. GERVIS, Esq., M.R.C.S.L., the formation of the abscess, which was Tiverton. opened by a lancet. In order to arrest the progress of the matter towards the thigh, a AT the commencement of August, 1830, firm compress and bandage was placed on I visited Miss Loosemore, aged nine years, the upper part, and pressure maintained who was affected with a considerable swell- above and below by broad straps of plaster, ing around the right knee-joint. On in- and a roller frequently applied. In order quiry into the history of the case, I found to bring the sides of the sinuses together, that about nine months previously she had pieces of sheet-lead and pads of differPDt fallen down the stairs and struck her knee, dimensions were used, and the whole joint which subsequently began to swell and in- was surrounded by a bandage. As the general Blisters and other means health improved, the parts began to wear a crease in size. were I believe had recourse to prior to the more healthy aspect, the matter discharged period of my attendance, without relief. became less in quantity, and of a better apWhen I first examined the joint, there was pearance, and the sinuses gradually to close. considerable external inflammation, with There was now more firmness in the limb, two sinuses on the posterior part, in the and the heel began to descend without much situation of the popliteal region, from which effort or pain in the attempt. The system a serous and ichorous fluid continued to of strapping with a soft plaster was purdischarge. One large abscess had begun to sued, with a bandage repeatedly put on, form on the inner side of the joint, which and the joint in this state was kept wet was subsequently opened with a lancet, and with a cold lotion, which had the effect of which terminated in a sinus extending con- producing a softness of the parts, and giv. siderably in two or three directions. An- ing additional flexibility to the limb. Stimuother abscess had formed just below, oppo- lating embrocations were in the subsequent site to the tendinous insertion of the mus stages had recourse to, and the plaster and cles of the thigh, which, in a very short bandages were used less frequently; the time, healed. The heel was elevated about size of the joint continued evidently, to an inch and a half from the ground as far as diminish, and the sinuses to close, ena. I can judge, so that the foot could not rest bling the young lady, with the assistance in its proper situation, or an erect position of crutches, to enjoy the open air, and to be maintained. There was considerable take occasional exerciseFrom this period stiffness about the joint, accompanied with daily improvement was visible in the gene-
493 ral health, as well as in the appearance of the joint, which began to assume its usual form, and to resume its wonted function, so that a slight alteration in the gait was all that could be discerned. The period of time which elapsed during this plan of treatment was five months, since which several months have transpired without any return of the complaint, the patient enjoyingthe perfect use of the limb. June 26,1831.
the child, at which period it did not appear than a walnut. Nothing was done for it, but the mother was requested to bring the child again to me, or give intimation in the event of the tumour bursting. In consequence she again applied at the dispensary on the 2nd of February, J 310, when the child was seen by the late Mr. Gelston, at that time the visiting apothecary of the institution, who directed-some simple local application, and gave it two grains of submuriate of mercury in sugar.
larger
CASE OF HYDRORACHITIS.
By
THOMAS
JEFFREYS, M.D., Liverpool.
send you the following case it has lain dorfor upwards of twenty years. Those of your readers who have’arrived at the same maturity in their practice as myself, I am fully aware it can only muse, but as it is intended more for those who belong to the rising medical generation, I trust the case may not be altogether useless, as an account of the appearances, progress, and termination, of hydro rachitis. I may avail myself too of this opportunity to enforce upon students in medicine and surgery the benefits they will derive by early and unremittingly habituating themselves to recording facts, to com. mitting to paper the results of their practice, and to preserving, in some form or other, On the 5th I saw it myself, but instead the conclusions they may draw from reading and reflection, if it be only even for the of finding the tumour broken and dischargprivate gratification which the practice will ing as I expected, it had increased in size atlord them, and which neither wealth, nor and tension, more especially at the upper hoaours, norrank, can impart. I have been part-appearing now nearly as broad as the led into these remarks by accidentally child’s back, and irregularly distended. dropping upon the following case, and the What the mother supposed to be a rupture drawing which accompanies it. I well re- of it, was merely all oozing from the right collect how much it interested me at the side, which she described as pus. Not’time, and how much it did towards fanning withstanding this horrid state of the disease the flame of science in the breast of my the little patient was lively and in good youngpupil Mr. Bridge, at that time an health, and, indeed, in all other respects apprentice in the Liverpool Dispensary (and was a beautiful and most interesting to whom I am indebted for the accurate The powder was taken daily, drawing I now send you), but whose preco- generally producing two alvine evacuations. cious talents were built upon too delicute a The circumference of the base of the tumour constitution to permit his mental powers to was eighteen inches. arrive at maturity. 16th. The tumour appears much in the Jane Ainsworth, aged eight months, was same state, except that it is perhaps larger, brought to me as a dispensary patient on although ;ic now measures round the ba,u the 9th of December, 1809, having a large, only fifteen inches, and from base to base, reddish, tense, elastic, and semi-transparent both longitudinally and laterally, only eleveit tumour, situated upon the lumbar vertebrae, inches. its appearance is thin and transpathe size of which was nearly equal to the rent. The child’s general health continues head of the child, occasioning apparently good. no inconvenience, nor producing any emacia- June 7th. Visited by Mr. Gelston, who tion of the body. The mother said it had reports that on the 4th the membrane be. been gradually increasing since the birth of came extremely -thin, and a slight oozing I
VENT17 RE to
of
hydrorachitis, although mant in my possession
infant.
!
I
it has been who devotes the
thought of by Dr. Epps, profits of this extremely interesting piece of biography to the most
but
much no
pain
and uneasiness, and there
was
doubt, from the existing symptoms, that
chronic inflammation had commenced on the external ligamentary structure of the kneevirtuous of purposes. joint, and an effusion of lymph had taken Leaving, then, untouched, ninety-nine place, producing the tumefaction and keep. out of every hundred pages of the volume, ing up a source of much irritation. Ulcer. ation had in all probability commenced in we cordially recommend our readers to the neighbouring parts from the pain occa. share the meed of benevolence with the sioned by motion, and from the necessity for author of the work. We have transferred the reclining posture, giving, in conjunction to our pages some account of a man who was with the other marked symptoms, an ap. closely connected with the history of a par- pearance of a diseased action in progress. ticular branch of medicine,-have said The constitutional symptoms were-loss of in a great degree, with much de. enough to show that his life is worth atten- appetite and wasting of the animal frame, bility tion,-and now avoid spoiling the curiosity occasional flushes of the cheeks, without of our readers, by closing our observations perspirations. The general health being concerning the work, expressing a hope that very delicate, my first attention was di. the directorship of the Royal Jennerian and rected to ameliorate the state of the consti. London Vaccine Institutions may for ages tution, to which end tonic medicines were administered three times a day, with the nud successors equally worthy with the late use of occasional sedatives to allay the irri. Dr. Walker to fill the important office tation of the system. Nourishing diet was which was vacated by his lamented death. also prescribed ; and as soon as the case would admit, wine, ale, &c., were freely taken with the most decided benefit. Per. fect rest was enjoined, and with regard CASE OF to local treatment, cold evaporating lotions were first used, with much success, to abate SWELLING AROUND THE the inflammation and swelling, followed by KNEE-JOINT. the application of a poultice to accelerate By FRED. S. GERVIS, Esq., M.R.C.S.L., the formation of the abscess, which was Tiverton. opened by a lancet. In order to arrest the progress of the matter towards the thigh, a AT the commencement of August, 1830, firm compress and bandage was placed on I visited Miss Loosemore, aged nine years, the upper part, and pressure maintained who was affected with a considerable swell- above and below by broad straps of plaster, ing around the right knee-joint. On in- and a roller frequently applied. In order quiry into the history of the case, I found to bring the sides of the sinuses together, that about nine months previously she had pieces of sheet-lead and pads of differPDt fallen down the stairs and struck her knee, dimensions were used, and the whole joint which subsequently began to swell and in- was surrounded by a bandage. As the general Blisters and other means health improved, the parts began to wear a crease in size. were I believe had recourse to prior to the more healthy aspect, the matter discharged period of my attendance, without relief. became less in quantity, and of a better apWhen I first examined the joint, there was pearance, and the sinuses gradually to close. considerable external inflammation, with There was now more firmness in the limb, two sinuses on the posterior part, in the and the heel began to descend without much situation of the popliteal region, from which effort or pain in the attempt. The system a serous and ichorous fluid continued to of strapping with a soft plaster was purdischarge. One large abscess had begun to sued, with a bandage repeatedly put on, form on the inner side of the joint, which and the joint in this state was kept wet was subsequently opened with a lancet, and with a cold lotion, which had the effect of which terminated in a sinus extending con- producing a softness of the parts, and giv. siderably in two or three directions. An- ing additional flexibility to the limb. Stimuother abscess had formed just below, oppo- lating embrocations were in the subsequent site to the tendinous insertion of the mus stages had recourse to, and the plaster and cles of the thigh, which, in a very short bandages were used less frequently; the time, healed. The heel was elevated about size of the joint continued evidently, to an inch and a half from the ground as far as diminish, and the sinuses to close, ena. I can judge, so that the foot could not rest bling the young lady, with the assistance in its proper situation, or an erect position of crutches, to enjoy the open air, and to be maintained. There was considerable take occasional exerciseFrom this period stiffness about the joint, accompanied with daily improvement was visible in the gene-
493 ral health, as well as in the appearance of the joint, which began to assume its usual form, and to resume its wonted function, so that a slight alteration in the gait was all that could be discerned. The period of time which elapsed during this plan of treatment was five months, since which several months have transpired without any return of the complaint, the patient enjoyingthe perfect use of the limb. June 26,1831.
the child, at which period it did not appear than a walnut. Nothing was done for it, but the mother was requested to bring the child again to me, or give intimation in the event of the tumour bursting. In consequence she again applied at the dispensary on the 2nd of February, J 310, when the child was seen by the late Mr. Gelston, at that time the visiting apothecary of the institution, who directed-some simple local application, and gave it two grains of submuriate of mercury in sugar.
larger
CASE OF HYDRORACHITIS.
By
THOMAS
JEFFREYS, M.D., Liverpool.
send you the following case it has lain dorfor upwards of twenty years. Those of your readers who have’arrived at the same maturity in their practice as myself, I am fully aware it can only muse, but as it is intended more for those who belong to the rising medical generation, I trust the case may not be altogether useless, as an account of the appearances, progress, and termination, of hydro rachitis. I may avail myself too of this opportunity to enforce upon students in medicine and surgery the benefits they will derive by early and unremittingly habituating themselves to recording facts, to com. mitting to paper the results of their practice, and to preserving, in some form or other, On the 5th I saw it myself, but instead the conclusions they may draw from reading and reflection, if it be only even for the of finding the tumour broken and dischargprivate gratification which the practice will ing as I expected, it had increased in size atlord them, and which neither wealth, nor and tension, more especially at the upper hoaours, norrank, can impart. I have been part-appearing now nearly as broad as the led into these remarks by accidentally child’s back, and irregularly distended. dropping upon the following case, and the What the mother supposed to be a rupture drawing which accompanies it. I well re- of it, was merely all oozing from the right collect how much it interested me at the side, which she described as pus. Not’time, and how much it did towards fanning withstanding this horrid state of the disease the flame of science in the breast of my the little patient was lively and in good youngpupil Mr. Bridge, at that time an health, and, indeed, in all other respects apprentice in the Liverpool Dispensary (and was a beautiful and most interesting to whom I am indebted for the accurate The powder was taken daily, drawing I now send you), but whose preco- generally producing two alvine evacuations. cious talents were built upon too delicute a The circumference of the base of the tumour constitution to permit his mental powers to was eighteen inches. arrive at maturity. 16th. The tumour appears much in the Jane Ainsworth, aged eight months, was same state, except that it is perhaps larger, brought to me as a dispensary patient on although ;ic now measures round the ba,u the 9th of December, 1809, having a large, only fifteen inches, and from base to base, reddish, tense, elastic, and semi-transparent both longitudinally and laterally, only eleveit tumour, situated upon the lumbar vertebrae, inches. its appearance is thin and transpathe size of which was nearly equal to the rent. The child’s general health continues head of the child, occasioning apparently good. no inconvenience, nor producing any emacia- June 7th. Visited by Mr. Gelston, who tion of the body. The mother said it had reports that on the 4th the membrane be. been gradually increasing since the birth of came extremely -thin, and a slight oozing I
VENT17 RE to
of
hydrorachitis, although mant in my possession
infant.
!
I