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GREAT NORTHERN HOSPITAL.
369 ST. THOMAS’S HOSPITAL.
Medical Societies.
CASE OF DISLOCATION AT THE KNEE-JOINT.
(Under the
care
of Mr. LE GROS CLARK. )
ROYAL MEDICAL AND CHIRURGICAL SOCIETY.
DISLOCATION of the knee-joint is not a common accident, TUESDAY, MARCH 13TH, 1866. and the displacement in this instance was not directly lateral. DR. ALDERSON, F.R.S., PRESIDENT. Considering the amount of injury inflicted on the ligaments internal and external to the joint, it is remarkable that these cases of partial dislocation should recover so quickly and well NOTES AND OBSERVATIONS ON FEVER DURING SERVICE ON BOARD H.M. SCREW CORVETTE, "PYLADES," ON THE WEST as they frequently do, and as was exemplified in this instance. COAST OF MEXICO IN THE YEAR 1860. (WITH MAP.) T. W-, a farm labourer, aged fifteen, was admitted on A before admission he had been 1865. short time BY JOHN CADDY, M.D., SURGEON, R.N. July 20th, thrown down and dragged under a harrow, which passed over (Communicated by Dr. HODGKIN.) his right leg. The limb was much bruised, and the knee was AFTER to the previous services of the Pylacles at referring of the tibia thrown behind distorted, the head being partially and to the outer side of the condyloid surface of the femur. Calcutta at the time of the Indian mutiny, and the subsequent The joint was thus expanded obliquely, and the patella pro- beneficial change produced on the crew by the climate of VanIsland in 1859, the author gave a statistical statement jected on its outer side. Extension and inversion of the leg couver’s of the fever cases on board when on the west coast of Mexico was followed by a restoration of the bones to their normal 1860, and drew inferences as to the greater liability of attack relation, and the limb was at once placed, slightly flexed, in a in in the ratio of greater age, and of the excess in length of the Liston splint. Considerable synovitis and effusion followed, and the swelling on the inside of the knee indicated that a sickness when treated on the coast to that treated in the ship. climates and geographical position of Mazatlan, Panama, portion of the internal vastus muscle must have been ruptured. LaThe Paz, Guaymas, San Blas, &c., and the comparative lengths This lad remained under treatment until Sept. 20th, being their dry and rainy seasons, were then described. The permitted latterly to get about with crutches and a knee sup- of arrived at Mazatlan in January, 1860, and details were Pylacles He the left port. hospital with a useful limb, though it was given of the first cases of remittent fever which occurred on still weak, and required the support of a knee-cap. board as they entered the Mexican tropics. Numerous cases of continued fever followed after the 21st of February, which were considerably added to by the occurrence of duties which GREAT NORTHERN HOSPITAL. involved much solar exposure, and the constant alternate landTREATMENT OF HIP-JOINT DISEASE BY GUTTA-PERCHA ing of officers and men for duty on shore at San Blas, up to the SPLINTS. beginning of June. The number of cases increased during the short passages between Mazatlan, La Paz, and Guaymas up to of the care Mr. (Under GAY.) the end of September ; but from that time the men’s health A FEW weeks since we noticed at this hospital a boy improved as the cool season advanced. suffering from disease about the hip-joint, in whom Mr. Gay The author then described the general symptoms seen in adopted a method for securing quietude which seemed very patients when first attacked, and the usual course of those as the fever increased. Only one case proved fatal. simple and to answer its purpose very well. When the limb developed vomit Black was of rare occurrence, it being unknown in the had been brought as nearly as possible in a line with the trunk, fevers at the commercial towns of San Blas, Mazatlan, and a large piece of gutta-percha, softened in hot water, was folded Guaymas. over the hip, lower part of abdomen and thigh, lint being inThe author, in describing his treatment, which proved most troduced to act as padding, and the whole firmly confined by successful, included fresh breathing-air, personal ablution, bandaging. When cool, the apparatus formed a firm support, close cutting of the hair, full supply of cooling drinks (those which allowed of no movement of the hip-joint, and yet per- made with the mineral acids being preferred), pouring of seamitted the patient to move about with a stiff limb on crutches. water on the head, mustard sinapisms and chloroform liniBefore this treatment was adopted the child was constantly in ments, and the of sesquicarbonate of ammonia in congiving pain, the limb somewhat fiexed, and not able to be moved with- junction with chlorate of potash early in the fever, the ammonia out distress. A week afterwards the child was brought to the having been suggested to the author by a previous West Indian hospital. He then walked without uneasiness, but with a experience in 1845-47, and at Calcutta in 1858. With the cesslight limp, and bore almost any movement of the joint with- sation of active symptoms, quinine and iron usually and speedily out appearing to suffer in the slightest degree. concluded the treatment of the cases. The value of the above In another case, also, the benefit of this proceeding was well treatment, the author said, he had been able to confirm by a marked. A girl of fourteen years of age was brought to the subsequent ten months’ service in the Gulf of Mexico in 1862, hospital six months ago with advanced hip-joint disease, with- and again among the West Indian Islands in 1863 in H.M. out, however, formation of abscess; although Mr. Gay thought screw frigate Plaaetora. it likely that absorption of a portion of the head of the femur Details followed of the total number and length of cases of had taken place. There was the usual semiflexed and everted fever in these later expeditions, and a summary of other disposition, with intense pain constantly, and especially on move- eases, which made up the total of 518 cases of sickness on ment. The patient being under the influence of chloroform, board the Pylucles in 1860, concluded the paper. Mr. Gay drew down the thigh, and placed the limb in a guttaThe PRESIDENTsaid the disease could not have been grave, percha case. All pain ceased. She left the hospital in six or the treatment must have been very good, to have resulted in weeks, still wearing the splint, and with instructions to move so great success. There had been no autopsy to confirm any about on one leg and supported by crutches. opinion as to the type of the fever. On March 17th she again presented herself. The flexion of Mr. GASKOIN thought papers on fever sent by surgeons from the thigh was found somewhat limited, but what movement remote parts of the world were most welcome contributions. there was took place without any pain. Her health, which He supposed the fever in Dr. Caddy’s cases was remittent, as had been very bad, was perfectly restored, and she suffered no’ during recovery it assumed an intermittent type, and there pain in the part. She walked about with one crutch at times, were as complications hemicrania and paralysis. It was not and often without any. The limb is apparently slightly short- clear to what this fever could have been due. Attention had ened, and a little everted. With the exception of a limp, recently been directed to the effect of "coaling" under an slight eversion, and somewhat lessened mobility at the hip- ardent sun as a possible cause of fever. Mr. Gaskoin concluded joint, the limb is as well as ever. by saying that a few months ago he saw in St. George’s HosMr. Gay told us that he had now adopted this plan of treatment for several years, and has every reason to feel satisfiedl whether the ammonia was theoretically wrong or not-the with its convenience and excellent results. patients thus treated did well. Dr. CADDY said his object was to bring forward the treatCHOLERA. Quarantine has been established atb ment by ammonia as treatment against that by calomel every Fortress Monroe, New Orleans, and all the Texan ports, oni four hours. The calomel treatment produced hypercatharsis account of the presence of cholera in the West Indies and1 and retching, and these were supposed to be symptoms of the disease. His treatment by ammonia had been suggested by parts of Mexico. o 2
I
’
’
’
pital cases of spottedfever treated byammonia, andthat-
-
Medical Societies.
CASE OF DISLOCATION AT THE KNEE-JOINT.
(Under the
care
of Mr. LE GROS CLARK. )
ROYAL MEDICAL AND CHIRURGICAL SOCIETY.
DISLOCATION of the knee-joint is not a common accident, TUESDAY, MARCH 13TH, 1866. and the displacement in this instance was not directly lateral. DR. ALDERSON, F.R.S., PRESIDENT. Considering the amount of injury inflicted on the ligaments internal and external to the joint, it is remarkable that these cases of partial dislocation should recover so quickly and well NOTES AND OBSERVATIONS ON FEVER DURING SERVICE ON BOARD H.M. SCREW CORVETTE, "PYLADES," ON THE WEST as they frequently do, and as was exemplified in this instance. COAST OF MEXICO IN THE YEAR 1860. (WITH MAP.) T. W-, a farm labourer, aged fifteen, was admitted on A before admission he had been 1865. short time BY JOHN CADDY, M.D., SURGEON, R.N. July 20th, thrown down and dragged under a harrow, which passed over (Communicated by Dr. HODGKIN.) his right leg. The limb was much bruised, and the knee was AFTER to the previous services of the Pylacles at referring of the tibia thrown behind distorted, the head being partially and to the outer side of the condyloid surface of the femur. Calcutta at the time of the Indian mutiny, and the subsequent The joint was thus expanded obliquely, and the patella pro- beneficial change produced on the crew by the climate of VanIsland in 1859, the author gave a statistical statement jected on its outer side. Extension and inversion of the leg couver’s of the fever cases on board when on the west coast of Mexico was followed by a restoration of the bones to their normal 1860, and drew inferences as to the greater liability of attack relation, and the limb was at once placed, slightly flexed, in a in in the ratio of greater age, and of the excess in length of the Liston splint. Considerable synovitis and effusion followed, and the swelling on the inside of the knee indicated that a sickness when treated on the coast to that treated in the ship. climates and geographical position of Mazatlan, Panama, portion of the internal vastus muscle must have been ruptured. LaThe Paz, Guaymas, San Blas, &c., and the comparative lengths This lad remained under treatment until Sept. 20th, being their dry and rainy seasons, were then described. The permitted latterly to get about with crutches and a knee sup- of arrived at Mazatlan in January, 1860, and details were Pylacles He the left port. hospital with a useful limb, though it was given of the first cases of remittent fever which occurred on still weak, and required the support of a knee-cap. board as they entered the Mexican tropics. Numerous cases of continued fever followed after the 21st of February, which were considerably added to by the occurrence of duties which GREAT NORTHERN HOSPITAL. involved much solar exposure, and the constant alternate landTREATMENT OF HIP-JOINT DISEASE BY GUTTA-PERCHA ing of officers and men for duty on shore at San Blas, up to the SPLINTS. beginning of June. The number of cases increased during the short passages between Mazatlan, La Paz, and Guaymas up to of the care Mr. (Under GAY.) the end of September ; but from that time the men’s health A FEW weeks since we noticed at this hospital a boy improved as the cool season advanced. suffering from disease about the hip-joint, in whom Mr. Gay The author then described the general symptoms seen in adopted a method for securing quietude which seemed very patients when first attacked, and the usual course of those as the fever increased. Only one case proved fatal. simple and to answer its purpose very well. When the limb developed vomit Black was of rare occurrence, it being unknown in the had been brought as nearly as possible in a line with the trunk, fevers at the commercial towns of San Blas, Mazatlan, and a large piece of gutta-percha, softened in hot water, was folded Guaymas. over the hip, lower part of abdomen and thigh, lint being inThe author, in describing his treatment, which proved most troduced to act as padding, and the whole firmly confined by successful, included fresh breathing-air, personal ablution, bandaging. When cool, the apparatus formed a firm support, close cutting of the hair, full supply of cooling drinks (those which allowed of no movement of the hip-joint, and yet per- made with the mineral acids being preferred), pouring of seamitted the patient to move about with a stiff limb on crutches. water on the head, mustard sinapisms and chloroform liniBefore this treatment was adopted the child was constantly in ments, and the of sesquicarbonate of ammonia in congiving pain, the limb somewhat fiexed, and not able to be moved with- junction with chlorate of potash early in the fever, the ammonia out distress. A week afterwards the child was brought to the having been suggested to the author by a previous West Indian hospital. He then walked without uneasiness, but with a experience in 1845-47, and at Calcutta in 1858. With the cesslight limp, and bore almost any movement of the joint with- sation of active symptoms, quinine and iron usually and speedily out appearing to suffer in the slightest degree. concluded the treatment of the cases. The value of the above In another case, also, the benefit of this proceeding was well treatment, the author said, he had been able to confirm by a marked. A girl of fourteen years of age was brought to the subsequent ten months’ service in the Gulf of Mexico in 1862, hospital six months ago with advanced hip-joint disease, with- and again among the West Indian Islands in 1863 in H.M. out, however, formation of abscess; although Mr. Gay thought screw frigate Plaaetora. it likely that absorption of a portion of the head of the femur Details followed of the total number and length of cases of had taken place. There was the usual semiflexed and everted fever in these later expeditions, and a summary of other disposition, with intense pain constantly, and especially on move- eases, which made up the total of 518 cases of sickness on ment. The patient being under the influence of chloroform, board the Pylucles in 1860, concluded the paper. Mr. Gay drew down the thigh, and placed the limb in a guttaThe PRESIDENTsaid the disease could not have been grave, percha case. All pain ceased. She left the hospital in six or the treatment must have been very good, to have resulted in weeks, still wearing the splint, and with instructions to move so great success. There had been no autopsy to confirm any about on one leg and supported by crutches. opinion as to the type of the fever. On March 17th she again presented herself. The flexion of Mr. GASKOIN thought papers on fever sent by surgeons from the thigh was found somewhat limited, but what movement remote parts of the world were most welcome contributions. there was took place without any pain. Her health, which He supposed the fever in Dr. Caddy’s cases was remittent, as had been very bad, was perfectly restored, and she suffered no’ during recovery it assumed an intermittent type, and there pain in the part. She walked about with one crutch at times, were as complications hemicrania and paralysis. It was not and often without any. The limb is apparently slightly short- clear to what this fever could have been due. Attention had ened, and a little everted. With the exception of a limp, recently been directed to the effect of "coaling" under an slight eversion, and somewhat lessened mobility at the hip- ardent sun as a possible cause of fever. Mr. Gaskoin concluded joint, the limb is as well as ever. by saying that a few months ago he saw in St. George’s HosMr. Gay told us that he had now adopted this plan of treatment for several years, and has every reason to feel satisfiedl whether the ammonia was theoretically wrong or not-the with its convenience and excellent results. patients thus treated did well. Dr. CADDY said his object was to bring forward the treatCHOLERA. Quarantine has been established atb ment by ammonia as treatment against that by calomel every Fortress Monroe, New Orleans, and all the Texan ports, oni four hours. The calomel treatment produced hypercatharsis account of the presence of cholera in the West Indies and1 and retching, and these were supposed to be symptoms of the disease. His treatment by ammonia had been suggested by parts of Mexico. o 2
I
’
’
’
pital cases of spottedfever treated byammonia, andthat-
-