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ROYAL SURREY COUNTY HOSPITAL.
42 walk with a stick. He left the hospital this day, with tumuch decreased in size, quite hard, with no pulsation ; fact, cured.
in
Provincial Hospital Reports.
mour
BRISTOL GENERAL HOSPITAL.
ROYAL SURREY COUNTY HOSPITAL. SIGNORINI’S TOURNIQUET
PATELLA ; SYNOVITIS ; SUPPURATION; JOINT ; RECOVERY. the care of Mr. ATCHLEY.)
INCISED WOUND OVER
A CASE OF ANEURISM OF POPLITEAL CURED BY MEANS OF
INCISION INTO
AFTER FLEXION
(Under
HAD FAILED.
THE following case, for notes of which we have to thank Mr. J. B. Withington, is interesting as furnishing evidence of the great value of free and early incision into a suppurating joint, and may serve to illustrate the importance of diagnosing correctly between disorganisation of a joint the result of primary disease of synovial membrane, and disorganisation of joint secondary to disease of the osseous structures, upon which to so great an extent the treatment
(Under the care of Mr. EAGER.) THE chief points of interest in this case are, that, althougl flexion did not curethe aneurism, it produced, by mean! of the strap causing compression upon the femoral, a cer tain amount of collateral circulation ; that, when tht tourniquet was applied, the pain was not very severe ; thai the patient could bear it very well, and with the opium a1 night had a moderate amount of sleep ; and that the partial stoppage of circulation through the femoral caused nc depends. In the present case, tension and constitutional irritation cedema of the leg. 3,lr. Thomas F. Hopgood, house-surgeon, were relieved, absorption of pus into the system effectually has obliged us with the notes. James R——,aged thirty-three, was admitted April 10th, prevented, and the treatment has terminated in the most 1868, suffering from aneurism of the popliteal artery. satisfactory condition of perfect anchylosis in a good and Patient says he was in very good health up to about six serviceable position. months ago, when he first noticed a swelling about the size William M , cooper, aged seventeen, was admitted on of half an egg, his attention being called to it by great March6th, for acute synovitis, following a wound done with pain in the leg. This got gradually worse, until about two a drawing knife three days previously. He had applied for weeks before admission. The only thing he can recollect relief at the time of the accident; but, although warned of was, that some time before he found the swelling he had a the danger he incurred, he refused to come into the hosblow in the bend of the knee, but says that he felt nothing pital ; consequently, the limb was fixed on a straight back of it at the time. Upon examination, his heart, lungs, and splint, and the wound (which did not penetrate the joint) dressed with carbolic oil. kidneys were found to be quite healthy. Mr. Eager attended him a short time before admission, When admitted, there was great swelling and some tenand found, upon examination, that the limb below the knee derness around the joint; the wound gaped on the removal was much tumefied, and the superficial vein much enlarged, of the sutures, but there was very little discharge, and no - a tumour in popliteal space, large and pulsating strongly, synovia. The leg was placed in a McIntyre splint, and cold with a considerable amount of cedema around it. The only irrigation applied continuously to the knee for forty-eight treatment used before admission was rest, the leg being hours ; but as the discharge from the wound increased, and elevated and evenlv bandaged. there was no diminution of the heat and swelling, this was Upon admission, the swelling of the leg was nearly gone discontinued, and poultices applied. was placed in bed, kept on very low diet, and had flexior as it was evident there was a great quantity On the of the leg with pad in popliteal space. This gave rise tc of pus in the joint, Mr. Atchley made a free incision on considerable pain, and he was unable to bear it very tight. either side, so that the forefinger could be passed easily The manner in which flexion was produced was by means of through, beneath the patella. The poultices were continued, a strap, which controlled the femoral artery to a certain and he was ordered beef-tea, eggs, milk, and four ounces of degree. This was continued till June, the tumour up to ’ wine.-At 9 P.M., his pulse was 120; temperature 1018°. 14th.-9 P.M.: Pulse 128 : temperature 102°. May having become less, but far from being cured. June 27th.-He began to take acetate of lead, one grain,. A.M.: Pulse 120; temperature 100.9°.—1 P.M. : twice a day, which was gradually increased to three grains Pulse 133; temperature 1029°. Ordered quinine and iron, a day, up to July 13th, when, as the lead had affected the and eight ounces of wine. 17th.-10 A.M.: Pulse 140; temperature 1014°. Ordered system, the blue line being marked along the gums, and the tumour not having diminished in size, he was ordered to’ eight ounces of brandy daily, instead of wine. have his medicine stopped, bandages removed, and to try 18th.-Pulse 128; temperature 1008°. to get the leg straight. Unable to straighten the leg more 19th.-Pulse 120; temperature 99.8°. than at a right angle to the thigh. To take full diet, quinine 20th.-Pulse 100. mixture, tincture of muriate of iron, and have Signorini’s From this time he improved continuously, the discharge, tourniquet applied to the femoral artery sufficient to nearly at first very profuse, gradully lessened, and his pulse and stop the circulation. When the tourniquet was applied suf- temperature fell. He has occasionally had an opiate at ficiently tight to stop circulation in the sac, there was still night, and a purgative when required. distinct pulsation felt in the tibial artery. To take tincture May 9th.-There is still some discharge from the inner of opium, twenty-live minims, to allay the pain at night. and great pain and tenderness only when moved; opening, July 15th.-Tumour smaller, very little pulsation in sac, otherwise is very comfortable, and improving in health. He To con- has now two ounces of brandy daily, and meat. even when the tourniquet is nearly unscrewed. tinue as before, with opium at night. He has been kept in the most absolute rest till June 6th, 18th.-Tumour much harder, and less pulsation when when he was allowed to get up, with a leather splint entourniquet is unscrewed. casing his knee. He has had no pain for some time past, 23rd.-Tourniquet entirely removed. There is no pulsa- and the incisions, with the original wound, are perfectly tion ; the tumour is quite hard. The tourniquet to be still healed. .
,
13th,
15th.-10
applied. 25th.-Tourniquet to and continue medicine at
night.
be left off, but to still keep in bed, before, but to discontinue opium
as
27th.-Allowed to get up for the first time.
Leg unable
to be straightened more than at right angles to the thigh. General To use crutches, and try to straighten the leg. health much improved. 30th.-Can now get about very well with crutches. Leg much straighter. August 23rd.-From July up to this time he has gradually improved, and is now able to get his foot to the ground, and
AN UNUSUAL
INQUIRY.—Bordeaux has
a
very
use-
ful Lock hospital, of which M. Venot, a specialist of great repute, is the surgeon. M. Venot’s views as to certain late symptoms in prostitutes-viz., various destructions or thickenings of parts originating in syphilis, which have lost their specificity-are peculiar. He considers girls found with such symptoms to be harmless. The lay committee of the hospital have expressed some anxiety on the subject, and they have entrusted M. Jeannel, head pharmacian of the military hospital, to inquire into M. Venot’s practice. M. Jeannel has accepted this rather invidious task.
in
Provincial Hospital Reports.
mour
BRISTOL GENERAL HOSPITAL.
ROYAL SURREY COUNTY HOSPITAL. SIGNORINI’S TOURNIQUET
PATELLA ; SYNOVITIS ; SUPPURATION; JOINT ; RECOVERY. the care of Mr. ATCHLEY.)
INCISED WOUND OVER
A CASE OF ANEURISM OF POPLITEAL CURED BY MEANS OF
INCISION INTO
AFTER FLEXION
(Under
HAD FAILED.
THE following case, for notes of which we have to thank Mr. J. B. Withington, is interesting as furnishing evidence of the great value of free and early incision into a suppurating joint, and may serve to illustrate the importance of diagnosing correctly between disorganisation of a joint the result of primary disease of synovial membrane, and disorganisation of joint secondary to disease of the osseous structures, upon which to so great an extent the treatment
(Under the care of Mr. EAGER.) THE chief points of interest in this case are, that, althougl flexion did not curethe aneurism, it produced, by mean! of the strap causing compression upon the femoral, a cer tain amount of collateral circulation ; that, when tht tourniquet was applied, the pain was not very severe ; thai the patient could bear it very well, and with the opium a1 night had a moderate amount of sleep ; and that the partial stoppage of circulation through the femoral caused nc depends. In the present case, tension and constitutional irritation cedema of the leg. 3,lr. Thomas F. Hopgood, house-surgeon, were relieved, absorption of pus into the system effectually has obliged us with the notes. James R——,aged thirty-three, was admitted April 10th, prevented, and the treatment has terminated in the most 1868, suffering from aneurism of the popliteal artery. satisfactory condition of perfect anchylosis in a good and Patient says he was in very good health up to about six serviceable position. months ago, when he first noticed a swelling about the size William M , cooper, aged seventeen, was admitted on of half an egg, his attention being called to it by great March6th, for acute synovitis, following a wound done with pain in the leg. This got gradually worse, until about two a drawing knife three days previously. He had applied for weeks before admission. The only thing he can recollect relief at the time of the accident; but, although warned of was, that some time before he found the swelling he had a the danger he incurred, he refused to come into the hosblow in the bend of the knee, but says that he felt nothing pital ; consequently, the limb was fixed on a straight back of it at the time. Upon examination, his heart, lungs, and splint, and the wound (which did not penetrate the joint) dressed with carbolic oil. kidneys were found to be quite healthy. Mr. Eager attended him a short time before admission, When admitted, there was great swelling and some tenand found, upon examination, that the limb below the knee derness around the joint; the wound gaped on the removal was much tumefied, and the superficial vein much enlarged, of the sutures, but there was very little discharge, and no - a tumour in popliteal space, large and pulsating strongly, synovia. The leg was placed in a McIntyre splint, and cold with a considerable amount of cedema around it. The only irrigation applied continuously to the knee for forty-eight treatment used before admission was rest, the leg being hours ; but as the discharge from the wound increased, and elevated and evenlv bandaged. there was no diminution of the heat and swelling, this was Upon admission, the swelling of the leg was nearly gone discontinued, and poultices applied. was placed in bed, kept on very low diet, and had flexior as it was evident there was a great quantity On the of the leg with pad in popliteal space. This gave rise tc of pus in the joint, Mr. Atchley made a free incision on considerable pain, and he was unable to bear it very tight. either side, so that the forefinger could be passed easily The manner in which flexion was produced was by means of through, beneath the patella. The poultices were continued, a strap, which controlled the femoral artery to a certain and he was ordered beef-tea, eggs, milk, and four ounces of degree. This was continued till June, the tumour up to ’ wine.-At 9 P.M., his pulse was 120; temperature 1018°. 14th.-9 P.M.: Pulse 128 : temperature 102°. May having become less, but far from being cured. June 27th.-He began to take acetate of lead, one grain,. A.M.: Pulse 120; temperature 100.9°.—1 P.M. : twice a day, which was gradually increased to three grains Pulse 133; temperature 1029°. Ordered quinine and iron, a day, up to July 13th, when, as the lead had affected the and eight ounces of wine. 17th.-10 A.M.: Pulse 140; temperature 1014°. Ordered system, the blue line being marked along the gums, and the tumour not having diminished in size, he was ordered to’ eight ounces of brandy daily, instead of wine. have his medicine stopped, bandages removed, and to try 18th.-Pulse 128; temperature 1008°. to get the leg straight. Unable to straighten the leg more 19th.-Pulse 120; temperature 99.8°. than at a right angle to the thigh. To take full diet, quinine 20th.-Pulse 100. mixture, tincture of muriate of iron, and have Signorini’s From this time he improved continuously, the discharge, tourniquet applied to the femoral artery sufficient to nearly at first very profuse, gradully lessened, and his pulse and stop the circulation. When the tourniquet was applied suf- temperature fell. He has occasionally had an opiate at ficiently tight to stop circulation in the sac, there was still night, and a purgative when required. distinct pulsation felt in the tibial artery. To take tincture May 9th.-There is still some discharge from the inner of opium, twenty-live minims, to allay the pain at night. and great pain and tenderness only when moved; opening, July 15th.-Tumour smaller, very little pulsation in sac, otherwise is very comfortable, and improving in health. He To con- has now two ounces of brandy daily, and meat. even when the tourniquet is nearly unscrewed. tinue as before, with opium at night. He has been kept in the most absolute rest till June 6th, 18th.-Tumour much harder, and less pulsation when when he was allowed to get up, with a leather splint entourniquet is unscrewed. casing his knee. He has had no pain for some time past, 23rd.-Tourniquet entirely removed. There is no pulsa- and the incisions, with the original wound, are perfectly tion ; the tumour is quite hard. The tourniquet to be still healed. .
,
13th,
15th.-10
applied. 25th.-Tourniquet to and continue medicine at
night.
be left off, but to still keep in bed, before, but to discontinue opium
as
27th.-Allowed to get up for the first time.
Leg unable
to be straightened more than at right angles to the thigh. General To use crutches, and try to straighten the leg. health much improved. 30th.-Can now get about very well with crutches. Leg much straighter. August 23rd.-From July up to this time he has gradually improved, and is now able to get his foot to the ground, and
AN UNUSUAL
INQUIRY.—Bordeaux has
a
very
use-
ful Lock hospital, of which M. Venot, a specialist of great repute, is the surgeon. M. Venot’s views as to certain late symptoms in prostitutes-viz., various destructions or thickenings of parts originating in syphilis, which have lost their specificity-are peculiar. He considers girls found with such symptoms to be harmless. The lay committee of the hospital have expressed some anxiety on the subject, and they have entrusted M. Jeannel, head pharmacian of the military hospital, to inquire into M. Venot’s practice. M. Jeannel has accepted this rather invidious task.