SURGERY.

648 SURGERY.

mained but to lay the patient on a soit:. Professor ble mattress, and by means of a polly 10

Interesting Surgical Cases, by Weinhold, of Hallé.*—Nos. 1

and 2.

apply

constant extension.

trial, however, convinced

Eight

days

that the caland that the foot must us

ixs was too hard, Cure of an irregular large Callus on the remain two inches shorter. Nothing cerlejt Femur, acrompanied by a shortening tain indeed, could be expected from this of the limb to the extent of two inches, old mode of treatment, as the fracture by a Seton introduced by means of had existed for three months, aud the callns was so hard as to bdffie any me. peculiar boring instrument. chanical remedy. John Xaver R— g, 18 years of age, We were just aboutto con,ider the case a native of Hall, farm-servant, had the as hopeless, when t made kuown in ttte misfortune to break his left thigh bone, pnblic demonstrations of the clinique about its middle, on the 21st of June, under care, all the similar cases nar-

my

1825. A surgeon residing on the spot rated in the history of surgery. No case took the patient under his care, and ob- was found where a callus converted mto served for a few weeks the treatment bone had been resolved by surgical art, necessary in cases of fracture. As ’he and a deformed fracture under this cirmaster required labourers, he consulted otmstunce healrd. It occurred to me that the surgeon whether the servant was not the followillg experiment might be perable to re commence his laboor imme- formed, and I accordingly proposed it. diately. Four weeks after the treatment To bore a hole through the callns, nnd inhad commenced, the patient resumed his troduce a seton somewhat about three lines work at the plough. thich. Afterwards to apply irritating reIt is not at all- curious then that witli medies to the chord wh ich would produce a soft callus, the under and upper frac an inflammation in the bone as well as for. tured surfaces should have rode over one mation of pus, and thus melt down and di. another, to the extent of nearly two minish tlae crillus. Afterwards to apply inches. During ten weeks continued hard extension by the machine to lengthen the labour, a tumour had arisen on the part shortened extremity. This was ouly a ra. nearly as large as the head of a new-born tional experiment that I proposud. No child, which made the patient a complete one could tell how it would succeed; cripple, compelled him to go out of his whether the bone could be inflamed and service, and become a burden on his poor afterwards made to suppurate. As all mother, who could scarcely gain her own hope of healing it otherwise had been en livelihood. The poor woman called on off, thepatient willingly agreed to under go me, in tears, to her unfortunate son. On this operation, which was performed in close examination I tound what I have the followiy way, in presence of my already noticed, namely, that the thigh pupils and certain other medical men. was broken in the middle, shortened by I took the blade of the needle trephine, two inches, and surrounded by a firm which I use in boring into the anuuur large callus; touching it produced very highmorianum, and other hard bony deTowards the knee and positions,’ and fastened it iuto a great pain. joint, as well as above and below, a bow, in the manner that mechanics dt, great quantity of lymph had been thrown when they wish to employ the sameftor out into the cellular texture and interstices piercing metals. Next, withont auy proof the muscles. Both in the direction of vions cutting, the point was thrust through the thigh and knee-joints there were se- the f-kin and muscles, an inch to the exvera) inflammatory spots in the hard cel- ternal side of the arteria cruralis, until it lular substance which ultimately gave rise reached the callus. The bore was now to discharge of pus and formation of set in action by means of the gut-string fistulae. and bow, and in le,s than a minute the In the state of surgical knowledge at anterior side of the callus was pierced. that time the case would have been con- The blade of the needle trephine then sidered as a complete deformity, which passed into a spa:!c of about four inches would stick to the patient as long as he before it reached the posterior part of the lived, rendering him a cripple. The cavity. The posterior side was then bored prognosis under these circumstances was

Iom

very

unfavourable ; indeed, nothing

re-

I

* Weinhold’s Ideen iiber die abnor-

sichtsknochen,

metamorphosen der Hyghtnotsbole, Hufeland and Osann’s Journal der 1810. Practischen, Heilkunde. Berlin, Febru- Ebend, uber die krankheiten der Geary, 1826. &c. 1817. men

*

’

649

moving of the instrument, it was disthrongh, and the point of the instrnment carried through the soft parts, which covered eight weeks afterwards that a were so stretched out by an assistant as complete false joint, with pus in the calf the leg had been formed by the nuto cause little or no pain. Scarcely an The seton was merous splints. ounce of blood was lost. now carried through the callus, having ’ Having been asked by a medical been previously well oiled by means of friend Mho had treated the patient, I unthe bladder. This was accomplished from dertook to operate and cure this false It. being squeezed on the way with the ’joint, according to my peculiar method. !tone forceps. i This differs from that of Dr. Phvsic’s of The patient was treated, during the New York, recorded in the first volume three first days, with cold applications. the Medical Repository, in so far as it On the fourth the chord wis touchedwith of acts more certain and more powerfully. " the halsam of arcaus twice a day, aud as Wardrop, in the fifth voliime of the often carried forwards. For thirteen Medico-Chirurgical Transactiona, has weeks he was not allowed to stir out of given cases where he was obliged to bed, iutt to lie constantly on his back. abandon Dr. Physic’s practice. HutchiIn tfre fifth week, the irritation which the son, in his practical observations, has seton produced in the soft parts softened narrated that he was obliged to retire the the indurated surrounding cellular tex- chord without effecting a cure. After (ure and lymphatic depositions so much, considerable search, I discovered that

the of

"

tlnt it

found necessary to make two the knee joint and one beneath it, to evacuate the pus. These openings, as well as the hard depositions, were all healed afterwards by compression. In the sixth week, inflammatory symptoms began to show themselves again, but they were subdued in 48 hours hy cold applications. In the seventh the long-looked for suppuration of the callus manifested itself at the entrance ami exit of the chord. Closer examination with the fore-finger showed, by the hole that was discovered, that the extension machine ought now to be applied. On the 10th week, such was its success that the diseased limb was only two lines shorter than the sound one. To ensure the cure the seton was allowed to remain until the 12th week, The when the openings were closed. callus in a few weeks became much less; the patient could walk without a crutch ; the deformed limb had nearly the same dtdmeter as the sound one; and finally the youth now proposes to commence the occupation of coachman. was

openings,

one at

week,

cause of the failnre was to be attributed to the too small re-action which a common’ chord can excite, and to the action of the air in producing caries. By making a funnel-shaped wound, and in-

the

a wedge-shaped setaceum; requisite: for the cure are sutftciently secured, as experience has proved.*

troducing

both

On the outer side of the tibia, and at inch and a hall’ from its lower extremity, an incision the length of an inch An eye of was made down to the bone. a trephine needle, armed with a bundle of threads having a wedge-shaped setaceum, was now taken ; the fal,e joint one

soughtforand bored through with the point, and the wedge brought out at the oppo-

site side. The operation did not occupy more time than three minutes. A bad symptom was, during its execution, discovered, namely, that the blood which flowed was mixed with ichor, and the latter increased in quantity by pressure on the calf of the limb. I now perceived that the pus formed in the calf was connected with the false joint, which rendered adhesive inflammation a little problematical. Hectic tever had commenced. The most fluctuating points were opened. A colliquative secretion of pus No. II. commenced, which brought the patient to On the Cure cf a False Joint in the lower the brink ot the grave. Both foreign and part of the left Tibia, between which a,forensic surgeons, who saw the unfortudeposition of lymph. had been formed, with II nate man, for instance, Di s. Wanenberg, a deep seated collection of pus in the calf Harsleben, Kahleis, Zwanzig, Mr. Charles of London, and many other-, of the Leg, were of opinion, that under the chcum"J. C. N—e, 52 years of age, was .stances, amputation above the knee-joint unfortunate in coming down from the fronti should be resorted to. seat of a roach, as io fracture the left tibia The powers of nature, assisted by surabout one inch and a half above the joint et the foot. On the following day thei hmfr was put up in the asual suspensory ; * Vide De Articolatione Spuria, et machine, but unfortunately, perhaps, from ::, novo eam curandi Methodo. Halx, 1822. ,

ti Loudon so:

I

650

patient could carry two pitchers of of and heavy sacks of grain to the 240 bandages, not only was the false i npper story of a granary. Proffesor joint cured, but the pus was also dried WEIN HOLD is, however, of opinion, that and the cure of the natural joint, even such burdens ought net to have been atrestored without anchylosis or stiffness, tempted for the first six months, as there although 13 weeks had passed over. It was home inflammation of the bone at tht must not be omitted, however, that during period alluded to. the secretion of the pus, the patient’s constitution was supported with 40oz. of Peruvian bark. CASE V.

gical art, effected

the

limb.

a

cure, without loss of’ the

For after the

application

’ water

up,

No. III.

The same mode of treatment was adopt. ed in this case, which was a fracture of ten years stand-the os femoris. As the accident, how-

of a False Joint of ing, with Caries and Fistulæ, in the’ ever, had not only injured the bone but right Femur, cured by means of the wedgealso the acetabulum, the want of success is attributed to the hectic which

Case

shaped seton ; in less than three months. J. C. H., 20 years old, a young man from

fever

, supervened.

The

patient died.

the country, broke, at the age of ten, the right femur above its middle. A CASE VI. country surgeon treated him in the usual way, but as his parents were necessitated A case of spina ventosa, in the lefi to attend their work in the field, and to femur of a young man, 19 years of age, leave the youth alone in the house, he which was three inches in diameter and In the 8th, a nine in circumference. The fistulæ which rose in the fourth week. complete false joint had been formed, the disease were laid into which compelled him to make use of a one, on the lips of the wound the stick in walking, at the age of 18. In instrument was introduced, the bone order to gain a better livelihood, he bored, and the seton carried through the changed his occupation of herding cat- hole. On the third day after the operatle, but as his work was much severer,tion, when the pain and inflammation the false joint inflamed, caries of thehad subsided, the seton was besmeared bone, with two fistular openings, soon a balsamic substance and moved followed. On examining the two fistulas, and morning. In this way the night they were found to open in the falsewound was prevented from closing, the joint itself. Both of’them were laid into’ air kept out, and in the thirdweek one, and in the chinks of the soft sub- healthy pus produced. statice the needle trephine was applied, In consequence of the inflammation boring a hole through the thigh ; into this the wedged shaped seton was after-produced the spina ventosa swelled at wards introduced. Cold applicationsthe commencement, and a pain was felt were then applied; a reaction com-at night all round the swelling. As the menced in the fourth week, and beforepreceding cases, however, had pointed the eleventh, the false joint was clearedout that healthy suppuration was the of its small bones, and the separation, consequence, that the best results mconly when the seton was withpreviously unhealthy, became muchceeded and the irritation taken awat. the better. In the twelfth week the callusdrawn was removed at the end of the began to harden. The limb bent nosetaceum weeks. The swelling of the more. The seton was reduced in sizethirteen one-third, and the daily, until only one string was felt. Inbone soon diminished work immediately the thirteenth week, the patient rose, andpatient began light in the sixteenth was so completely cured, after. as to be able to follow his usual occupations.

accompanied

with

CASE IV. This was a case similar to the preceding. The false joint was also in the femur, and healed in the same way. So perfect was the cure, that five months afterwards