Second memoir on excision of the knee-joint : to which is appended a remarkable example of the power of operative surgery in saving the same articulation / by Richard G.H. Butcher.

  • Butcher, Richard G. H., 1819-1891
Date:
1857
Catalogue details

Licence: Public Domain Mark

Credit: Second memoir on excision of the knee-joint : to which is appended a remarkable example of the power of operative surgery in saving the same articulation / by Richard G.H. Butcher. Source: Wellcome Collection.

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    an abscess in the situation of the gall-bladder, were found. There was no union of the ends of the bones, but large sinuses about the part. The veins of the lower extremities, and even the iliac veins, were impacted with fibrinous clots; but there were no purulent deposits, so called.” In the report of the case it is stated that the operation afforded an exemption from pain for three months: as much as possibly could have been expected from any operative interference, when such extensive disease of vital organs prevailed. The fifth fatal case, No. xxiii., was operated on by Mr. Cutler. In my mind this case does not fairly come within the category of those of excision of the knee at all. An imperfect operation was accomplished; the diseased car¬ tilaginous surface of one bone removed, while the other was permitted to remain. True, it is stated that the small spot of caries on the tibia was gouged out. But this is not enough, according to my views, for the perfection of the operation of excision of the knee-joint. I contend, if the ar¬ ticulating surface of one bone be taken away, that of the other must likewise be removed, whether diseased or healthy. The thinnest slice will suffice, so that the cut osseous surfaces may lie in contact, and ultimately be grown into each other. The polished cartilage will not unite with the cut bone—no strong, permanent union will cement them together, and Nature, if she has sufficient power, will struggle to remove the cartilage, and then bring about union; but during these efforts profuse dis¬ charge is kept up; the tendency to capillary phlebitis evoked, sinuses are formed, and ultimately the patient, worn out with a partially developed hectic, sinks and dies. The sixth fatal case, No. xxvi., was operated on by Mr. Moore. It is not recorded whether the end of the femur was removed or not; but it is stated:—“ In the evening it was found necessary to open the parts again, on account of hemorrhage; all the sutures were removed, and the parts left exposed for the night.” The irritation created by the disturbance and expo¬ sure of the extensive cut parts, no doubt, contributed to the manifestation of the great constitutional excitement which car¬ ried off the patient on the fourth day. The seventh fatal case, No. xxvii., was operated on by Mr. Fergusson, and died, on the fifteenth day, of extensive phle¬ bitis, pleuritis, and vomicae. The eighth fatal case, No. xxviii., was operated on by Mr. Windsor. It is stated that about “ three hours” after the ope¬ ration “ hemorrhage to so great an extent took place, that he [the patient] became almost pulseless.” From this period con-