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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    from whom he excised the knee-joint, January 12, 1855, he says:—“The leg is an inch shorter than its fellow, but is evi¬ dently keeping pace in growth with it, and the rest of the body. In my former essay I described the various ways of incising the soft parts, and the operative methods preferred by different surgeons: exception being taken to that recommended by Mr. Syme, from its perfectly unwarrantable nature. In my former essay I laid stress upon the propriety of di¬ viding the bones from behind forwards by means of a fine saw, which I invented and described. One word in reference to this instrument—it is now used most extensively, and I have been gratified to hear of its efficiency in other hands besides my own, even from some of the first operating surgeons in England. In my former essay I laid great stress upon the mode of managing the limb immediately after the operation; how that it should be placed in the extended position and retained so, in a solid case specially made for the purpose, before the patient was taken from the operating table. The difficulties to be over¬ come in obtaining this result were likewise considered, and modes prescribed according to the exigency of the case. Even here I have advised the division of the hamstring tendons, and in these words:—“But if this method fails (speaking of the milder mode by traction, &c.), and it will most likely do so in those cases where the leg has been for a length of time flexed upon the thigh, and the muscles have assumed a spastic con¬ traction of a settled character,—here I would most certainly recommend the surgeon to divide the hamstring tendons (in preference to cutting off another piece of the healthy bone) ; this becomes more imperative when the head of the fibula has not been removed, and the tendon of the biceps interfered with ; it is the powerful and spasmodic action of these hamstring muscles, dragging the leg upwards and backwards, that creates, to a great extent, the deformity, by the thrusting of the thigh¬ bone forwards: by their division, then, not only is reduction easily secured, but all tendency to after-displacement checked. ’ This paragraph, I think, anticipates by more than a year one of ]NIr. Hutchinson’s Two Suggestions respecting Excision of the Knee-Jointa. And I think my directions have likewise forestalled the second—“Making an opening in the popliteal space.” After enumerating various methods of operation, I con¬ tinue :—“ By incisions planned after either, the joint can be very a Two Suggestions respecting Excision of the Knee-Joint, by Jonathan Hutchin¬ son, Esq., Surgeon to the Metropolitan Free Hospital.—Medical Times and Gazette,