A clinical lecture delivered to the students of surgery in the Royal Infirmary of Edinburgh, at the conclusion of the summer course for 1827. Edinburgh, July 1827 / [George Ballingall].

  • George Ballingall
Date:
[1827]
Catalogue details

Licence: Public Domain Mark

Credit: A clinical lecture delivered to the students of surgery in the Royal Infirmary of Edinburgh, at the conclusion of the summer course for 1827. Edinburgh, July 1827 / [George Ballingall]. Source: Wellcome Collection.

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    which was exhibited to you immediately after the operation, the extremity of the tibia was found deprived of nearly the whole of its cartilaginous covering ; the end of the fibula covered with pale spongy granulations ; and the astragalus lying dead in the bottom of the ulcer, imbedded in pus, nearly detached from its connections, and divested of its cartilaginous sur- faces. In commenting upon this case, I observed to you that the extreme youth of this subject was in some respects an advantage to him, and in others the reverse. You must all have seen very extraordinary instances of the system accommodating itself to privations and injuries sustained in early life, and, on the other hand, surgeons have learned by experience that the extreme irritability of childhood is upon the whole rather unfa- vourable to capital operations. I pointed out to you, in reference to this case, several instances in the writings of Dupuytren, of Cooper, of Gooch, of Hey, and of Trye, where the astragalus had been either removed by exci- sion, or separated by the powers of nature, and a useful limb preserved ; and had this boy’s health been more prosperous, I should have been en- couraged to hope for a similar termination here, although, in this case, the ulceration on each side of the joint was a most unfavourable circum- stance, by preventing the application of a splint, or the adoption of any sufficient means to preserve the limb at rest; upon which you know that the successful treatment of wounds and inflammations of the joints so es- sentially depends. I would here notice, more with a view of soliciting information for my- self than of offering it to you, the case of James Dali, a robust hale-look- ing man fifty-six years of age, who was admitted on the 4th of June, with two chronic abscesses—one in the left forearm, and another a little below the right knee. This man was induced, in consequence of some family circumstances, to leave the house a few days after his admission; the ab- scess near his knee having been previously opened by a puncture with a lancet, and about two ounces of matter discharged from it. This is one of four cases which I have now treated in this house, where abscesses have formed in different parts of the limbs, of the face, and of the trunk of the body, without any apparent cause, without any discoloration of the skin, or any considerable pain ; without any evident marks of preceding inflam- mation, and almost without the patient’s knowledge. These abscesses are seated in the cellular membrane, are altogether unconnected with any af- fection of the bones, or of the glandular parts, and often, as in this man's forearm, at a distance from any of the usual seats of scrofulous disease. In Dali’s case, these abscesses were considered as a sequela of rheumatism, but in other instances no such origin has been assigned to them.
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