Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner.

Date:
MDCCCXLIX [1849]
Catalogue details

Licence: Public Domain Mark

Credit: Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner. Source: Wellcome Collection.

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    thirteen years of age; the operation was, as regards the result, the same as that of Mr Syme, hut the mode of operating dif¬ fered, in as much a,s M. Robert commenced hy disarticulating the foot, and then car¬ ried the knife behind the os calcis so as to divide the tendo-achillis, and complete the operation by forming the plantar llap last: the malleoli were then sawn off. At the time of the report, three weeks after the operation, the flap had adhered in the greater part of its extent, and the cure was going on favourably. — Annales de Therapeutique, MM. Chir., Sept, and Oc¬ tober 1848. [The modification adopted by M. Ro¬ bert, and which the Parisian editor seems to think less convenient than the usual plan of dissecting up the plantar flap in the first instance, has been performed here in some cases, and for our own part, after having tried both plans repeatedly on the dead body, and performed them both on the living, we think the method pursued in M. Robert’s case is preferable, as being rather more expeditious, and, what is of greater consequence, causing less twisting and disturbance of the tissues composing the plantar flap, than where we begin by dissecting up that flap. The French editor remarks, that the ankle- joint amputation is at present engaging much attention in Paris, as to the after condition of the patient in regard to their ability to use the stump for walking. We should have thought the facts published by Mr Syme and others, in this country, and the cases of MM. Baudens and Jules Roux, &c., in France, would have satisfied the most sceptical. But it seems that M. Bauden’s patient, after walking perfectly on the stump with the assistance of a simple shoe with a metal plate, for up¬ wards of two years, had to submit to amputation of the leg for a return of the disease (caries). Some of the Parisian surgeons choose to attribute this to the stump being badly adapted for walking. As regards the recorded facts of Mr Syme and J. Roux, they seem to wish to form their judgment from the cases operated on within their own immediate sphere, rather than from facts reported from a distance. Of two patients operated on by M. Blan- din, one is dead, and the other is cured, but the superficial sinuses which existed before the operation continue open. M. Blandin is of opinion that the patients should use an artificial leg, like that worn after amputation above the malleoli, in¬ stead of walking on the stump, and on this account he does not saw off the malleoli. We have noticed these opinions in refer¬ ence to this amputation, to show how far prejudice and preconceived ideas, backed by a few isolated and misinterpreted facts, will go to prevent the general adoption of an operation, the advantages of which one would think almost self-evident. To the profession in this country, where the operation is established, and its advantages universally admitted, no comment is need¬ ed on the doubts expressed by the Parisian surgeons.] 13. —Amputation of the Thigh. By M. Baudin.—In amputating at the upper third of the thigh, on account of a gun¬ shot wound, M. Baudin combined the flap and circular operations, by making, from without inwards, a small anterior flap, consisting only of the skin and cellular tissue, and then completing the operation by the circular incision. He considers this method to possess the following advantages. The semilunar flap, falling from its own weight, covers the wounded surface—the edges of the wound are more easily kept in contact— there is a free exit for the purulent dis¬ charge—and the cicatrix being situated behind, is not so liable to be injured by wearing an artificial limb.—Gazette des Hopitaux, 9th November. 14. —Case of undescribed Congenital Malformation of the Shoulder-Joint, simu¬ lating Congenital Dislocation. Dr Bel¬ lingham, on examining a patient, noticed that his right shoulder and arm presented a very different appearance from the left; the muscles, particularly the deltoid, being atrophied, and the bulk of the arm being one-half that of the opposite limb, in which the muscles were largely developed. He could not raise the arm to a right angle with the body, but all the underhand mo¬ tions were well performed, and he stated that he could carry heavy bodies in the hand. On being questioned, he said this had been the eondition of the arm as long as he could remember; he had never re¬ ceived an injury in the part until two or three years since, when the clavicle on that side was fractured. On examination, the shoulder-joint pre¬ sented somewhat the appearance of a congenital dislocation ; the acromion pro¬ cess was very prominent, the deltoid 1 muscle scarcely developed, and the arm about half the size of the opposite limb; in every motion of the joint, the scapula moved with the humerus, as if anchylosis had taken place; the arm could not be brought to a right angle with the body ; when raised nearly to this point, there was a sudden check to its further elevation. The head of the humerus did not form any prominence in the axilla, nor was there a vac.ant .sp.ace between the acromion pro-