Excision of the larger joints of the extremities / by H. Culbertson.

  • Culbertson, H. (Howard), 1828-1890
Date:
1876
Catalogue details

Licence: Public Domain Mark

Credit: Excision of the larger joints of the extremities / by H. Culbertson. Source: Wellcome Collection.

    37/794 (page 11)
    29 are primary, or 36.70 per cent. 38 intermediate, 48.10 12 secondary, 15.20 79 total cases, 100 The mortality was therefore about 11 per cent, greater in the intermediary cases than in the primary; but the latter class exhibits a mortality greater by 21 per cent, than that shown in the secondary excisions. The contrast in the death-rate is still greater when we institute the comparison between the secondary and intermediary operations, in which a difference in the I'esults is evident in favor of the secondary excisions of nearly 33 per cent. This table, therefore, seems to indicate the propriety of per- forming secondary excisions of this joint for gunshot wounds. But what are the risks in this course ? It is certain that a large number of cases subjected to this course will pass through numerous dangers before the secondary period is reached, and during this time these patients are under the influence of the con- servative treatment. AVhat then is the effect of this period upon the progress of the cases ? B. von Langenbeck,^ in his Tables No. 1 and 2, considers this subject. He here cites 88 cases of gunshot wounds of the hip-joint treated by the conservative method during the late Franco-Prussian war. Of these, 25 recovered and 63 died, a mortality of 71.59 per cent. This compares favorably with the mortality shown by this table of 106 cases with 13 recoveries; equal to 87.60 per cent. That is, the conservative plan of treatment gives better results by about 16 per cent. This is a large difference in a question involving an operation of such magnitude as excision at the hip-joint. It is possible that in some of the cases treated conservatively by Prof Langenbeck, and other eminent surgeons, during the late for- eign war, it may ultimately be found that the cavity of this joint was not opened in instances in which it was supposed to have been, and hence the results of this treatment in such cases cannot appropriately be compared with the effects of excisions of this articulation,^ ' Arch, fur Klin, Cliirg., B. 16, H, 2, § 309, et seq. 2 In thirteen (13) of tlie cases in Prof. Langenbeck's table No. 1 (viz. num- bers 4, 5, 6, 8, 9, 11, 15, 16, 18, 21, 22, 23, and 25), which were treated conserva- tively, there would sei-m to be doubts that the joint was directly involved, and if !< was not in these instances, the value of the <;onc]usious in this series of exam- ples thus treated conservatively is greatly impaired.