Contributions to practical surgery / by William Stokes, jun.

  • Stokes, Sir William, 1839-1900.
Date:
1868
Catalogue details

Licence: Public Domain Mark

Credit: Contributions to practical surgery / by William Stokes, jun. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the disease, which were present both by day, on making the slightest movement, and also by night, when they occurred with a violence and frequency Avhich caused her often to scream, so painfully acute were they. The knee, which had been affected in this way for upwards of eighteen months, was not much swollen, being free from effusion, but over the inner side of the joint there was the peculiar elastic, indiaii-rubber sort of sensation, wliich is so often present in articulations affected with much synovial thickening. The joint was strongly flexed, and any attempts to alter its position were wholly unavailing, owing to the extreme pain that they produced. There was no physical sign or symptom of any organic disease elsewhere to be found. Shortly after the patient’s admission into hospital, I put her under the influence of chloroform, and extended the leg, and kept it in that position by an apparatus, which I made for the purpose, of Si)ark’s prepared lejither. In addition to this, I kept continually applied to the joint the belladonna liniment of the Pharmacopoeia, and internally administered opium and cicuta in large doses, during both day and night. Under this treatment the patient aj)peared for some time to derive benefit, but it was not permanent, and after trying rest and the other treatment I have already alluded to, for more than two months, and not finding any improvement in the patient’s general condition, I determined, should she accede, to have recourse to some operative interference. The patient promptly and positively refused to have an amputation performed, although I expressed my opinion that, owing to her very debilitated condition, I thought the chances of subsequent convalescence would be greater if she selected amputation, in preference to excision, of the knee-joint. To the latter ])rocedure, however, she would only accede. Nor, I confess, was I at all despondent about bringing the case to a successful termination, for there were some features connected Avith it Avhich, I thought, made the resection of the knee-joint a perfectly fitting and justifiable operation to have recourse to. Among others, her freedom from disease elsewhere, and above all, her youth. Resec- tion, therefore, being agreed upon, the next important question for me to determine Avas, what line of incision I should adopt. As I Avas very anxious to preserve the patella, should that bone and its cartilage be found healthy, I anxiously considered the propriety of performing the operation by the single longitudinal incision, one great advantage of Avhich is, that the ligament of the patella and