The formation of abnormal synovial cysts in connection with the joints / by W. Morrant Baker.

  • William Morrant Baker
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: The formation of abnormal synovial cysts in connection with the joints / by W. Morrant Baker. 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 size, at that time, of a hen’s egg, and this has gradually in- creased in size. The swelling, which at the time of his admis sion measured about 4 inches in length by 3 in breadth, was situated at about the middle of the upper arm in front, immedi- ately over the biceps muscle, to which it seemed to be adherent. It fluctuated readily, and was formed obviously by a sac of some kind containing fluid. It had been punctured on the previous day in the surgery by a grooved needle, and a small quantity of thin straw-coloured fluid had escaped. There was slight redness of the skin over the swelling, but it nowhere “ pointed ” like an abscess. At this time no complaint was made regarding the shoulder-joint, and nothing regarding its condition was recorded in the notes. [Three years previously the patient had undergone amputation of the thigh on account of “ white swelling ” of the knee-joint. Beyond this there was nothing apparently worth noting in his previous history, unless that he had had an abscess in each groin about four years ago, and that he had had small-pox.] From the general character of the swelling, and the absence of complaint on the part of the patient of any symptom which might have guided one to a different diagnosis, I came to the conclusion that the tumour must be either a simple cyst or a chronic abscess, and gave directions that it should be again punctured. The house-surgeon accordingly punctured it with a tenotomy knife. About two ounces of straw-coloured fluid escaped first; then the fluid became blood-stained, and this was followed by the escape of about a dessert-spoonful of curdy lymph or pus. On examination the fluid was found faintly alkaline, and became solid on boiling. Mixed with liq. potassse it became slightly gelatinous. The pus (?) was slightly soluble in cold liq. potassae, and completely so on boiling. [The urine was normal. Sp. gr. 1025.] Oct. 2, 1883.—To this date (four days after the puncture), the patient had had no pain in the arm ; a good deal of clear fluid had escaped from the site of the puncture. _ On the following day the patient complained of headache, and his temperature rose to io2°F. Pulse 100. In the evening the temperature was 104° F. A good deal of purulent fluid escaped from the wound. Oct. 6.—The temperature was at this date 1020 F. There had been less discharge from the wound. At about this time the patient first complained of pain in the shoulder, and I begati to suspect the true nature of the swelling ol the arm. But unless I had previously known that a synovia