The pathology of tuberculous bone / by Cornelius Black.

  • Black, Cornelius, 1822-1887.
Date:
1859
Catalogue details

Licence: Public Domain Mark

Credit: The pathology of tuberculous bone / by Cornelius Black. 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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    moderately clean, the appetite regular, and tlie sleep hut little disturhed. There was no tliirst; the bowels were torpid, and menstruation was irregular. In the treatment, the foot and ankle were surrounded by a starched bandage, in which a sufficient opening was made opposite the sinus for the exit of pus. The foot was borne about an inch from the ground l\y a sling passing round the neck, the patient was put upon crutches, and exeici.se in the open air was enjoined. The bowels were at first regulated by alterative doses of mercury with the compound rhubarb pill, and she took regularly, three times a day, four grains of the iodide of potassium in an ounce of bitter infusion. A generous diet was ordered, together with half a pint of porter daily. By and by, the iodide of iron was substituted for the preparation of potash ; and this, in a short time, gave place to the cod-liver oil, which was exhibited for many months, in doses from two drachms at the commencement, to an ounce three times a day at the termination of the case. During the exhibition of the cod- liver oil, a grain of the sulphate of iron, one-fourth of a grain of aloes, a grain of the extract of henbane, and two grains of the extract of gentian, were given in the form of pill every night and morning. Under this treatment she slowly but steadily improved; menstruation became regular, several small portions of dead bone separated and were removed from the sinus which led to their posi- tion, and, in a little more than two years from my first attention to the case, the wound healed. Three years and a half, however, elapsed from the assumption of crutches before the condition of the joint admitted of their being laid aside. Four years have already passed since this occurrence, and the cure remains complete. Her father, writing to me on the 5th of March 1859, says, with respect to this case, that the ankle-joint appears to be “ quite sound ”—that it is not now swollen—that the patient can use it pretty well, but not so freely as the other—that she can manage short distances without fatigue, but that a long walk even yet distresses the joint. The indications of treatment which arise, in the above stage of tuberculosis of bone, have for their object:— I. To remove the diseased bone by manual operation, or to favour its separation. II. To favour the healing process by local and constitutional means, and to relieve urgent symptoms. In fulfilling the former indication, it ought always to be borne in mind, that, before recovery can take place, those portions of diseased bone which have either lost their vitality, or retain this in a very small degree, must be separated from those which are not similarly affected. The first object, therefore, of the surgeon should be—to effect, with as little delay as possible, this separation, by the employ- ment of those means which a full knowledge of the extent of the disease and of the particular features of the case may suggest. Now, it has been already shown, that the extent of the disease may vary from tuberculosis of a very small portion of a bone to the complete invasion of the latter. Hence, the treatment, as to the extent of manual interference, must also vary. V^ hen tuberculosis has in- vaded the whole of a short bone, or the entire extremity of a long bone, recovery cannot, after the manifestation of the ulcerative stage, take place with retention of the diseased bone. This, therefore, must be removed by operative procedure ; and, to accomplish this object, cither excision or amputation will be necessary. I'bc former o])eration, when by it the whole disease can be removed, is the one