The practice of surgery / by James Gregory Mumford ... with 682 illustrations.

  • James Gregory Mumford
Date:
1910
Catalogue details

Licence: Public Domain Mark

Credit: The practice of surgery / by James Gregory Mumford ... with 682 illustrations. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    966/1044 (page 960)
    forced motion and passive movements are apt to do more harm than good, though massage and hyperemia may give rehef. Our princi]nil resource is mechanical suppoit for the mild cases, adhesive-plaster strapping, and flannel bandages; for the severe cases fixation in leather splints or plaster spHnts. Thus b}- reducing the local irritation of the soft i)ai-ts, there may be secured some return to painless function. Occasionally, when the j-ray shows conspicuous bone overgrowths locking the joints, we may operate to remove such growths, and then continue the treatment b}' fixation. I have said that the prognosis of chronic arthritis is progressively- bad. Locke and Osgood seem to take a less pessimistic view, for the}' say: We can no longer consider this group of diseases as hopelessly incurable. The success of modern therapy offers the greatest encourage- ment. ... In cases of simple villous arthritis, after a fair trial of conservative methods, radical operation is advised. In the infectious eases early motion and as little fixation as possible are indicated. In the atrophic, a judicious combination of fixation and motion affords the greatest relief, and in the hypertrophic, partial or complete fixation with as little motion as possible most favorably arrests the process. Let us trust that these views will be justified by further experience. Tuberculosis of the joints is probably the largest subject which confronts the orthopedic surgeon—and it still concerns the general surgeon as well, especially in its later manifestations. General surgeons have not yet ceased to excise and to amputate for the cure of tubercu- lous joints. Joint tuberculosis has been recognized for upward of one hundred years. Brodie and Nelaton were among the early writers on the subject; while Virchow, Rokitanski, and other continental investigators said much about the prevalence of bone and joint tuberculosis. We used to talk of ''white swelling, meaning tuberculosis of the knee-joint in the modern sense. Now we have learned, through the researches of Nichols especially, that tuberculosis infects the joints secDndarily from a tuberculous focus in an adjacent epiphysis. The disease is of hematogenous origin—first, the blood-stream, second, the ep^iphyses, third, the joint. The process reaches the joint either by erosion of the joint cartilage or by extension along the ligaments. Then the bacilli are set free within the joint cavity, when, through the syno- vial fluid as a medium, and by the action of the limb, they are worked thoroughly into the recesses of the joint. It is needless to describe in minute detail the pathology of the dis- ease further than to state that all parts of the joint caseate and break down. The serosa is destroyed, the ligaments are infiltrated and weakened, and the cartilages and bones are eroded. In advanced cases the surrounding stnictures take part in the tuberculous disease, when, by the formation and coalescence of tubercles in these soft tissues, an abscess may develop of the so-called cold-abscess type. ITnlike those joints the seats of acute pyogenic infections, or those joints involved in chronic arthritis, tuberculous joints may heal, for