Licence: Public Domain Mark
Credit: On disease of the hip-joint / by Lewis A. Sayre. 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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![4 1 21] PI IP-JOINT DISEASE. 21 the point of section with the saw, as is too often done by luxating the bone too forcibly. If upon the first section it is found that the caries has extended still farther down the femur, you can very easily separate it from its periosteal attachments, and whatever amount of bone is necessary can be removed in the same manner with the saw. . Under no circumstances should bone forceps be used in the sec- tion of so large a bone. The trochanter major should always be removed, even if it is not diseased, as otherwise it would occlude the opening, and prevent the escape of the discharge; and by peeling it from its periosteum, as I have before described, the attachments of the muscles are all left for future use. When the head and neck have thus been removed, you have a fair opportunity for exploring the acetabulum, and to remove all the carious or necrosed bone by scraping and gouging. If the acetabulum be perforated, which I have frequently found to be the case, with a little care the necrosed bone can be broken off down to the point where the periosteum is attached. I have only in one instance found the internal periosteum perforated. After washing the wound carefully with warm water, fill it with Peruvian balsam; a round small plug of oakum, long enough to reach the very bottom of the acetabulum, is inserted, and left dependent from the wound. The upper and lower ends of the incision are then brought together by stitches and adhesive plaster, and the patient placed in the wire cuirass which has been con- structed for this purpose, with a window opposite the place of incision. As it is of the greatest importance that this dressing should be done with care, I will describe to you my mode of doing it. The cuirass being properly prepared and well padded, the patient is laid in it so that the anus is opposite the opening and free from any possibility of obstruction, when the well leg is the first to be dressed. By making it perfectly straight and screwing up the^foot-](https://iiif.wellcomecollection.org/image/b22382410_0025.jp2/full/800%2C/0/default.jpg)
