Amputation at the knee-joint by disarticulation : with remarks on amputation of the leg by lateral flaps / by Thomas Bryant.

  • Bryant, Thomas, 1828-1914.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: Amputation at the knee-joint by disarticulation : with remarks on amputation of the leg by lateral flaps / by Thomas Bryant. 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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    this abscess the divided end of the popliteal artery lay, presenting a most interesting condition. Suppuration bad taken place between its middle and inner coats burrowing upwards in such a manner as to completely separate the two for a distance of an inch and a half, so that the internal coat lay like a cast in the middle of the tube, and looked not unlike a coagulum. The upper part of this inner coat was thin and papery, and the upper.limit of its separation from the outer coats abrupt and well defined. The lower three fourths of an inch, shaggy, softened, and sloughing, lay loose in the cavity. Above this presented the opening into the interior of the tube- like inner coat, which for a distance of an eighth of an inch contained the remains of some broken-up adherent coagulum. It was from this orifice that the hgemorrhage had taken place into the suppurating cavity and sinus. Corresponding to the whole length of the suppuration between the coats, the outer coats were found to be thickened by inflammatory material to double their normal size, and this condition extended upwards for a quarter of an inch above the upper limit of separation of the coats. Above this all the arterial coats appeared to be healthy. Below, the outer coats were continuous with that lining the abscess cavity and ended indistinguishably in it. The femoral vein was plugged for a distance of five inches with firm adherent clot. The suppuration between the coats of the popliteal artery being directly continuous with the cavity below, was clearly due to an inflammatory affection extending from the latter to the coats of the vessel, setting up a diffused suppurative arteritis. This inflammatory process is of an exceedingly unhealthy character, as shown by the sloughy condition of the wound and twisted end of the artery. I believe that all cases of secondary hsemorrhage at the present day will be found to be directly traceable to this particular inflammatory condition of the wound impli- cating the arterial coats. That this is a so-called septic form of inflammation I am not inclined to believe, but