The surgical treatment of the diseases of infancy and childhood / by T. Holmes.
- Timothy Holmes
- Date:
- 1868
Licence: Public Domain Mark
Credit: The surgical treatment of the diseases of infancy and childhood / by T. Holmes. Source: Wellcome Collection.
421/700
![tissue to relieve the tension, under the idea apparently that the case was one of diffuse inflammation. Symptoms of pyaemia, however, rapidly developed themselves, and she died. On post-mortem examination a large quantity of foul matter was found between the radius and its periosteum, dissecting the membrane from the whole extent of the shaft of the bone, which was in the course of separation from its lower epi- physis, but not yet separated. On rotating the hand, crepitus was produced between the carpal bones and the lower end of the ulna. This proceeded from the abscess having communicated with the wrist-joint, and exposed the semilunar, trapezium, and cuneiform bones, which, as well as the lower end of the ulna, were deprived of cartilage, and rough on their surface. Death was caused in this in- stance by pyaemia. More commonly, when the disease commences, as is usual, in the shaft, it remains limited to the diaphysis; but even then inflammation of the neighbour- ing joint is very common, if the periosteal inflammation extends as far as the limit of the shaft. This inflammation seems to be of the ordinary synovial charac- ter, and by no means precludes the success of treatment directed to save the limb, even when SO [Kg. 59. The tibia in the case of E. J. Eade. Am- putated at the knee-joint for acute periosteal abscess opening into the ankle, a a show the strips of periosteum left after a large part of that membrane had sloughed, b b show the corresponding strips of bone deposited on the surface of the necrosed shaft, c shows the pit communicating with the ankle-joint, and from which a sequestrum had been removed: most probably the epiphysial nucleus, necrosed.] large a joint as the knee is the one involved. In other cases, periostitis, even when it comes on acutely and with slight exciting cause, stops far short of such extensive destruction, nay may often be ar- rested by judicious treatment before the suppurative stage has set in.](https://iiif.wellcomecollection.org/image/b20416325_0421.jp2/full/800%2C/0/default.jpg)
