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.
507/700
![of phthisis. He had undergone excision of the hip several years before; one of the first operations of the kind per- formed in London. The limb was much wasted, and hung loosely from his body by a flail-like joint or ligament several inches in length. Under such circumstances it was, of course, so far from any help to him, that it was a very serious en- - cumbrance; but the state of his health forbade its removal. The preparation after death, which would have been a very interesting one, was unfortunately not preserved. The most difficult task in treating; of excision for hip- Indications disease consists, I think, in laying down rides for perform- operation, ing or avoiding it in appropriate cases. Some surgeons (as Fock) say that the operation ought to be performed as soon as caries can be certainly ascertained. I myself believe that this rule would be beneficially applied to the class of hospital patients with whom we have to deal; but I could not press the operation as a necessary one on the parents of children who have more command of the requisites for recovery which I have above enumerated. I think, however, that the opera- tion should always be recommended when along with caries there is progressive deterioration of the general condition, and at the same time an immunity from visceral mischief. The most important question relative to the excision of Contra-in- 1 1 dications. the hip is, whether and how far the implication of the ace- Disease of tabulum is a contra-indication to the operation. If it be a bulum. formal contra-indication, the operation would, indeed, be a rare one, and would be pretty nearly confined in theory to those less usual conditions spoken of above (p. 458) ; and which, as they cannot be diagnosed from the more common states of diseased joint, would not affect the practical ques- tion. The only circumstances in which, as far as I can see, bility of ankylosis, and refers to a case which he says refutes my assertion. However, all I said was, bony ankylosis, if it ever occurs, must be exceedingly rare; and I say so still. In the case which Dr. Eulenburg refers to, the patient was alive and well, so that the most convincing proof of bony ankylosis, viz. dis- section, had not been given. All that I need here say is, that bony ankylosis is not a common event, nor one against which any ]ireca\itions need be taken in ordinary cases. I am not at all sure that if I believed bony ankylosis to be in pro- gress, I should think it right to interfere with it, for the limb, if less movable, would be perhaps firmer, and would be quite useful, while the passive motion which would be required to avert the ankylosis might easily set up renewed dis- ease in the bones.](https://iiif.wellcomecollection.org/image/b20416325_0507.jp2/full/800%2C/0/default.jpg)
