On excision of the elbow and wrist joints and the preservative surgery of the hand / by Richard G.H. Butcher.

  • Butcher, Richard G. H., 1819-1891
Date:
1855
Catalogue details

Licence: Public Domain Mark

Credit: On excision of the elbow and wrist joints and the preservative surgery of the hand / by Richard G.H. Butcher. Source: Wellcome Collection.

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    nipulation the part may be induced not to resent the violence offered to it by any destructive burst of inflammation. After the flaps have become united, and consolidation of the parts within has progressed to firmness, about the end of the fourth or fifth week, very small and passive motion may be commenced, so that, by carefully apportioning exercise to the repaired and condensed structures, the limb may be restored, efficient and useful for all the purposes of life. Sometimes the union be¬ tween the bones may be slow in consolidation; it was so in the instance which I have recorded, yet after the lapse of some months it was sufficiently firm for all the necessities of manual labour. The surgeon, I say, then, need not be disheartened by the tediousness of recovery; in the end it will come. It was so likewise in one of Moreau’s cases, who writes thus: “ The flexion of the forearm upon the arm is strong, firm, and steady; it was a long time before the movement was regained: when he wanted to bend the arm, the forearm shook and fell in to¬ wards the inner side, but he has got the better of that of late, and now this motion is free and correct.” Further on he men¬ tions, in relation to this case: “ I must not forget to state, that this man has now the use of his arm so completely that he uses it in thrashing in the barn, holding the plough, &c.” I shall append to these remarks on excision of the elbow- joint the impressive and simple words of Moreau: “ If these things seem to be incredible, they may be easily brought to the test of experiment. I am firmly of opinion, that, in similar circumstances, the issue will be the same.” There is a condition of the elbow free from disease, the result of injury, when it has become fixed by bony anchy¬ losis in the straight position, that requires special notice. I at once cede the point that, by many, such an inconvenience might be borne with rather than running risks by submitting to a severe operation; but, on the other hand, there are some upon whom the effect would be to deprive them of the means of earning their bread, and, having no resources, would, of neces¬ sity, consign them to be inmates of a poor-house for the rest of their days. Here, I think, surgery legitimately offers her powers to relieve. In such a condition of parts I would not excise the joint, but would execute the following operation. I have frequently performed it on the dead body, and a dex¬ terous hand may readily accomplish it in the living. The arni being placed in the same position as that for resection, an incision should be made, about an inch in length, behind the in¬ ternal condyle, and the ulnar nerve freed from its bed, and drawn
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