Quarterly report of the Edinburgh Surgical Hospital, from May to August 1829 / [James Syme].

  • James Syme
Date:
[1829]
Catalogue details

Licence: Public Domain Mark

Credit: Quarterly report of the Edinburgh Surgical Hospital, from May to August 1829 / [James Syme]. Source: Wellcome Collection.

    6/86 (page 6)
    There was nothing in the previous history of these cases worthy of mention. They both laboured under well-marked caries of the elbow-joint, and would both, a short time ago, have been condemned to amputation without any ceremony. Janet Burns was harassed by a slight degree of chronic bron¬ chitis, which delayed her recovery, and rendered the complete and permanent establishment of her health somewhat doubtful. She left the Hospital considerably better in this respect than when she entered it, and with the prospect of retaining a useful arm. The boy was a most favourable subject for the operation. His disease resulted from external injury, a fall on the elbow, his constitution was good, and he possessed a most excellent dispo¬ sition, which induced him to perform accurately whatever he was desired in regard to the position and exercise of the limb. Five weeks have now elapsed since the operation, and he is beginning to regain command of the joint, which is nearly as moveable as ever. I expect a most complete recovery in this case, which will be the more remarkable, as a very large portion of the ulna was removed. After sawing off the extremity of the humerus, and cutting away with the pliers the olecranon and head of the radius, I thought from the sound appearance of the different surfaces that enough had been done, and dressed the wound. But it fortunately happened that when the ex¬ cised portions were afterwards more carefully examined, one of the gentlemen present, l)r Vallange, observed, that the cut surface of the olecranon presented a small carious cavity, a portion of which must consequently have been allowed to remain. I im¬ mediately undid the dressings, and by replacing the olecranon discovered the carious part, which was a sort of cylindrical ex¬ cavation no wider than a common quill, but running deeply into the bone. Having ascertained its extent by introducing a probe, I insulated the ulna as far as was necessary, and cut it across through the shaft, so as to detach the whole spongy portion of the bone, which was then removed, though not without some difficulty, owing to the connexion of the brachiaeus internus. In this case the only muscle left undisturbed was the biceps; and the difficulty of moving the joint ought to have been if pos¬ sible still greater than some people allege it to be, when merely the triceps is detached from its insertion. It has surprised me considerably to find that my pupils felt it difficult to conceive how the efficiency of the muscles could be restored in these circumstances* since there are so many parallel cases of every day’s occurrence, for instance the use of a stump, which is so soon regained, owing to the muscles fixing themselves round the bone.