On excision of the knee-joint / by R.J. Mackenzie.

  • Mackenzie, Richard James, 1821-1854.
Date:
1853
Catalogue details

Licence: Public Domain Mark

Credit: On excision of the knee-joint / by R.J. Mackenzie. 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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    (lays only having elapsed since the performance of the operation, when I saw this boy, 1 can, of course, say nothing as to the result. He was suffering little or nothing when I saw him ; and Mr Jones writes to me four weeks after the operation, that the boy progresses most favourably, and gives promise of a still more satisfactory result tlian in any of his former cases. The next two cases which I have to mention are those in wliich I have myself performed the operation. The following brief outline of these cases is taken from the hospital reports of my house-surgeon. Dr Thom, under whose immediate care the ])atients were, and whose care and attention has contributed materially to the hitherto satis- factorv result of these cases. Case I.—.William Harrison, aet. 42, an hostler from Carlisle, was admitted under my care in the Infirmary by the recommendation of Mr Macdonald of Leith, September 28, 1852, suffering under dis- ease of the left knee-joint of five years’ standing. The symptoms were those which are usually attributed to ulceration of the carti- lages, uniform thickening of the parts around the knee, severe gnaw- ing pain, especially during the night, and much aggravated by the slightest motion of the joint. Considerable relief was obtained by the joint being kept immoveable in leather splints, and by the re- peated a]3plication of the actual cautery. The thickening of the soft parts became diminished, and I hoped the patient was to recover with a stiff joint. A painful spot, however, remained over the inner side of the head of the tibia, on account of which the counter-irrita- tion was continued, and the joint retained for a long time fixed by the leather splints. He continued in this condition till about the middle of January, when, without assignable cause, the pain in the knee, especially on each side of the head of the tibia, became much aggravated. The pain was now so severe and constant that, in spite of the free and frequently repeated use of morphia, he scarcely slept night nor day. The swelling of the joint again increased, and the foot and leg became oedematous. On the 26th of January I called a consultation of my colleagues on the case, as it appeared to me that the removal of the disease by operation was alone likely to save my patient. It was thought, however, that a repetition of the same measures as had been already adopted, might still save the joint. The leather splints were accordingly readjusted, and the cautery once more applied in front of the joint. No relief, however, was obtained, and after ten days’ further delay I yielded (with the consent of my colleagues, who saw the case with me) to the earnest solicitation of the patient, to remove the disease by operation. The operation was performed, Febntary 5, 1853. A straight incision was made across the front of the joint, a little below the level of the patella, and extending to rather less than half the cir- cumference of the limb, and at right angles to each end of this