middlesex hospital

480

MIDDLESEX HOSPITAL.

CASE OF COMPOUND FRACTURE OF THETIBIA.

Bartholomew McGennis, the old piperwho has for so many years past paradedOxford—street and Its neighbourhood, wasbrought to the Ho’pital on Saturdaynight, June 10. The poor old man was82 years of age, and quite blind ; he hadbeen knocked down by a horse, and hadreceived severe injury to the leg.The tibia was found to he fractured at

about the distance of two-thirds down theleg and there was an extensive laceratedwound communicating with the fracture.The wound extended in an oblique direc-tion from the fracture upwards. Thetreatment adopted by the House Sur-geon was as follows :-The limb was

placed in the strait position on a pillow,over which a piece of oil-skin was laid;the edges of the wound were brought tightlytogether, and over the whole a roller was

apyl2ed !!*13. On visiting the patient to-day, Mr.

Bell remarked, that from the appearanceof the limb (which was much swollen andfirmly embraced by the bandage) thecase had been neglected. He thereforedesired the House Surgeon, to takeoff the bandage and adhesive straps.This being done, the wound and partsaround it wele found to be in a sloughinggangrenous condition. The pulse at thistime was very feeble, the countenanceanxious, the tongue was moist and coveredwith a brownish fur. The bowels are

open; he obtains but little sleep. Nothinghas been done since his admission.

Mr. Bell directed a carrot poultice tobe applied over the wound, and the pa-tient to have generous diet, with wine.

15. The appear auce of the wound muchthe same. The pulse continues feeble,and he answers questions in an indistinctand irrational manner. He obtained somesleep last night. Continue the applica-tion of poultices and the exhibition ofwine, with strong broth.He is evidently worse, the pulse is now

fluttering and all the vital powers are

mnch depressed. The whole limb hasassumed a livid aspect. The poor man,however, lingered until the 19th, when he

* This is a pretty sample of MiddlesexHospital surgery, and of the competencyof the House Surgeons. The younggentleman," whose skill we now record,is the same individual who a few monthssince dismissed a poor Irishman with dis-location of the humerus, as a sprain ; thiscase was reported in THE LANCET.

died; the slougliing of the wound had

greatly increased.

CASE OF LACERATION OF THE TENDON

OF THE B RECTUS- FEMORIS.

S. C., a stotit muscular man, 52 yearsof age, was brought into this Hospital on11th of Jnne, in consequence of an in-

jury which he had sustained by a fall.On examining the injured limb, the

seat of mischief was found to be at theknee joint; the patella was sound, buton making pressure immediately above it,at the insertion of the tendon of the ree.tus, the finger sank into a depression.About an inch and a halt above the upperedge of the patella, there was the usualfirm resisting feel. As the p aboutthe knee were much swoll n, twelveleeches were applied to the part, and adose of aperient medicine was exhibited.

13. The knee joint is considerablyswollen, and the patient complains ofpain. There is not much constitutionaldisturbance ; the tongue is slightly furred,the bowels open, and pulse somewhat ac.celerated. The limb to.day is partiallyflexed, and the rnan says it has been inthat position since yesterday! Mr. C.Bell, nncler whose care the man was

placed, pointed out to Mr. Hind, thehouse surgeon, the impropriety of tile

present position ofthe limb; he reqnestedthat the limb might be elevated andplaced in the extended position. Clothsmade wet with an evaporating lotion tobe applied to the part. The patient in-formed ns, that the right patella hdd beenfractured twice; ox examination, we

found it firmly united by ligament.14. The limb now lies in the extended

position ; the tumefaction is lessened, butthere is still much pain abont the seat ofinjury. Repeat the applicatiou ofleeches,and continne the cold lotion.

17. The parts are resuming their na-turdl appearance ; the swelling and painar lessened, and much relief was ob-tained from the application oftheteerbes.The patient is free front any constitutionaldisturbance.

21. The limb continues to be keptstraight, and cold lotion applied. On ex·

amination to-day, we find there is still adepression immediately above the patella,and a considerable space intervenes be.tween its upper edge, and the laceratedportion of the tendon. The swelling Ita;;,however, so far lessened, that the joluthas resumed its natural contour. At tliedate of this report, the limb was stillplaced in the extended position, and nofurther means had been used to bring theparts in apposition.

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