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formed a similar operation for a ruptured perinaeum with suc-cess, and more recently repeated it in a case of procidentiauteri, usins deep sutures without quills.
HYDATIDS IN THE TIBIA.
WE are glad to state that the interesting example of thisrare affection at St. Mary’s Hospital went on very well, (THELANCET, Dec. 5th.) Mr. Coulson subsequently removed thepiece of bone which had become black and necrosed, and whendoing that a number of these parasites (hydatids) were foundto be still present at the back of it, all of which were carefullyremoved. The great cavity which contained these animals,although close to the articulation, gradually filled up, and acapital cure resulted. Mr. Stanley and many other surgeons ofrepute have seen the case. Mr. Stanley stated that he hadnot before met with an instance of hydatids in the tibia.
ARM CRUSHED BETWEEN RAILWAY BUFFERS;DISARTICULATION OF THE SHOULDER.
AT Leighton Buzzard, about forty miles from London, a rail-way porter, aged twenty-six years, was helping to move for-ward some of the carriages, when his left arm was caught be-tween two buffers, and completely crushed. The bone wasshattered, and all the soft parts bruised and torn, and a lacera-tion extended down the forearm. This accident occurred ateleven o’clock on the morning of the 16th February. He was
brought up to town, and conveyed to University College Hos-pital, and placed under Mr. Quain’s care. As the injuries weretoo extensive to permit any portion of the arm being saved, Mr.Quain, at half-past four of the same day, removed the limb at theshoulder-joint, which was fortunately uninjured, but there wasvery little sound skin to form flaps; they therefore includedsome of the bruised integuments. The clavicle and scapulawere not injured. There was a little haemorrhage from thewound the same night; he had anodynes, and passed a quietnight, but next day complained of soreness about his left chest.His pulse was 132 at three P.M. on the 17th, and he was goingon as well as could be anticipated. The patient’s subsequentprogress, although slow, was good; the wound has healed urto some extent, and the man is gradually gaining strength.His life at any rate is safe. When last we saw him he was ableto sit up in bed and have his stump dressed, although veryweak.
REMOVAL OF THE LEG OF A CHILD AGED TWOYEARS AND A HALF.
PERHAPS the most interesting feature of this case is theperiod at which the limb was amputated, the child being alittle over two-and-a-half years of age. Very rarely has ampu-tation been found necessary at this time of life, unless fromsome grave accident. The child, a patient of Mr. Coulson’s,at St. Mary’s Hospital, was the subject of scrofulous dis-ease of the knee, which was lined with a false membrane, andan opening existed in the tibia, which extended downwardsinto the shaft. The disease was too extensive to admit ofexcision, and Mr. Coulson resorted to amputation; and whenwe last saw the little fellow he was going on well. A circum-stance, however, transpired about this child’s history whichhad been kept concealed by the mother until after the opera-tion, namely, that the child had had four epileptic convulsionseight months ago, which were followed by hemiplegia of theunamputated side. The child has now (Jan. 20th) a dischargefrom both ears, with some redness about the mouth, and israther restless at night. The paralysis was not noticed beforethe operation, from the fact of the child never having walked,nor even sat up.
DISLOCATION OF THE HEAD OF THE HUMERUSINTO THE AXILLA.-
WHILST Mr. de Meric was seeing the out-patients at theRoyal Free Hospital on the 23rd of March, a robust man ofabout thirty was brought to him, who had just had a fall uponthe shoulder, the result of which was the injury above-men-tioned. The diagnosis was extremely easy; and as the acci-dent was so recent, Mr. de Meric tried to reduce at once byforcibly raising the arm in the direction of the axis of the body.This was done without using much force, and scarcely was the
elbow brought in a line with the vertex, when the character-istic crack was heard, and the head of the bone had returnedto the glenoid cavity. The reduction did not take more thana minute; Mr. O’Loughlin, house-surgeon.to the hospital, whowas present, bandaged up the arm in its accustomed position forsuch cases, and the patient walked away. We mention thisto induce those who often have to deal with such injuries totry the same method, before resorting to the heel, especiallyin
AMPUTATION OF AN EXCISED WRIST.
OF the various joints which become diseased, and are subjectedto the operation of excision, the wrist would appear to be theonly one which does not offer the most promising results. Of
several examples which we have noticed, in which this pro-ceeding was resorted to, amputation ultimately has had to beperformed. This appears to depend upon the remarkable com-plexity of the structures entering into the formation of this im-portant part of the body, which may be pronounced a series ofsmall joints in connexion with one another. On the 20th ofMarch, Mr. Fergusson amputated the wrist of a young man,who had been admitted into King’s College Hospital some fivemonths ago with extensive disease of this joint. At the timeit was sufficiently extensive to have justified removal; but asthe patient wanted his hand saved if possible, an attempt wasmade to do so, by making free openings on either side of thearticulation, and scraping out all the diseased parts that couldbe got at. The disease, however, continued to extend, and asecond time the remainder of the whole of the carpal boneswas t-tken away in a diseased condition. This second excision,if we may so express it, did not afford the amount of improve-ment anticipated, and the conclusion was come to, that, besidesdisease of the bones, the synovial membranes, the tendons, andsoft parts generally were greatly involved, and remaining in anutterly incurable condition. This turned out to be the case on
performing the operation of removal, for all the structureswere disorganized, extending towards the fingers, which couldbe moved in any direction, owing to a gelatinous softening ofthe tissues, a peculiarity very commonly seen in these cases.This was only the second instance in which Mr. Fergusson hasamputated the hand at the wrist-joint, and in the present in-stance it was one of easy performance from there being an ab-sence of any carpus. The flaps were of a semilunar form,and the articular surface of the radius was removed with asmall saw. In a former " Mirror," (THE LANCET, vol. ii. 1856,p. 431,) will be found the record of two instances of this opera-tion, performed at this hospital by Mr. Fergusson, and a refe-rence to other cases which have from time to time appeared inthis journal.
WEBBED FINGERS IN A GIRL.
A GIRL of about seventeen came under Mr. Cock’s care, atGuy’s Hospital, with webbed fingers of both hands, whichwere of congenital origin. The ring and little fingers of theright hand were united by a web of skin, and the three middlefingers of the left hand were united in a similar manner, witha partial web between the little and ring finger of this hand.Mr. Cock had separated the fore-finger from the middle-fingerby division of the web three weeks ago, and with success; andon the 16th March he divided the web between the little and
ring finger of this hand, under chloroform. The others hewould not interfere with, because the last phalanx appeared tobe rudimentary in one or two of the fingers. We have recordedseveral instances of this kind, in which operations proved suc-cessful. As a rule, when both hands are thus affected, oneonly is operated upon at a time, as a safeguard in the event oferysipelas ensning, and moreover so as to permit the patient tohave the use of one hand in the mean time. This. girl is
doing well, but there is in these cases a remarkable tendencyin the web to reunite, which can only be prevented by tying apiece of string at the bottom of the fissure, as was done in thisinstance.
A TESTIMONIAL.-On the 20th ultimo, a large numberof the principal inhabitants of Lamberhurst and the surround-ing district assembled to present a silver tea-service and salverto G. B. Irving, Esq., M.R.C.S. This gratifying testimonialwas the result of a general subscription entered into to markthe esteem in which Mr. Irving is held by his neighbours, andtheir regret at his leaving the neighbourhood.
