king's college hospital. disease of the hip-joint in a girl aged six years, with sinuses,...

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362 was pale and presented no redness in any part. The liver was rather larger than natural and congested. Bladder full. All the other organs of the abdomen were in a healthy state. The brain was congested at its base. No serum in the ventricles, but a large quantity of fluid blood in the sinuses. Analysis.-I took one-fifth of the contents of the stomach, and half of the stomach itself, and conducted an analysis in the manner recommended by Mr. Rodgers and Mr. Girdwood, and reported in THE LANCET of June 13th, and procured about three grains of pure strychnine. Crawley-street, St. Pancras, 1857. A Mirror OF THE PRACTICE OF MEDICINE AND SURGERY IN THE HOSPITALS OF LONDON. IMPLICATION OF THE HIP-JOINT. Nulla est alia pro certo noscendi Tia, nisi quam plurimas et morborum et .dissectionum historias, tam aliorum proprias, colleetas habere et inter se com- parare.-MORGAGNI. De Sed. et Cau8. )IIorb. lib. 14. Procemium. I KING’S COLLEGE HOSPITAL WESTMINSTER ... UNIVERSITY COLL. CHARING-CROSS ... ST. THOMAS’S ... ST. BARTHOLOMEW’S ST. MARY’S ... ST. GEORGE’S ... Excision of Hip-joint Excision of Hipjoint ; . " ".o. " " .. 17 77 .. 17 , .. Reduction of Dislo- i cated 7)MeaM’p- J joint ......... j Excision of Ilip foint .. A cut; IlIjlamnw’Úon 0/ i Acute Inflammation of Hip-joint. } Excision of Hip-joint .. putation at .. " }: .. Mr. BOWMAN. ..Mr. FERGUSS01i ..Mr. HOLT. .Mr. ERICHSEN. .Mr. HANCOCK. ..Mr. SiMON. Mr. SOUTH. Mr. STANLEY. .Mr. COOTE. Mr. STANLEY. . Mr. URE. .Mr. LANE. .Mr. TATCM. KING’S COLLEGE HOSPITAL. DISEASE OF THE HIP-JOINT IN A GIRL AGED SIX YEARS, WITH SINUSES, CARIES OF THE HEAD OF THE FEMUR, ACETABULUM, AND PUBIS; EXCISION OF THE JOINT, WITH GOOD RESULTS, BUT DISEASE OF THE HEART REMAINING. (Under the care of Mr. BOWMAN.) THE little patient who was the subject of the following case was hardly in such a favourable condition as the boy in Mr. Bowman’s first case. The disease of the joint had existed for the same period of time-two years-and had nearly run its course, being followed by a sort of spurious anchylosis with the limb in an exceedingly awkward position, almost at right angles to the trunk of the body. The notes state that the affected leg was shorter than the other, although there was no dislocation; this is accounted for by the condition in which the head of the bone was found on removal. It was almost destroyed from absorption and disintegration, a number of fragments lying loose in the acetabulum. This we described, when referring to this case on a former occasion, as a novel feature, of unusual interest. All these pieces of bone were re- moved, together with the head and neck below the great trochanters. The diseased surface of the acetabulum, as well as the denuded ramus of the pubis, were scraped with the gouge, and we recollect well, during the operation, that the ’femoral vessels could be distinctly felt. Mr. Bowman re- marked at the time, that there was a fair chance of recovery, although the disease of the bones was extensive, but still he said bone might be bare-referring to the denuded pubis- without being in a state of necrosis. We have heard Mr. Fer- gusson make the same observation on f.U70 nr three ocassions when having to treat bone denuded of periosteum, especially the femur. The little girl was at once put in a "Heath’s swing," without any splint,* and went on admirably, without an untoward symptom, so far as the effects of the operation were concerned, the wound being all but healed, and the limb in. a capital position. Unfortunately, valvular disease of the heart has supervened, and she is in a very precarious state indeed- so much so, that we fear her condition is hopeless. For the notes of this and the next case, we are indebted to the kindness of Mr. W. P. Swain, house-surgeon to the hospital. Ellen S-, aged six, was admitted, on June l7th, with disease of the right hip. The right leg was shorter by an inch and a quarter than the left, drawn upwards to the pelvis, and crossed over its fellow. The fold of the nates was effaced, and the hip considerably rounded. Behind the trochanter major there were two or three small openings, which discharged matter. The femur was quite immovable on the pelvis. On June 26th, Mr. Bowman removed the head of the femur, by enlarging the original openings, and forcibly luxating the head of the bone from the acetabulum, which enabled him to apply the saw just below the great trochanter. The acetabular cavity being exposed was found to be diseased, and its surface was scraped with the gouge. The finger could be passed in front of the acetabulum on to the horizontal ramus of the pubis, which was found to be bare, and was also scraped with the gouge. The limb not readily coming into position, another portion of the femur was removed, just below the lesser trochanter, which allowed it to be placed in good position. After the operation, the patient was removed to the ward,- and placed in the " Heath swing." Little or no pain was experi. enced by the patient after she had been swung, and on July 20th, the wound was reported as being " reduced in size, and healthily healing," the limb being in good position. On August 17th, the wound was reported as being "completely healed, except one small sinus in the centre. Limb in good position." On Sept. llth, the patient having suffered much from palpitation of the heart and frequent fits of dyspncea, an examination was made, when it was found that a diastolic mitral bruit existed. Since that period, the pabient has gradually become weaker, and is at present in a very precarious condition. The wound, however, is quite healed, with the exception of a very small point, and the limb is in a most favourable uosition. DISEASE OF THE HIP-JOINT, IN A GIRL ELEVEN YEARS OLD, WITH PARTIAL DISLOCATION ; CARIES OF THE HEAD OF THE FEMUR AND THE ENTIRE ACETABULUM ; EXCISION OF THE JOINT; RECOVERY. (Under the care of Mr. FERGUSSON.) The most remarkable features of this case were, the partial dislocation of the femur, and the extent of the disease of the acetabulum, the cotyloid cavity being entirely affected and lying loose, like an exfoliation ; this was removed with a pair of forceps, and the pelvis was found not to be perforated. The patient was a very delicate, strumous girl, with a large abscess over the adductor muscles. The condition of the acetabulum has not in any way interfered with the process of healing, and although nine weeks have elapsed since the operation, she is doing well, with the wound nearly closed, and has already been up and on crutches in the ward. Moreover there is a diminu- tion in the amount of curvature of the spine which was present before the operation. Sarah Agnes M-, aged eleven, was admitted with disease of the right hip-joint on July 18th. She is a slight, delicate- looking girl. The thigh was flexed at right angles with the pelvis, and admitted of very limited motion. The muscles of the thigh and leg were very much wasted, and a large abscess existed over the adductors. On August 8th, Mr. Fergusson proceeded to excise the head of the femur. Having made an incision, four inches in length, over the head of the bone, which was found to be partially dislocated, it was turned out of the cotyloid cavity, seized with the "lion" forceps, and sawn through below the trochanters. Nearly the whole of the acetabulum was also removed. At the time, the limb could not be placed in a straight position. The wound being situated far back, it was impossible for the patient to lie on her back. She was therefore suspended in the " Heath swing" after the operation, and experienced no pain whatever. On Aug. 17th, the limb was reported to be in somewhat better position, but the head of the bone had a tendencytopro- ject outwards. On the 20th the limb was placed in a splint, * A drawing was given of it in THE LANCET o flast week.

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Page 1: KING'S COLLEGE HOSPITAL. DISEASE OF THE HIP-JOINT IN A GIRL AGED SIX YEARS, WITH SINUSES, CARIES OF THE HEAD OF THE FEMUR, ACETABULUM, AND PUBIS; EXCISION OF THE JOINT, WITH GOOD RESULTS,

362

was pale and presented no redness in any part. The liver wasrather larger than natural and congested. Bladder full. Allthe other organs of the abdomen were in a healthy state. Thebrain was congested at its base. No serum in the ventricles,but a large quantity of fluid blood in the sinuses.Analysis.-I took one-fifth of the contents of the stomach,

and half of the stomach itself, and conducted an analysis in themanner recommended by Mr. Rodgers and Mr. Girdwood,and reported in THE LANCET of June 13th, and procured aboutthree grains of pure strychnine.

Crawley-street, St. Pancras, 1857.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

IMPLICATION OF THE HIP-JOINT.

Nulla est alia pro certo noscendi Tia, nisi quam plurimas et morborum et.dissectionum historias, tam aliorum proprias, colleetas habere et inter se com-parare.-MORGAGNI. De Sed. et Cau8. )IIorb. lib. 14. Procemium. IKING’S COLLEGEHOSPITAL

WESTMINSTER ...

UNIVERSITY COLL.CHARING-CROSS ...

ST. THOMAS’S ...

ST. BARTHOLOMEW’S

ST. MARY’S ...

ST. GEORGE’S ...

Excision of Hip-joint Excision of Hipjoint ; .

" ".o.

" " ..

17 77 ..

17 , ..

Reduction of Dislo-i cated 7)MeaM’p- Jjoint ......... jExcision of Ilip foint ..

A cut; IlIjlamnw’Úon

0/ iAcute Inflammation ofHip-joint. }

Excision of Hip-joint ..putation at ..

" }: ..

Mr. BOWMAN...Mr. FERGUSS01i..Mr. HOLT..Mr. ERICHSEN..Mr. HANCOCK...Mr. SiMON.

Mr. SOUTH.

Mr. STANLEY..Mr. COOTE.

Mr. STANLEY.

. Mr. URE.

.Mr. LANE.

.Mr. TATCM.

KING’S COLLEGE HOSPITAL.

DISEASE OF THE HIP-JOINT IN A GIRL AGED SIX YEARS, WITHSINUSES, CARIES OF THE HEAD OF THE FEMUR, ACETABULUM,AND PUBIS; EXCISION OF THE JOINT, WITH GOOD RESULTS,BUT DISEASE OF THE HEART REMAINING.

(Under the care of Mr. BOWMAN.)THE little patient who was the subject of the following case

was hardly in such a favourable condition as the boy inMr. Bowman’s first case. The disease of the joint had existedfor the same period of time-two years-and had nearlyrun its course, being followed by a sort of spurious anchylosiswith the limb in an exceedingly awkward position, almostat right angles to the trunk of the body. The notes statethat the affected leg was shorter than the other, althoughthere was no dislocation; this is accounted for by the conditionin which the head of the bone was found on removal. It wasalmost destroyed from absorption and disintegration, a numberof fragments lying loose in the acetabulum. This we described,when referring to this case on a former occasion, as a novelfeature, of unusual interest. All these pieces of bone were re-moved, together with the head and neck below the greattrochanters. The diseased surface of the acetabulum, as wellas the denuded ramus of the pubis, were scraped with thegouge, and we recollect well, during the operation, that the’femoral vessels could be distinctly felt. Mr. Bowman re-

marked at the time, that there was a fair chance of recovery,although the disease of the bones was extensive, but still hesaid bone might be bare-referring to the denuded pubis-without being in a state of necrosis. We have heard Mr. Fer-gusson make the same observation on f.U70 nr three ocassions

when having to treat bone denuded of periosteum, especiallythe femur.

The little girl was at once put in a "Heath’s swing,"without any splint,* and went on admirably, without anuntoward symptom, so far as the effects of the operation wereconcerned, the wound being all but healed, and the limb in. acapital position. Unfortunately, valvular disease of the hearthas supervened, and she is in a very precarious state indeed-so much so, that we fear her condition is hopeless.For the notes of this and the next case, we are indebted to

the kindness of Mr. W. P. Swain, house-surgeon to the hospital.Ellen S-, aged six, was admitted, on June l7th, with

disease of the right hip. The right leg was shorter by an inchand a quarter than the left, drawn upwards to the pelvis, andcrossed over its fellow. The fold of the nates was effaced, andthe hip considerably rounded. Behind the trochanter majorthere were two or three small openings, which dischargedmatter. The femur was quite immovable on the pelvis.On June 26th, Mr. Bowman removed the head of the femur,

by enlarging the original openings, and forcibly luxating thehead of the bone from the acetabulum, which enabled him toapply the saw just below the great trochanter. The acetabularcavity being exposed was found to be diseased, and its surfacewas scraped with the gouge. The finger could be passed infront of the acetabulum on to the horizontal ramus of the pubis,which was found to be bare, and was also scraped with thegouge. The limb not readily coming into position, anotherportion of the femur was removed, just below the lessertrochanter, which allowed it to be placed in good position.After the operation, the patient was removed to the ward,- andplaced in the " Heath swing." Little or no pain was experi.enced by the patient after she had been swung, and on July20th, the wound was reported as being " reduced in size, andhealthily healing," the limb being in good position. OnAugust 17th, the wound was reported as being "completelyhealed, except one small sinus in the centre. Limb in goodposition." On Sept. llth, the patient having suffered muchfrom palpitation of the heart and frequent fits of dyspncea, anexamination was made, when it was found that a diastolicmitral bruit existed. Since that period, the pabient hasgradually become weaker, and is at present in a very precariouscondition. The wound, however, is quite healed, with theexception of a very small point, and the limb is in a mostfavourable uosition.

DISEASE OF THE HIP-JOINT, IN A GIRL ELEVEN YEARS OLD, WITHPARTIAL DISLOCATION ; CARIES OF THE HEAD OF THE FEMUR

AND THE ENTIRE ACETABULUM ; EXCISION OF THE JOINT;RECOVERY.

(Under the care of Mr. FERGUSSON.)The most remarkable features of this case were, the partial

dislocation of the femur, and the extent of the disease of theacetabulum, the cotyloid cavity being entirely affected andlying loose, like an exfoliation ; this was removed with a pairof forceps, and the pelvis was found not to be perforated. The

patient was a very delicate, strumous girl, with a large abscessover the adductor muscles. The condition of the acetabulumhas not in any way interfered with the process of healing, andalthough nine weeks have elapsed since the operation, she isdoing well, with the wound nearly closed, and has already beenup and on crutches in the ward. Moreover there is a diminu-tion in the amount of curvature of the spine which was presentbefore the operation.Sarah Agnes M-, aged eleven, was admitted with disease

of the right hip-joint on July 18th. She is a slight, delicate-looking girl. The thigh was flexed at right angles with thepelvis, and admitted of very limited motion. The muscles ofthe thigh and leg were very much wasted, and a large abscessexisted over the adductors.On August 8th, Mr. Fergusson proceeded to excise the head

of the femur. Having made an incision, four inches in length,over the head of the bone, which was found to be partiallydislocated, it was turned out of the cotyloid cavity, seized withthe "lion" forceps, and sawn through below the trochanters.Nearly the whole of the acetabulum was also removed. At thetime, the limb could not be placed in a straight position. Thewound being situated far back, it was impossible for the patientto lie on her back. She was therefore suspended in the " Heathswing" after the operation, and experienced no pain whatever.On Aug. 17th, the limb was reported to be in somewhat

better position, but the head of the bone had a tendencytopro-ject outwards. On the 20th the limb was placed in a splint,

* A drawing was given of it in THE LANCET o flast week.