Harry Campbell
1904 The Lancet  
the middle of the shaft of the left femur, oblique from behind forwards (as shown by radioscopy), and wit,h an inch of shortening. Under anaesthesia the fracture was reduced. A Liston's splint and short local splints were applied. During the next few days there was much swelling at the site of the fracture and the boy complained of pain which kept him awake at night. On the 18th the swelling seemed to be still increasing ; the splints were changed, extension tapes were applied, the local
more » ... were retained, and the limb was elevated to a right angle by means of an apparatus fixed to scaffolding over the bed. On the 21st it was noted that there was no improvement and that the temperature had been steadily rising and had reached 102° F. At this time the swelling was found to be fluid. This, taken in conjunction with the pyrexia and great pain and tenderness, led to the view that there was a secondary inflammatory process. The pulse was 140 and a discolouration, which appeared to be a bruise, was noticed over the radial artery. On further examination bruises were found on different parts of the body. Then the following history was obtained. The boy had diphtheria at the age of eight months which was accompanied by haemorrhage from the nose and mouth. Subsequently it was noticed that he bruised very easily. A short time before the accident a tooth was extracted and he bled for a week in spite of firm plugging. In the last two or three years one or other knee was frequently swollen. He would go to bed quite well and awake with swelling in one or other joint. There was no family history of haemophilia. During the remainder of the boy's stay in hospital the diagnosis of hæmophilia was fully confirmed ; bruises appeared wherever the splints pressed. On April 28th all the signs of a hæmophilic joint developed in the left knee. Union of the fracture was not delayed ; at the end of four weeks it was firm and there was no shortening. At the time of the report the boy was under treatment for a recurrence of the effusion in the left knee. The important points in the case are : (1) the enormous effusion of blood around the fracture and its association with symptoms suggesting inflammatory effusion, and (2) the fact that union took place satisfactorily and early. Mr. Monsarrat regards the pyrexia as an exaggeration of the traumatic fever which occurs in most cases of simple fracture. THE medical officer of the Cape Colony states that for the week ending Nov. 12th the state of plague in the colony was as follows. Only 1 case was discovered during the week at Port Elizabeth but plague-infected rodents were found. Plague-infected rodents were also found at East London but elsewhere in the colony no plague in man or animals was found. As regards the Mauritius, a telegram from the Governor received at the Colonial Office on Dec. 2nd states that for the week ending Dec. lst there were 32 cases of plague and 25 deaths from the disease, of which 2 were of white persons. -OUR Paris correspondent informed our readers last week that a committee had just been constituted in Paris to make preparations for a visit of British physicians and surgeons next year in return for that recently paid by their French
doi:10.1016/s0140-6736(01)35386-2 fatcat:dx6eqhudw5d7rftheon2tiaisa