RESECTION OF THE KNEE

1857 The Lancet  
August, with a foul ulcer situated at the inside of the left cheek, somewhat backwards. It was the size of a pennypiece, and on careful examination was found to be cancerous*, but it had been only in an ulcerated condition some weeks, commencing in the form of a tubercle. There was nothing to lead one to suppose on looking at this man that anything was the matter with him. nor could there be traced the slightest hereditary taint whatsoever. There was a decayed molar tooth near the ulcer, but it
more » ... r the ulcer, but it had nothing to do with its appearance. A case of this kind was looked upon as of so much importance by-the surgeons of the hospital, that the patient was taken in to 'have the progress of this ulcer stayed, else it would in a short time perforate the cheek. We will watch the case, and report upon it on another occasion. NEUROMATOID ULNAR TUMOUR. THE title explains itself, for the disease consisted of a growth the size of a small nut, situated near the ulnar nerve, on the left wrist of a man in King's College Hospital, which had been growing for fifteen years, during the whole of which time it caused much suffering, and at last had become so painfully distressing that he sought means of relief. Slight pressure over it caused a sensation of fainting on the part of the patient. It was removed on the 16th August by Mr. Henry Lee, and the patient left the hospital the same day, perfectly relieved from every inconvenience, the ordinary sensation in the fingers and other parts being left unimpaired. On examining the minute structure of this tumour, it proved to be fibro-cellular, with several minute nervous twigs ramifying over it, springing from the ulnar nerve, which of itself was not implicated. In this respect it resembled a neuroma, although not a real one, and therefore may be with propriety called neuromatoid. We would here take occasion to refer to an example of neuroma in the sixth volume of the Pathological Society's "Transactions," p. 49, in which the tumours were developed within the membrane which encloses the nerve tubules; each swelling was the enlargement of an individual fasciculus. No doubt the stretching of these minute filaments over the tumour, small as was its size, was the cause of the severe pain so long suffered by Mr. Lee's patient. STRANGULATED INGUINAL HERNIA. A YOUNG man, aged nineteen, a baker, was admitted into University College Hospital, at one A.M. on Sunday morning, July 5th, in a state of intoxication. In the course of the morning he was able to state that three hours previous to,lis admission he had felt, while carrying a weight, sudden severe pain in the right groin. There was a swelling there, which he believes had not existed before, except on one occasion, two years ago, at which time it was reduced by a surgeon, 'who stated it to be a rupture. The bowels were opened as'usual on Saturday morning; the taxis was applied without success. Sunday morning.-:Tumour in the scrotum, rounded, distinct, unequal to feel, red also, and painful; testicle not -very distinctly felt, but little fulness in the situation of the cord. Patient states that he has a urethral discharge; a little bilious vomiting; tongue coated; still somewhat confused from the effects of liquor. Taxis repeated, and the hot-bath. Some little doubt as -to the hernial character of the tumour seems to arise, on account of the existence of signs of orehiti-3.-Five P.M: He was seen by Mr. Henry Thompson. Pulse 90; sickness as before; tumour larger and redder; no pain or tenderness in the abdomen, except in the immediate vicinity of the cord. A brisk purge was ordered, to be followed by enema. In the course of the evening, a good many scybalae followed the enema. After this the pulse rose, abdomen became painful, and bilious vomiting continued. Mr. Thompson visited him about seven o'clock on Monday morning, and decided to operate at once. The sac was soon reached and opened, when three or four inches of dark and highly-congested gut were found, with a little omentum, apparently in a congenital sac, to which a long and narrow canal led. At the upper end of this was the stricture, which being divided the contents were returned without difficulty. A spica bandage was applied in the usual manner. Thirty minims of Battley's sedative solution -were immediately given to keep the bowels quiet. The man expressed himself much relieved two hours afterwards, and flatus passed by anus. Next day free relief took .place by the bowels. July 9th.-He is free from pain, the bowels -have again acted, and he is doing as well as possible. He subsequently left the hospital cured. - LOSS OF A CASE OF EXCISION OF THE KNEE BY PERITONITIS. LET a case be ever so well suited to an operation, with everything in favour of complete success-nay, let it be the model of a selected case for a given operation, the surgeon knows it may go on badly nevertheless, and he must at all times be prepared for any untoward result. The correctness ef this remark was forcibly impressed upon us, when we learnt the result of Mr. Walton's case of excision of the knee, at St. Mary's Hospital, which we gave in a previous number (ante p. 84). The girl went on most favourably, in every respect, for about eight days, when she complained of pain about the abdomen, which turned into acute peritonitis, under which she sank a few days after. When speaking of the case, we mentioned that it seemed one of the most favourable cases for the operation performed which we had met with for some time. In our report of it, the word trephine was inadvertently used in place of the tourniquet, which was put on to prevent the possibility of bleeding. All the other cases of this operation are going on favourably. We add the subjoined at St. George's Hospital :--RESECTION OF THE KNEE. WE should have noticed this case before, as it occurred about the same time as some of the others described on a previous occasion. 'The patient was an elderly man, with disease of the knee for about twelve months, commencing with inflammation and swelling all around the joint, at which time he was apatient in St. George's Hospital. The inflammatory symptoms subsided under treatment, but he was ever after liable to reo peated attacks, and finally re-entered the hospital with his joint much diseased. Suppuration had occurred, with the formation of sinuses, and the poor man was most anxious that something should be done before (as Mr. Tatum remarked) the disease extended any further. He accordingly determined to excise the joint, as everything seemed quite favourable for such a -proceeding, more especially as the patient's general health was pretty good, and the disease not of long duration. On the 9th July excision was accomplished by the usual H incision, the patella being retained in the upper flap of the H. The ends of both bones were sawn off, and accurately came into contact. The cartilages were almost completely destroyed by erosion of the bones, besides which the synovial membrane was in a state of pulpy degeneration of a yellowish colour, not unlike the fat of beef, and was sufficient in quantity of itself alone to destroy the joint. The operation therefore was the most suitable and proper for the individual case, and everything promised most satisfactorily. He has gone on well to the present time,.and the wound has almost healed up.
doi:10.1016/s0140-6736(02)36531-0 fatcat:mruacoq4tnf7tjjtrr3o3k3ylu