Report on Surgery to the Santa Clara County Medical SocietyCox, J. Bradford (Joseph Bradford)
Science
Report on Surgery to the Santa Clara County Medical Society
Cox, J. Bradford (Joseph Bradford)
Medicine -- California -- Santa Clara County; Surgery -- Case studies
major, with compresses so arranged as to obliterate the sack, if possible.
The patient, up to this time, had been slowly losing flesh, and was now
very much emaciated. A general typhoid condition existed, the temperature
ranging from 101 to 103.5; the pulse from 115 to 135, tongue coated, poor
appetite, and in short, the patient in a very critical condition. The use
of chloroform, and the shock from the evacuation of the pus, added to the
gravity of all the symptoms, and for about two weeks the patient was in
great danger of death from asthenia. However, by liberal use of whisky,
quinia, beef tea, cod liver oil, etc., he slowly rallied. Two smaller
abscesses formed below the knee, but those gave no great anxiety, not
so much as some bed sores on the back and hips. The sack or pouch became
gradually obliterated, down as far as the knee. The cavity of the joint,
however, did not seem to be well drained from the opening in the thigh,
notwithstanding it had been kept open freely by tents. About three weeks
from this last operation, the sinus or pouch within the knee-joint being
so imperfectly drained as above indicated, I made an opening directly into
the joint at the outer and posterior part, one inch long, through which I
could introduce the probe between the ends of the femur and tibia, without
any difficulty, through all parts of the joint. However, I discovered no
necrosed bone by so doing. Put a tent into this opening, and let the one
above heal up, which it did in about two weeks. This latter opening into
the joint I kept open by means of tents until the joint became anchilosed
and ceased to discharge pus. The patient made a slow and steady recovery,
and about the middle of April was able to get out doors again.
The special points of interest in this case seem to be the obscure and
insidious mode of attack; the slow progress of the inflammation, it being
rather sub-acute than acute; and the fact of its being a sequela of
pneumonia.
Prof. Gross, in his excellent work on surgery, says, "synovitis, in the
great majority of cases, arises from the effects of rheumatism, gout,
eruptive fevers, syphilis, scrofula, and the inordinate use of mercury."
Prof. Hamilton, in "Principles and Practice of Surgery," says, "synovitis
may be caused by exposure to cold, or may occur as a consequence of a
rheumatic, strumous, or syphilitic cachexia, as a gonorrhoeal
complication, as a sequela of fevers, and from many other causes, whose
relation to the disease in question may not always be easily determined."
Since there was no local injury to the knee in this case which could have
caused the disease, we must seek some other cause for it.
Public-domain text, read in full here on John Shaqi.
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