A Sketch of the History of the Surgical Means for Arresting Bleeding from Arteries
Authors: A. M. Edwards
Journal: BMJ (1860)

than ever.Poultices were discontinued, and the leather splint was reapplied.July 26th.Operation.Under chloroform, Mr. Quain pro- ceeded to excise the joint in the usual manner, by making an H-shaped incision, and removing the patella and the ends of the femur and tibia.On removing the bones, the principal seat of disease, as had been anticipated, was found to be situated in the lower end of the femur; for, on cutting through the condyles, they proved to be softened and infiltrated with matter, there existing also a cavity, of the size of a hazel-nut, filled with dark puriform matter.The head of the tibia and the patella were comparatively healthy; but the cartilages of the joints generally were very much eroded, and, in some places, altogether destroyed.There was little hemorrhage, but a good deal of oozing from the cut bones, which continued for some time.Several points of suture were applied, and the limb bandag-ed to a straight back splint, with foot-piece and side- flaps.Aug. 1st.Since last note, the startings in the limb had continued as before the operation.Pressure was ordered to be made on the joint with plastic strapping and many tailed banlage.He continued to take full doses of opium at night.Aug,. 7th.The startings in the limb had completely gone since the pressure was applied.The discharge was healthier; the wound was closing.Aug. 13th.He was going on well.He was ordered to have seven minims of sesquichloride of iron in a mixture twice a day.He took also full diet, and eight ounces of wine.Aug. 23rd.The wound on the outer side was closing rapidly; that on the inner side still discharged a good deal.It was ordered to be injected with an astringent lotion.His iron was changed to quinine.Sept. 5th.Piessure over the jointwas increased byapplying strips of moist calico.No osseous union had, as yet, taken place.Oct. 5tb.During the last month, the size of the joint had decreased at the rate of nearly half an inch in circumference per week.The wound on the outer side was nearly closed; that on the inner side was looking healthier, but still (lis- charged.Oct. 10th.A leather cap was fitted to the knee to give addi- tional pressure.Nov. 2nd.The wooden splint was now removed, and two leather splints, reaching the whole length of the limb, were applied; by this means the patient was enabled to get about, on crutches.The joint was now pretty firm, and the wounds were reduced to mere points.Nov. 30th.By help of a wooden clog to his boot, the patient could now get about, bearing on the limb.His health was excellent.He was now discharged.REMARKS.In his clinical lecture on this case, MIr.Quain made the following observations:- " I have seen the term conservative applied, in some publications, to the treatment of disease of which this case affords an example; but I could not adopt that term, without implying that some other surgical treatment is destructive.Now, the operation is often unsuccessful; the mortality being, according to Mr. Butcher, one in five.But the results of amputation of the thigh, as you will see in your text-books, are very unfavour- able; thus, out of 143 cases, collected by Mr. Bryant (On Causes of Death after Amputation, Medico-Chirurgical Trans., vol.xlii), 39 proved fatal, or 1 in 3-6, which he divides in the following way Fatality.1. Pathological amputations .................. 1 in 5-53. Amputations of expediency (deformities, etc.) 1 in 3-16 :.