Two cases illustrating the treatment of advanced hip-joint disease by Mr. Howse's method of preliminary amputation at the knee / by R. Lawford Knaggs ; communicated by Mr. Howse.

  • Knaggs, Robert Lawford.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Two cases illustrating the treatment of advanced hip-joint disease by Mr. Howse's method of preliminary amputation at the knee / by R. Lawford Knaggs ; communicated by Mr. Howse. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    umbilicus, and bare bone was felt in the acetabulum. In January, 1888, the child grew worse, the discharge in- creased, and the albumen reappeared. On March 9th, 1888, the patient’s state was so unsatisfactory that it was generally agreed that to amputate at the hip or to leave the case alone must inevitably end in death. It was decided to adopt Mr. Howse’s plan. Amputa- tion at the knee was performed, and in spite of an attack of erysipelas, and the formation of an abscess in the front of the stump, the child had quite recovered from the operation by the middle of May. At that time the liver was smaller, the discharge less, but a trace of albumen persisted. On July 10th she had been out of hospital three weeks with the sinus closed. The albuminuria had disappeared. On August 27th the sinus continued closed, but there was slight tenderness on pressure over the cicatrix and above Poupart’s ligament. She looked fat and well but pallid, and weighed 4 st. 2 lbs. In September she caught cold, the sinus reopened, and she began to lose flesh rapidly. The urine remained free from albumen. On October 19th Furneaux-Jordan’s amputation at the hip was performed. The head was not dislocated, but had penetrated the floor of the acetabulum; and the shaft of the femur, which was no thicker than an index finger, was broken in attempting to lever out the head. When the head had been dissected out the opening in the acetabulum led into a cavity lined by granulation tissue, in which small fragments of bone could be felt. The opening was enlarged and the cavity scraped; still portions of bone were felt, but the patient was suffering from considerable shock, so the cavity was plugged and the operation concluded. There had been much oozing from the small vessels, especially in the periosteum, but the femoral artery was about the size of the radial. The future progress was slow and uneventful ; portions