On the surgery of the knee-joint : and the responsibility placed on the physician and general practitioner by the modern progress of surgery : being the inaugural and retiring presidential addresses delivered before the West London Medico-Chirurgical Society, on October 7th, 1887, and May 4th, 1888, respectively / by C.B. Keetley.

  • Keetley, Charles Bell, 1848-1909.
Date:
[1888]
Catalogue details

Licence: Public Domain Mark

Credit: On the surgery of the knee-joint : and the responsibility placed on the physician and general practitioner by the modern progress of surgery : being the inaugural and retiring presidential addresses delivered before the West London Medico-Chirurgical Society, on October 7th, 1887, and May 4th, 1888, respectively / by C.B. Keetley. 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.

    11/28 (page 9)
    culosis unassisted by the surgeon. The misfortune is that it is so dilatory in the exercise of its healing powers that very often the patient or his joint, or both, are destroyed before the disease, but when vigorously helped by the surgeon, time wakes up as it were. It has been often observed, after excision of a joint, that tuberculous granulations have sprung out, say, from a sinus left by a drainage tube, lived a precarious existence, and then perished spontaneously, or with very little interference from the surgeon. Nevertheless, it is well to operate with the greatest possible care and thoroughness. Next, with regard to the treatment of healthy bone, it used to be the rule to take away the patella lest it might become diseased. Some surgeons—eg., P. PI. Watson of Edinburgh — opposed the practice, but they were exceptions. Now, when once the tuber- culous foci have been found and thoroughly removed, not an atom of bone should be cut away except to favour drainage, or to make opposed surfaces fit after excision. After a really complete and systematic operation on a tuberculous knee-joint the fear of recurrence is small. And if we are to attempt to abolish it by removing all cancellous bone in which the return can possibly take place, amputation may as well be done at once. In fact, those surgeons who, with these views, always amputate and never excise are strictly logical. In children, more bone and articular cartilage have usually to go than in adults. I have several times completely, or almost completely, scraped out the bony part of the epiphyses, always carefully leaving the so-called epiphysial cartilage,