On exfoliations from the bones of the pelvis as causing the obstinacy of sinuses in this situation / [James Syme].

  • Syme, James, 1799-1870
Date:
[1829]
Catalogue details

Licence: Public Domain Mark

Credit: On exfoliations from the bones of the pelvis as causing the obstinacy of sinuses in this situation / [James Syme]. Source: Wellcome Collection.

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    Obstinacy of Sinuses in this situation. By James Syme, Esq. Surgeon, and Lecturer on Surgery in Edinburgh. (From the Edinburgh Medical and Surgical Journal, No. 99.J -Every practical surgeon must have observed that obstinate sinuses are met with nowhere so frequently as in the region of the pelvis. Those which remain after the opening of abscesses depending on carious vertebrae, or caries of the hip-joint, are truly incurable, and being unfortunately of common occurrence, have led to the opinion that little can be done for the remedy of any sinus so situated. The patient is therefore usually com¬ mitted to the power of his own constitution, nothing being at¬ tempted to cure the complaint, except perhaps the occasional injection of some stimulating wash to prevent the appearance of total neglect. The object of the following paper is to show that the sinuses in question sometimes depend not on caries, but on death of bone, which exfoliating in some part of the pelvis far from the surface, causes continued irritation by the presence of the loose portion; whence it is proper in the treatment of all sinuses in this part of the body not obviously proceeding from caries, to search for such exfoliations, and remove them if they are found to exist. Case I.—John Benn, aged 7 years, of a pale complexion, but otherwise in good health, has a small fistulous opening in the upper and back part of the thigh, a little below the tuber¬ osity of the ischium. He suffers little pain, but when sitting is observed to rest on the sound hip. His mother states that the complaint commenced without any obvious cause about two years and a half ago, when a tumour, the size of an egg, made its appearance in the seat of the sinus. She applied to a sur¬ geon, who evacuated, by incision, a great quantity of matter. The opening continued to discharge for a year afterwards, when a small bit of bone appeared at the orifice, and was re¬ moved by a gentleman, to whom she applied for the purpose. The sinus remained nearly well for six months, when the run¬ ning again commenced, and has persisted more or less ever since, that is to say for about a year. On introducing a probe I detected a loose piece of bone, which was readily extracted so soon as the opening had suffer¬ ed dilatation by incision. The exfoliation appeared, when carefully examined, to have been detached from a spongy bone, and I concluded that the ischium must have been the one con¬ cerned, since the sinus would have opened much lower in the A