On excision of the knee-joint / by R.J. Mackenzie.

  • Mackenzie, Richard James, 1821-1854.
Date:
1853
Catalogue details

Licence: Public Domain Mark

Credit: On excision of the knee-joint / by R.J. Mackenzie. 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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    unsatisfactory. Of eleven cases in which it had been performed, six had died, and five had I’ecovered. Of the fatal cases, however, some at least may be said to bear little on the merits of the question of excision, Mulder’s case for instance, where the patient was far advanced in pregnancy when the operation was performed, and died of tetanus after parturition; and Mr Cranipton’s case, in which, although between six and seven inches of the thigh bone were re- moved, and the disease not yet eradicated, the ]>atient lived for more than three years, and vdtimately died from tubercular phthisis. The epidemic dysentery, however, which carried off Moreau’s first case, cannot, I think, be altogether looked upon as an accidental occur- rence, diarrhoea and gastro-enteritis being, as is well-known, a com- mon cause of death after all severe operations. The result in tlie remaining three fatal cases was attributable in each case to the direct effects of the operation. Of the five cases which had recovered, the limb appears to have been thoroughly serviceable in three; the amount of usefulness of the limb in the fourth is unknown, and in the fifth case (Mr Syme’s) the limb was ultimately useless. In 1850, the operation was revived by Mr Fergusson; and within the last three years the operation has, as far as 1 can ascertain, been perfonned thirteen times: in three cases by Mr Fergusson, in six cases b}T Mr Jones of the Island of Jersey, in one case by Mr Page of Carlisle, in one case by Dr H. Stewart of Belfast, and in two cases by myself. Of the results of these cases I shall give some de- tails immediately. Of the thirteen, three have died, two directly from the effects of the operation, and one from dysentery. The re- maining ten are, as far as I know, at present alive. In five the limb is already used freely in progression ; in one the result, as regards the usefulness of the limb, is yet uncertain; in one, I am ignorant as to the result; in the remaining three, sufficient time has not yet elapsed to render the result certain, but of each the most favourable expecta- tions may be entertained. Such is a brief outline of the history of all the cases in which, as far as I can ascertain, the operation has hitherto been performed, and I think I am justified in saying, that an impartial review of these cases, especially of the later series, at least proves that the propriety of the operation is yet an open question. In order to contribute to the solution of this question, I shall now give a short account of the cases in which the operation has been performed within the last three years, and of the present condition of the cases in which the operation has proved successful; and I shall point out one cii’cumstance which, in my opinion, has hitherto been erroneously allowed, in most cases, to interfere with the success of the oj)eration. The following account of these cases, I should mention, is given, with three exceptions, from my own ])ersonal ob- servation of them. To satisfy myself more fully as to tlie I’esults of the operation than could have been done by a written description of the cases, I lately crossed the channel to the Island of Jersey, where.