HO
INDIAN MEDIOAL GAZEnE.
Would inevitably hue hnd,Iam conviueed,i( 1 hnd lr
� �irror of ios�ilnl t)1p1dii1. A CASE OF A.\lPUTATION AT THE HIP JOINT. llr Strir.o&o�-H.uo• E. S. BRANDER, ».a., f.&.c.lU-, OJ.NOA.RAH, at. 20, wu ndmitted into the Etnwnh Di1peusnry on th April 1890. He Wll.8 " bnlhut coolie on� the railway aml wu eugn ge!l iu unloniling·I ck, contaiuiug i ron r:1.ilL While so employed, oue nccidcntnlly
t�rn1
:i:!v�! r;:c t��i: :r:: � :�b�: "�!'tl� with much bruising or the d:1iu 11t tl,e ,ite or iujury. The fracture .,.11,1 !rented in the utunl w111111u, but in" few d11y11 ulcernliou commenced nnd the whole limb bec:ime much iuA:1med. The tibin becrune ezteusinly n:poted, a116, tbere 11 t ie e ir:;l0!1, b:� t�e':�n�ie � t �!��t�cd�!��b:i� to the'ope r11tiou. Profuse 1uppurn.tiou ,.111 now eatllbliahed, and the whole or the front of tlio lejr,from belo" i(llee to withiu2 inchu or the 1111kle, becllme out larg e cmvitJ from wl,ich J10rtion1 ofufolillted bone were Leingoo111ta11t• ly removed. 'l'liis dr11.i110111he 1y1tern reduced the pntient to" very n.tten ulltecl ooudition,wheu 1eeiug Ill length t he futility of further oppoai . t ion heoou aeutedto:111 oper11tion. 1 r 1 u 1 3 th�i'im� :1 1�1� mt!i�'!} pos terior flap,, with ,ery little Ion of blood or shook to tire pnticnt. The p•rt1 were dreued antiuptically, there wuno fner or other unto1nnl •rmptom after the operntioi(, llud the fl11pa uoitcd s:1usfoctorily. Everyt!,iu g we11t well until the 22nd Septem. ber, wl,en he hnd An n t tnck of �cute coryza,from r
1
(t e
�!�
�t: �fj;�;,
:;� �:�=
[Mu 1891.
;e:T:i��p�=r�! c'::1:1:\::;��:;t,�j� fl:�-:� 111. A variety of local applicnlious ..-ere tri ed, ,trid ntten ti ou wna giveu to local draio:ige,and a libern.l diet with tonice and etimul!Ulte wu ndminis tered, but the 1lou gliiu g continued until the 1h11ftof t lrefemur l11ul become ezpoaed. It ".:'·' found impracticable t o runputnte the thi gh lugher up for wnnt of the requisite henlthy 1liio for in.p,. It Wll8 tlie refore decided to amputa te n t the hipjo iut n, the lut clrauce,to which tire patieut rudily consented, �aud the ope ration wu'per formed on the 20th December. In the ahlence or ,n abdominal t ou rniquet tl1e only means 10 reatrai n l111emorrb1ge wu by pre"ure 011 tl,e e•ter11al iliac artery, which wu adroitly m•iutained by Auiataut.-Surgeoo. N. R. B•uuerji. The patient. being d uly under chloroform,the point of t he knife wu entered below the anterior rrupetior apine of the ilium, and, being kept eloae to the joint, 1flll br ought o ut above the itchi11.[ tubero1i1y, and a flap nbout 5 inches lou g rnpidly cut from within out. wnrds. Thi 1 1,na eleverly 1eiz:ed eud bel.l b.1 tha1 t , or ;t;:�:�: r:r::�=j �rt:�; �:� :e��:t�:f 1 with n v ery 1mall loa of blood. The limb wu then nerred and th e e:i.ps ular l igllf1ltnt of the d g �tt:�:in �,:!:!iui�7�� w!: �!e::: �ffic:i! to obtain the requisite amount or abduction aod everaiou ueceuary to cauae the head of the femur to ,tart out 1nlB.c ieutly fro1n 1he aeeta bnlum. Thi, b,eing, l,o,.ner, effected tho Jig•· mentum teru 11nd retnAins of c11paulnr ligament ..-ere re:1tlily dirir.led, 1111d poeterior flap ma.de eomewl111t ehorter than the anterior ooe, by cutting from witliin outw11rd1. The aute rior A1p h•d beeu l,ilherto heir.I by hand tiglitly, tn re,train. bleeding from othe r veuel1 th1111 the femoral, but on the aeparatiou or the limh beiog completed, the pruaure wu relu:ed and the internal and ezternel circum· flu: arteries togetl,er with 10mi'large miaoular bnnche11 w11re t11ke11 up 1nd tied. l1L t bepoa-- t erior fla11 ouly the .eiatio nrtery had to be tied. The tlnpa were united Ly nbout a do:i:eu 1u\ure1, A dmiua ge tube inaerted the whole u
c
{��-
�;;!l!1
::,�i:�:t0J:
/ t:u:i��:�i,1: j i::b::�: some weeb, but t hi1 gradually 1ult1ided, 1111d tha h i 1 11. t e flaps u11ited ..-itliout any tenclency to ulcera tion �'r�:!dJ�; lf�: �ii::� �!�1i:!1J� u i b 1 ahny1 been frn.ctiou1 a11Jperver1e,611ding f1ult i/��:.rt�: :� 1 ��j �:;: with l,isdiel,refU1ing hinmedieine1, nud quarrel ing wi1h t he o ther p11tie1111, nod t he m11.uifeeta tlie cicatrix hu become 1ulB.cieutly .6rm will b e providtd wit h 1uitD.bl e cr n tcbea 11nd dis-· tion or tileae tr:ii11, doubtlu�, con duced to the unfnvourable condition whicl, e naaed. Havio g char
INDIAN MEDIOAL GAZEnE.
Would inevitably hue hnd,Iam conviueed,i( 1 hnd lr
� �irror of ios�ilnl t)1p1dii1. A CASE OF A.\lPUTATION AT THE HIP JOINT. llr Strir.o&o�-H.uo• E. S. BRANDER, ».a., f.&.c.lU-, OJ.NOA.RAH, at. 20, wu ndmitted into the Etnwnh Di1peusnry on th April 1890. He Wll.8 " bnlhut coolie on� the railway aml wu eugn ge!l iu unloniling·I ck, contaiuiug i ron r:1.ilL While so employed, oue nccidcntnlly
t�rn1
:i:!v�! r;:c t��i: :r:: � :�b�: "�!'tl� with much bruising or the d:1iu 11t tl,e ,ite or iujury. The fracture .,.11,1 !rented in the utunl w111111u, but in" few d11y11 ulcernliou commenced nnd the whole limb bec:ime much iuA:1med. The tibin becrune ezteusinly n:poted, a116, tbere 11 t ie e ir:;l0!1, b:� t�e':�n�ie � t �!��t�cd�!��b:i� to the'ope r11tiou. Profuse 1uppurn.tiou ,.111 now eatllbliahed, and the whole or the front of tlio lejr,from belo" i(llee to withiu2 inchu or the 1111kle, becllme out larg e cmvitJ from wl,ich J10rtion1 ofufolillted bone were Leingoo111ta11t• ly removed. 'l'liis dr11.i110111he 1y1tern reduced the pntient to" very n.tten ulltecl ooudition,wheu 1eeiug Ill length t he futility of further oppoai . t ion heoou aeutedto:111 oper11tion. 1 r 1 u 1 3 th�i'im� :1 1�1� mt!i�'!} pos terior flap,, with ,ery little Ion of blood or shook to tire pnticnt. The p•rt1 were dreued antiuptically, there wuno fner or other unto1nnl •rmptom after the operntioi(, llud the fl11pa uoitcd s:1usfoctorily. Everyt!,iu g we11t well until the 22nd Septem. ber, wl,en he hnd An n t tnck of �cute coryza,from r
1
(t e
�!�
�t: �fj;�;,
:;� �:�=
[Mu 1891.
;e:T:i��p�=r�! c'::1:1:\::;��:;t,�j� fl:�-:� 111. A variety of local applicnlious ..-ere tri ed, ,trid ntten ti ou wna giveu to local draio:ige,and a libern.l diet with tonice and etimul!Ulte wu ndminis tered, but the 1lou gliiu g continued until the 1h11ftof t lrefemur l11ul become ezpoaed. It ".:'·' found impracticable t o runputnte the thi gh lugher up for wnnt of the requisite henlthy 1liio for in.p,. It Wll8 tlie refore decided to amputa te n t the hipjo iut n, the lut clrauce,to which tire patieut rudily consented, �aud the ope ration wu'per formed on the 20th December. In the ahlence or ,n abdominal t ou rniquet tl1e only means 10 reatrai n l111emorrb1ge wu by pre"ure 011 tl,e e•ter11al iliac artery, which wu adroitly m•iutained by Auiataut.-Surgeoo. N. R. B•uuerji. The patient. being d uly under chloroform,the point of t he knife wu entered below the anterior rrupetior apine of the ilium, and, being kept eloae to the joint, 1flll br ought o ut above the itchi11.[ tubero1i1y, and a flap nbout 5 inches lou g rnpidly cut from within out. wnrds. Thi 1 1,na eleverly 1eiz:ed eud bel.l b.1 tha1 t , or ;t;:�:�: r:r::�=j �rt:�; �:� :e��:t�:f 1 with n v ery 1mall loa of blood. The limb wu then nerred and th e e:i.ps ular l igllf1ltnt of the d g �tt:�:in �,:!:!iui�7�� w!: �!e::: �ffic:i! to obtain the requisite amount or abduction aod everaiou ueceuary to cauae the head of the femur to ,tart out 1nlB.c ieutly fro1n 1he aeeta bnlum. Thi, b,eing, l,o,.ner, effected tho Jig•· mentum teru 11nd retnAins of c11paulnr ligament ..-ere re:1tlily dirir.led, 1111d poeterior flap ma.de eomewl111t ehorter than the anterior ooe, by cutting from witliin outw11rd1. The aute rior A1p h•d beeu l,ilherto heir.I by hand tiglitly, tn re,train. bleeding from othe r veuel1 th1111 the femoral, but on the aeparatiou or the limh beiog completed, the pruaure wu relu:ed and the internal and ezternel circum· flu: arteries togetl,er with 10mi'large miaoular bnnche11 w11re t11ke11 up 1nd tied. l1L t bepoa-- t erior fla11 ouly the .eiatio nrtery had to be tied. The tlnpa were united Ly nbout a do:i:eu 1u\ure1, A dmiua ge tube inaerted the whole u
c
{��-
�;;!l!1
::,�i:�:t0J:
/ t:u:i��:�i,1: j i::b::�: some weeb, but t hi1 gradually 1ult1ided, 1111d tha h i 1 11. t e flaps u11ited ..-itliout any tenclency to ulcera tion �'r�:!dJ�; lf�: �ii::� �!�1i:!1J� u i b 1 ahny1 been frn.ctiou1 a11Jperver1e,611ding f1ult i/��:.rt�: :� 1 ��j �:;: with l,isdiel,refU1ing hinmedieine1, nud quarrel ing wi1h t he o ther p11tie1111, nod t he m11.uifeeta tlie cicatrix hu become 1ulB.cieutly .6rm will b e providtd wit h 1uitD.bl e cr n tcbea 11nd dis-· tion or tileae tr:ii11, doubtlu�, con duced to the unfnvourable condition whicl, e naaed. Havio g char
