CASES FROM PRACTICE. ABSTRACT OP EIGHT CASES OF AMPUTATION AT THE HIP-JOINT. By J.
Faykek, M.D., C.S.I.
Case I.?Immediate Amputation for gun-shot wound. Death from Tetanus. (Clinical Surgery in India, p. 630.) Moung Shewe* Mo, Burman, aged 30, Rangoon, shot in the left thigh on 15th July, 1853, with slugs; head and neck of femur comminuted. He was amputated at the hip on the 16th, immediately after being brought in, by antero-posterior flaps. He did well, and the wound had nearly cicatrized, until the 5th of March, when, after a great fright, he was attacked with tetanus, of which he died on the 17th March, just one month after the operation. Case II.?Re-Amputation for secondary causes. Recovery. (Clinical Surgery in India, p. 607.) Sheikii Ashgur, Mahomedan, aged 16 years, was admitted into the Medical College Hospital, Calcutta, on the 10th April, 1864, with severe iniuries inflicted by a horse on his knee and
thigh.
Amputation at the lower third of the thigh by modified circular of flaps was performed on the 12th April; severe symptoms of osteo-myelitis and pyaemia set in; the limb was amputated at the joint by antero-posterior flaps on the 24th April. The bone was infiltrated with pus. He recovered perfectly, and was discharged, cured, on 31st July. He was long employed, after this, as a tailor in the hospital. Case III.?Re-Amputation for secondary causes. Pyaemia. (Clinical Surgery in India, p. 669.)
Death from
Lascar Ishmail Hadji, a Mahomedan sailor, admitted into the Medical College Hospital, on 2nd October, 1865, with serious injuries to the right knee and leg. The thigh was amputated on the 25th October, by modified flap and circular. On the 9th November, marked symptoms of osteo-myelitis and pyaemia having set in, he was amputated by antero-posterior flaps at the hip-joint. He died of pyajmia on the 13th. The thoracic cavity contained sero-purulent lymph. The lungs were studded with patches of dead tissue, (the crro-
12
THE INDIAN MEDICAL GAZETTE.
neously called abscesses). The right cavity of the pulmonary arteries contained firm decolorized clots,
heart and the imme-
diate cause of death. The bone was found to be infiltrated with pus throughout, with isolated depots of pus in the cancellated tissue, of the size of a pea. Case IV.?Cancer. Late Toxa:mia.
Amputation.
Death from
general
Mutty, Hindoo peasant, age 25 years, admitted 6th October, 1865. Medullary carcinoma of knee and lower part of thigh; knee-joint disorganized; duration of disease five years, excited into action by an accident and puncture of knee with a thorn. He was very low; amputation at hip-joint by antero-posterior flaps, on the 15th January. He died on the 27th January, thirteen days after the operation, of pyaemia; the lungs were studded with patches of dead and cancerous deposit tissue. There was also a large abscess in the right lung. There was mixed with this a quantity of cancerous deposit. There was There moreover a large patch of the left lung quite dead. were firm fibrinous coagula in the right cavities of the heart and pulmonary artery.
1871.
far as the operation in the treatment of the disease was concerned. In one, a case of gun-shot wound, the patient had all hut recovered from the operation, when he was carried off by tetanus. One was a case of secondary amputation after a gunshot wound, when the constitution had become much affected; being young, (about 21 years,) and otherwise healthy, it gave the patient a chance, but he died in a few hours after the operation, of pulmonary embolism. The results were:? One recovery. One death from tetanus after a month. One death from osteo-myelitis and pyaemia on the 5th day. One death from pyoemia, cancerous deposits and pulmonary embolism on the 13th day. One death from pyajmia and pulmonary embolism on 2nd day# One death from shock, a few hours after operation. One death on 6th day from exhaustion. One death in a few hours from exhaustion and pulmonary so
i
[Jakuaht 2,
embolism.
There was mucb pus in the psoas and iliacus muscles. Femoral vein and artery healthy. Case Y.?Ee-Amputation at Hip, for secondary causes. Death from Pyasmia, and pulmonary embolism. Pookan, a Hindoo gardener, age 21, was admitted 24th June, 1867.?His knee-joint was disorganized, the consequence of an accident, and the thigh infiltrated with pus. The limb was amputated at the lower third of the thigh, on the 2nd J uly, by the modified flap and circular operation. He had fever, secondary haemorrhage and osteo-myelitis. Amputation by antero-posterior flaps was performed at the hip-joint on the 4th July, he died on the 5th, about 26 hours after the operation. The lungs were found to be very anaemic. The pulmonary artery and the right ventricle contained firm fibrinous clots, the immediate cause of death. There were no other important visceral changes. Death was caused, as it frequently is in similar cases, by plugging of the pulmonary artery. Case VI.?Immediate Amputation for Shark-bite. Death from shock. (Medical Times and Gazette, London, p. 657, 1868.) j Ram Chand, Hindoo, aged 55 years, admitted into the Medical | College Hospital, Calcutta, on 13th May, 1868, with severely I lacerated wounds inflicted by a Shark, when bathing at a ghat in the Hooghly, within the city of Calcutta, and among a crowd of people. The hip-joint was laid open, and the bone grooved by the Shark's teeth; head and shaft of femur exposed for two inches. Amputation by internal and external flaps performed within a few hours of the accident. The patient died the same day, within six hours after the operation. No examination after death.
j
Case VII.?Immediate Amputation. Death from exhaustion. Busheeh, aged 20, a Mahomedan, admitted into the Medical College Hospital, Calcutta, on the 2nd December, 1868, with a rapidly forming cancerous tumour of the right thigh, attended with much local and constitutional suffering; was amputated at hip-joint by antero-posterior flaps.
Died on the 7th December of exhaustion. Cancerous masses found in right lung; no other visceral change of impor-
were
tance.
Case VIII.?Secondary Amputation for gun-shot wound. Death from pulmonary embolism and exhaustion. Lieut. II ?, Bengal Army, age 21, was wounded accidently when out shooting at night, by a Snider bullet, on the 12th September, 1867. The ball penetrated and comminuted the head and neck of the left femur; the ischium was also injured. The oaccident ccurred at Trincomalee; he was brought to Calcutta, and on the 25th September, I amputated him by antero-posterior flaps at the hip-joint as the last and only chance of saving life. Pya2mic symptoms had then set in. He died a few hours after the operation from exhaustion and pulmonary embolism. The body was examined after death, firm clots in right side of heart and pulmonary artery; lungs pale and ex-sanguine. Reaction fully set in, but with it the formation of fibrinous coagula in the right side of the heart, which proved rapidly fatal. IIemakks.?Of these eight cases, three were re-amputations after amputation at the thigh; in all the system being affected more or less by toxtemia; one recovered. Four were immediate,
Faykek, M.D., C.S.I.
Case I.?Immediate Amputation for gun-shot wound. Death from Tetanus. (Clinical Surgery in India, p. 630.) Moung Shewe* Mo, Burman, aged 30, Rangoon, shot in the left thigh on 15th July, 1853, with slugs; head and neck of femur comminuted. He was amputated at the hip on the 16th, immediately after being brought in, by antero-posterior flaps. He did well, and the wound had nearly cicatrized, until the 5th of March, when, after a great fright, he was attacked with tetanus, of which he died on the 17th March, just one month after the operation. Case II.?Re-Amputation for secondary causes. Recovery. (Clinical Surgery in India, p. 607.) Sheikii Ashgur, Mahomedan, aged 16 years, was admitted into the Medical College Hospital, Calcutta, on the 10th April, 1864, with severe iniuries inflicted by a horse on his knee and
thigh.
Amputation at the lower third of the thigh by modified circular of flaps was performed on the 12th April; severe symptoms of osteo-myelitis and pyaemia set in; the limb was amputated at the joint by antero-posterior flaps on the 24th April. The bone was infiltrated with pus. He recovered perfectly, and was discharged, cured, on 31st July. He was long employed, after this, as a tailor in the hospital. Case III.?Re-Amputation for secondary causes. Pyaemia. (Clinical Surgery in India, p. 669.)
Death from
Lascar Ishmail Hadji, a Mahomedan sailor, admitted into the Medical College Hospital, on 2nd October, 1865, with serious injuries to the right knee and leg. The thigh was amputated on the 25th October, by modified flap and circular. On the 9th November, marked symptoms of osteo-myelitis and pyaemia having set in, he was amputated by antero-posterior flaps at the hip-joint. He died of pyajmia on the 13th. The thoracic cavity contained sero-purulent lymph. The lungs were studded with patches of dead tissue, (the crro-
12
THE INDIAN MEDICAL GAZETTE.
neously called abscesses). The right cavity of the pulmonary arteries contained firm decolorized clots,
heart and the imme-
diate cause of death. The bone was found to be infiltrated with pus throughout, with isolated depots of pus in the cancellated tissue, of the size of a pea. Case IV.?Cancer. Late Toxa:mia.
Amputation.
Death from
general
Mutty, Hindoo peasant, age 25 years, admitted 6th October, 1865. Medullary carcinoma of knee and lower part of thigh; knee-joint disorganized; duration of disease five years, excited into action by an accident and puncture of knee with a thorn. He was very low; amputation at hip-joint by antero-posterior flaps, on the 15th January. He died on the 27th January, thirteen days after the operation, of pyaemia; the lungs were studded with patches of dead and cancerous deposit tissue. There was also a large abscess in the right lung. There was mixed with this a quantity of cancerous deposit. There was There moreover a large patch of the left lung quite dead. were firm fibrinous coagula in the right cavities of the heart and pulmonary artery.
1871.
far as the operation in the treatment of the disease was concerned. In one, a case of gun-shot wound, the patient had all hut recovered from the operation, when he was carried off by tetanus. One was a case of secondary amputation after a gunshot wound, when the constitution had become much affected; being young, (about 21 years,) and otherwise healthy, it gave the patient a chance, but he died in a few hours after the operation, of pulmonary embolism. The results were:? One recovery. One death from tetanus after a month. One death from osteo-myelitis and pyaemia on the 5th day. One death from pyoemia, cancerous deposits and pulmonary embolism on the 13th day. One death from pyajmia and pulmonary embolism on 2nd day# One death from shock, a few hours after operation. One death on 6th day from exhaustion. One death in a few hours from exhaustion and pulmonary so
i
[Jakuaht 2,
embolism.
There was mucb pus in the psoas and iliacus muscles. Femoral vein and artery healthy. Case Y.?Ee-Amputation at Hip, for secondary causes. Death from Pyasmia, and pulmonary embolism. Pookan, a Hindoo gardener, age 21, was admitted 24th June, 1867.?His knee-joint was disorganized, the consequence of an accident, and the thigh infiltrated with pus. The limb was amputated at the lower third of the thigh, on the 2nd J uly, by the modified flap and circular operation. He had fever, secondary haemorrhage and osteo-myelitis. Amputation by antero-posterior flaps was performed at the hip-joint on the 4th July, he died on the 5th, about 26 hours after the operation. The lungs were found to be very anaemic. The pulmonary artery and the right ventricle contained firm fibrinous clots, the immediate cause of death. There were no other important visceral changes. Death was caused, as it frequently is in similar cases, by plugging of the pulmonary artery. Case VI.?Immediate Amputation for Shark-bite. Death from shock. (Medical Times and Gazette, London, p. 657, 1868.) j Ram Chand, Hindoo, aged 55 years, admitted into the Medical | College Hospital, Calcutta, on 13th May, 1868, with severely I lacerated wounds inflicted by a Shark, when bathing at a ghat in the Hooghly, within the city of Calcutta, and among a crowd of people. The hip-joint was laid open, and the bone grooved by the Shark's teeth; head and shaft of femur exposed for two inches. Amputation by internal and external flaps performed within a few hours of the accident. The patient died the same day, within six hours after the operation. No examination after death.
j
Case VII.?Immediate Amputation. Death from exhaustion. Busheeh, aged 20, a Mahomedan, admitted into the Medical College Hospital, Calcutta, on the 2nd December, 1868, with a rapidly forming cancerous tumour of the right thigh, attended with much local and constitutional suffering; was amputated at hip-joint by antero-posterior flaps.
Died on the 7th December of exhaustion. Cancerous masses found in right lung; no other visceral change of impor-
were
tance.
Case VIII.?Secondary Amputation for gun-shot wound. Death from pulmonary embolism and exhaustion. Lieut. II ?, Bengal Army, age 21, was wounded accidently when out shooting at night, by a Snider bullet, on the 12th September, 1867. The ball penetrated and comminuted the head and neck of the left femur; the ischium was also injured. The oaccident ccurred at Trincomalee; he was brought to Calcutta, and on the 25th September, I amputated him by antero-posterior flaps at the hip-joint as the last and only chance of saving life. Pya2mic symptoms had then set in. He died a few hours after the operation from exhaustion and pulmonary embolism. The body was examined after death, firm clots in right side of heart and pulmonary artery; lungs pale and ex-sanguine. Reaction fully set in, but with it the formation of fibrinous coagula in the right side of the heart, which proved rapidly fatal. IIemakks.?Of these eight cases, three were re-amputations after amputation at the thigh; in all the system being affected more or less by toxtemia; one recovered. Four were immediate,
