CASES TREATED AT THE HUTTESING
HOSPITAL
AHMEDABAD. Reported by Assistant-Surgeon T. M.
Shah.
Case No. I. Excision of Jtnee.?A boy, aged 10 years wis admitted into hospital on the 2nd June 1881, for "anchylosis of the left knee-joint. ?< The knee is bent, at an acute angle
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/ V
3I0
THE INDIAN MEDICAL GAZETTE.
[November 1,
1881.
both alas, a portion of the septum nasi and the adjoining and the limb is somewhat atrophied from disuse. The patella surface of upper lip have been sliced away. On healing, the is immovably fixed between the condyles of the femur. The upper lip has been somewhat drawn upwards by cicatricial father of the patient says that three years ago the boy used to the front teeth exposed slightly when complain of pain in the knee, and it became gradually con- contraction,shekeeping ordinarily kept her mouth closed. tracted. There was no swelling, inflammation or injury. She was anxious to have a new nose. The deficient portion There is no pain whatever now except on forcible entension." of the nose was shaped and framed on paper and according 6th June.?Patient was put under chloroform and the inner to the paper-sample each lateral half was marked out with hamstrings which were felt tense were divided by tenotomy, ink on each cheek. Each flap was then dissected up as fax* but the joint could not be extended. On employing force in as almost the bridge of the nose which formed the base of entension the tibia remained fixed to the posterior part of the The edges of the nose were then pared and the condyles and a tendency to dislocation was produced. There the flaps^ were nicely adjusted and kept in position by silver flaps was no doubt that the interior of the was : disorganized joint sutures. excision was therefore performed. An incision was made The sides of the wound on each cheek were sutured and from the posterior margin of one condyle to the other below carbolic oil and straps of adhesive plaster completed the the patella. The skin flap was reflected upwards ; ligamendressing. tum patella divided and the joint opened. The condyles of In a few days the parts united and the artificial nose was the femur and the head of the tibia were sawn off and the leg so perfect in its symmetry and contour that it could hardly and thigh were brought into a straight line and put upon a be made out from a natural nose. It is a pity that no diawooden splint. The skin flap was brought into position by sugrams can be produced here. tures. No blood vessel required ligature. The old method of taking a flap from the arm is altogether The patella was soldered with the femur by osseous union. out of fashion. The modern method for rhinoplasty is to The cartilaginous surfaces of the tibia and femur were partitake a flap from the forehead. But this leaves an ugly lump ally destroyed. There was no softening or active disease in at the seat of twist of the flap. This method of taking the interior of the joint. It appeared to be a case of chronic flaps from the cheeks appears to be of recent date. It gives osteo-arthritis. Wound was dressed with Carbolic oil. a very good nose and leaves but an insignificant disfigure5 p. M,?There is some bleeding from the wound soaking the ment on the face. In the present case the outline of the and delirious. Patient is Preslightly dressing bandages. nose was so perfect that there appeared to be no necessity scribed Liquor morphia draught. for a new columna. The flap-operation from the cheeks 1th June.?Complains of pain ; slept fairly. Bowels is not described by Erichsen or Bryant in their works. moved : no fever. Prescribed morphia draught morning and Case No. III.?A woman, aged 30 years, was admitted with evening. 5 P. M.?Has got fever. Temperature 102?. deformity of nose on 4th June 1881. In this second case of 8th June.?There has been oozing of blood from the wound cut nose the deformity was much less than in the preceding which is distended with coagulum. The bones are also disShe states that about two years ago her nose was case. placed ; the femur forwards and over-riding the tibia. bitten o?E by her husband. Only the tip and a small portion Patient was therefore put under chloroform and the wound of the adjoining alaa and columna was deficient. The greater opened ; coagulum removed. There was no bleeding vessel. portion of the alee was present. The deficiency being only The surfaces of tibia and femur were brought into apposition small and at the tip, any flap operation from the forehead and the limb put upon a posterior splint and two lateral or cheek was considered unsuitable. The tip alone was splints, bandaged and dressed. wanting and the septum was exposed. A wedge-shaped 9 th June.?Temperature 100?; pulse 116. Bowels costive; of the septum was excised and the lower portion of slight oozing of blood continues. Complains of pain. Pre- piece the ridge of the nose was drawn down and sutured with the rescribed Castor oil and morphia draught. 5 p. m,?Tempermaining columna nasi. This little operation flattened the ature lOW5. nose slightly and somewhat diminished the deformity. But 10th June.?Some sanious discharge. Pain much dimithe woman would not be satisfied with such trifling improvenished ; slept well. Bowels inclined to be loose. Temperament. ture 1013. On the 27th June she was again put under chloroform and 11th June.?Temperature 100\ Patient involuntarily draws the tip was formed from the upper lip. The whole thickness the pelvis to the right side and thus gives a slanting direcof the upper lip in its middle was divided by two lateral tion to the femur, causing a tendency to displacement. Thereincisions and the flap dissected from its alveolar attachment fore in addition to the lateral and under splint for the limb and raised up. The remnants of the old columna and a portion a long splint on the outer side, reaching from the ankle to of the septum were excised for receiving this flap which the ribs, was applied to correct the tendency to displacement. formed both the columna and the tip of the nose at the same Prescribed Tincture of steel and chlorate of potash. time. The sides of the upper lip were united by two hareFrom this time forwards to the 26tli of July, on which day lip pins. The parts healed up well. But the new columna he left the hospital, the progress of the patient towards reis a little too much below the level of the alas. A portion with the was of and covery exception steady uninterrupted of it requires to be sliced away in order to improve her a slight attack of diarrhoea that was easily checked by In this case the deformity was much less appearance. Bismuth. than in the former case, but the difficulty of repair was Remarks.?There was but moderate discharge throughout, greater. In ordinary cases the columna alone is shaped out and no high fever although no antiseptic measures were of the upper lip, but in this case the columna as well as the 2 about The limb was inches after shorter adopted. recovery tip had to be formed from the upper lip. Besides the columthan the sound limb. The time occupied in healing was na being in a lower level than the alse there was also a groove comparatively short. There was rather troublesome bleeding at the junction of the nose with the lip-flap. So on the from mere oozing from the bony surfaces. There was great whole this case did not prove so satisfactory as the previous difficulty in maintaining the proper position?from two causes : one. one was a tendency of the femoral end tilting forwards and the second arose from obliquity of the pelvis throwing the lower end of the femur outwards. These tendencies were counteracted and corrected by lateral and posterior splints. No splint could be applied in front as the wound had to be daily dressed. ^
Case No. II. Rhinoplasty.?Cases of cut nose in this country not very uncommon. The source of this mishap is generally jealousy of a husband or a paramour, and the victim is generally a woman. The act is as a rule performed in a great hurry, and the wound inflicted is not uniform. The deformity that the Surgeon meets with varies therefore in form, degree and extent. Cut nose may be met with among males. Syphilis is a common cause of nose deformity. A woman, aged 25 years, in stout health, was admitted with put nose on the ?th May 1881. She states that her husband put her nose with! a knife about; three months ago. The tip, are
HOSPITAL
AHMEDABAD. Reported by Assistant-Surgeon T. M.
Shah.
Case No. I. Excision of Jtnee.?A boy, aged 10 years wis admitted into hospital on the 2nd June 1881, for "anchylosis of the left knee-joint. ?< The knee is bent, at an acute angle
\
/ V
3I0
THE INDIAN MEDICAL GAZETTE.
[November 1,
1881.
both alas, a portion of the septum nasi and the adjoining and the limb is somewhat atrophied from disuse. The patella surface of upper lip have been sliced away. On healing, the is immovably fixed between the condyles of the femur. The upper lip has been somewhat drawn upwards by cicatricial father of the patient says that three years ago the boy used to the front teeth exposed slightly when complain of pain in the knee, and it became gradually con- contraction,shekeeping ordinarily kept her mouth closed. tracted. There was no swelling, inflammation or injury. She was anxious to have a new nose. The deficient portion There is no pain whatever now except on forcible entension." of the nose was shaped and framed on paper and according 6th June.?Patient was put under chloroform and the inner to the paper-sample each lateral half was marked out with hamstrings which were felt tense were divided by tenotomy, ink on each cheek. Each flap was then dissected up as fax* but the joint could not be extended. On employing force in as almost the bridge of the nose which formed the base of entension the tibia remained fixed to the posterior part of the The edges of the nose were then pared and the condyles and a tendency to dislocation was produced. There the flaps^ were nicely adjusted and kept in position by silver flaps was no doubt that the interior of the was : disorganized joint sutures. excision was therefore performed. An incision was made The sides of the wound on each cheek were sutured and from the posterior margin of one condyle to the other below carbolic oil and straps of adhesive plaster completed the the patella. The skin flap was reflected upwards ; ligamendressing. tum patella divided and the joint opened. The condyles of In a few days the parts united and the artificial nose was the femur and the head of the tibia were sawn off and the leg so perfect in its symmetry and contour that it could hardly and thigh were brought into a straight line and put upon a be made out from a natural nose. It is a pity that no diawooden splint. The skin flap was brought into position by sugrams can be produced here. tures. No blood vessel required ligature. The old method of taking a flap from the arm is altogether The patella was soldered with the femur by osseous union. out of fashion. The modern method for rhinoplasty is to The cartilaginous surfaces of the tibia and femur were partitake a flap from the forehead. But this leaves an ugly lump ally destroyed. There was no softening or active disease in at the seat of twist of the flap. This method of taking the interior of the joint. It appeared to be a case of chronic flaps from the cheeks appears to be of recent date. It gives osteo-arthritis. Wound was dressed with Carbolic oil. a very good nose and leaves but an insignificant disfigure5 p. M,?There is some bleeding from the wound soaking the ment on the face. In the present case the outline of the and delirious. Patient is Preslightly dressing bandages. nose was so perfect that there appeared to be no necessity scribed Liquor morphia draught. for a new columna. The flap-operation from the cheeks 1th June.?Complains of pain ; slept fairly. Bowels is not described by Erichsen or Bryant in their works. moved : no fever. Prescribed morphia draught morning and Case No. III.?A woman, aged 30 years, was admitted with evening. 5 P. M.?Has got fever. Temperature 102?. deformity of nose on 4th June 1881. In this second case of 8th June.?There has been oozing of blood from the wound cut nose the deformity was much less than in the preceding which is distended with coagulum. The bones are also disShe states that about two years ago her nose was case. placed ; the femur forwards and over-riding the tibia. bitten o?E by her husband. Only the tip and a small portion Patient was therefore put under chloroform and the wound of the adjoining alaa and columna was deficient. The greater opened ; coagulum removed. There was no bleeding vessel. portion of the alee was present. The deficiency being only The surfaces of tibia and femur were brought into apposition small and at the tip, any flap operation from the forehead and the limb put upon a posterior splint and two lateral or cheek was considered unsuitable. The tip alone was splints, bandaged and dressed. wanting and the septum was exposed. A wedge-shaped 9 th June.?Temperature 100?; pulse 116. Bowels costive; of the septum was excised and the lower portion of slight oozing of blood continues. Complains of pain. Pre- piece the ridge of the nose was drawn down and sutured with the rescribed Castor oil and morphia draught. 5 p. m,?Tempermaining columna nasi. This little operation flattened the ature lOW5. nose slightly and somewhat diminished the deformity. But 10th June.?Some sanious discharge. Pain much dimithe woman would not be satisfied with such trifling improvenished ; slept well. Bowels inclined to be loose. Temperament. ture 1013. On the 27th June she was again put under chloroform and 11th June.?Temperature 100\ Patient involuntarily draws the tip was formed from the upper lip. The whole thickness the pelvis to the right side and thus gives a slanting direcof the upper lip in its middle was divided by two lateral tion to the femur, causing a tendency to displacement. Thereincisions and the flap dissected from its alveolar attachment fore in addition to the lateral and under splint for the limb and raised up. The remnants of the old columna and a portion a long splint on the outer side, reaching from the ankle to of the septum were excised for receiving this flap which the ribs, was applied to correct the tendency to displacement. formed both the columna and the tip of the nose at the same Prescribed Tincture of steel and chlorate of potash. time. The sides of the upper lip were united by two hareFrom this time forwards to the 26tli of July, on which day lip pins. The parts healed up well. But the new columna he left the hospital, the progress of the patient towards reis a little too much below the level of the alas. A portion with the was of and covery exception steady uninterrupted of it requires to be sliced away in order to improve her a slight attack of diarrhoea that was easily checked by In this case the deformity was much less appearance. Bismuth. than in the former case, but the difficulty of repair was Remarks.?There was but moderate discharge throughout, greater. In ordinary cases the columna alone is shaped out and no high fever although no antiseptic measures were of the upper lip, but in this case the columna as well as the 2 about The limb was inches after shorter adopted. recovery tip had to be formed from the upper lip. Besides the columthan the sound limb. The time occupied in healing was na being in a lower level than the alse there was also a groove comparatively short. There was rather troublesome bleeding at the junction of the nose with the lip-flap. So on the from mere oozing from the bony surfaces. There was great whole this case did not prove so satisfactory as the previous difficulty in maintaining the proper position?from two causes : one. one was a tendency of the femoral end tilting forwards and the second arose from obliquity of the pelvis throwing the lower end of the femur outwards. These tendencies were counteracted and corrected by lateral and posterior splints. No splint could be applied in front as the wound had to be daily dressed. ^
Case No. II. Rhinoplasty.?Cases of cut nose in this country not very uncommon. The source of this mishap is generally jealousy of a husband or a paramour, and the victim is generally a woman. The act is as a rule performed in a great hurry, and the wound inflicted is not uniform. The deformity that the Surgeon meets with varies therefore in form, degree and extent. Cut nose may be met with among males. Syphilis is a common cause of nose deformity. A woman, aged 25 years, in stout health, was admitted with put nose on the ?th May 1881. She states that her husband put her nose with! a knife about; three months ago. The tip, are
