Patient Case Study: Balch, Elizabeth

HOSPITAL ADMISSIONS RECORD

Hospital Dorset County Hospital Patient type Out-patient
Number 6533 Date admitted 3 Oct 1858
Name Balch, Elizth. Renewed
Age 7 Under whose care Mr. Tapp
Occupation Brickmaker’s ch[ild] Disease Dis[ease] of knee
Parish Minterne Discharged 3 Jan 1859
Recommended by Lady Digby Outcome Made in-patient
Source Dorset History Centre, Dorset County Hospital out-patient admissions register 1857-64, NG/HH/DO(C)/5/1/2

The above entry indicates that Elizabeth was made an in-patient on 3 Jan 1859. However, there is no entry for her in the in-patient admissions register for that date (NG/HH/DO(C)/5/2/1) nor is she listed as an in-patient admission in the management committee minutes for January 1859 (NG/HH/DO(C)/1/2/2). The minutes do record (on 24 March 1859) an in-patient called “Elizth. Belch” being discharged and made an out-patient, but again she is not listed in the minutes as an out-patient admission for that day nor in the relevant part of the out-patient admissions register (NG/HH/DO[(C)/5/1/2).

Hospital Dorset County Hospital Patient type In-patient
Number 4929 Date admitted 3 May 1860
Name Balch, Elizth. Renewed 28 Jun & 25 Aug by Lady Digby
Age 7 Under whose care Mr. Tapp
Occupation Lab.’s child Disease Disease of knee
Parish Lion’s Gate [Minterne] Discharged 20 Sep 1860
Recommended by Lord Digby Outcome Cured
Note The management committee minutes refer to her as “Bessy Balch”. If she was aged 7 in 1858 then she could not have been 7 in 1860
Source Dorset History Centre, Dorset County Hospital in-patient admissions register 1859-67, NG/HH/DO(C)/5/2/2; management committee minutes 1856-62, NG/HH/DO(C)/1/2/2, entry for 20/09/1860

 

OTHER SOURCES

  1. Elizabeth Balch’s birth was registered in the September quarter of 1851, in Dorchester registration district. [General Register Office index, vol. 8, p. 49]
  1. Elizabeth Balch, daughter of William Balch, brickmaker of Minterne Magna, and his wife Elizabeth, was baptised on 11 Jan 1852 at Minterne Magna. [Dorset History Centre, Minterne Magna baptism register, PE/MIN: RE 2/1, p. 41, entry 328]
  1. DORSET COUNTY HOSPITAL. EXCISION OF THE KNEE-JOINT. Under the care of Mr. TAPP. Reported by Mr. D. W. PHILLIPS, House-Surgeon. The following case exemplifies two important in the performance of excision of the knee-joint : first, the careful removal of only a very thin slice from the head of the tibia. Recent doctrines as to the development of the long bones have taught that their chief growth is effected by the epiphysis, and that the preservation of the latter is therefore of great importance when excisions of joints are performed in young persons. It is not of course always that the Surgeon is able to choose as to the exact extent of the part to be removed, and the condition of the bone may, and often does, necessitate his cutting through the head of the tibia below the junction of the epiphysis. If, however, this can be avoided there appears fair reason to hope that the growth of the limb may not arrested by the operation.   Bessy B., aged 9, a kiln-man’s daughter, of scofulous diathesis, was admitted in January, 1859, with disease of the knee of eight months’ standing. She was but little benefited by treatment, and returned home in March. In the following October she fell, and hurt her knee. She kept her bed until her second admission on May 3, 1860. The joint was then about twice its normal size, the epiphyses of femur and tibia very much enlarged, and the other parts of the leg much atrophied. The leg formed with the thigh an angle of about 45o. There were several cicatrices of wounds, but no open sinuses. Inability to move the knee, and a desire to have a straight leg, prompted her re-admission ; and after full consideration of the special features of her case, Mr. Tapp determined on the performance of excision of the articular ends of the diseased bones.  The joint was excised on May 15 by the semilunar flap method. The patella was found quite healthy ; the epiphyses of femur and tibia were very much enlarged and soft. There was incipient ulceration of the cartilages, and the synovial membrane throughout was totally changed in structure, having been converted into a firm, fleshy mass. This was carefully dissected away, and a slice of an inch taken from the condyles of the femur with Butcher’s saw, and a thin slice from the exposed surface of the tibia. The patella was left intact. The leg was subsequently extended and bandaged firmly on Liston’s swing splint. The child recovered without a bad symptom. In thirteen weeks the leg was found to be quite firm, and she was able to walk with the aid of crutches. She was discharged on September 13, able to walk without stick or crutch, and with but a slight limp. The accompanying engraving will show the state of her limb at the date of her discharge.  Remarks.–The fleshy gelatinous state of the synovial membrane added much to the difficulty, as well as to the length, of the operation : it also explained the non-formation of bony anchyloses after the child’s first admission. Immediately after the operation the limb was fully one inch and a-half shorter than its fellow. The state of things six months later, when the two limbs were nearly of equal length, seemed therefore to prove that new bone had been deposited, which had contributed to the length of the limb. Wagner, in his excellent memoir on “Resection” (published by the New Sydenham Society in 1859), reports experiments on the rabbit, and admirably shows the process of repair. There is, then, little room for doubt that new bone has been deposited from the epiphysis, especially that of the tibia. Mr. Tapp was very careful in the operation not to remove the whole of the tibia epiphysis, adopting the opinion now generally held as to the paramount importance of that structure in the growth of the bone. [Medical Times & Gazette, 1860, vol. 2, p. 456]
  1. 1861 census – Elizabeth Balch, scholar, aged 9, born Minterne, living with her family headed by her father William Balch, brickmaker, aged 50, at Lyons Gate, Minterne. [The National Archives, 1861 census, RG9/1358, folio 46, p. 12]
  1. 1871 census – Elizabeth Balch, pauper, aged 20, unmarried, born Lyon’s Gate, an inmate in the Cerne Abbas Union workhouse. [The National Archives, 1871 census, RG10/2015, folio 11, p. 13]
  1. Elizabeth Balch, spinster, aged 27, of Lyme Regis, daughter of William Balch, labourer, married Herbert Lovell, bachelor, a shoemaker, aged 34, also of Lyme Regis, on 1 Mar 1879 at Lyme Regis. [Dorset History Centre, Lyme Regis marriage register, PE/LR: RE 3/5, p. 16, entry 32]
  1. 1881 census – Elizabeth Lovell, aged 29, married, born Lion’s Gate, wife of Herbert Lovell, shoemaker, aged 35, living at Dennings Court, Lyme Regis, with their daughters Clara, aged 1 and Bessey, aged 5 months. [The National Archives, 1881 census, RG11/2126, folio 66, pp. 33-34]

 

Comments: This case is a good example of how experimental research, and the latest developments in clinical practice, informed the work of the surgeons at the hospital. It is also an example of the poor record keeping at the hospital during the 1850s and 1860s. The patient moved from being an out-patient to being an in-patient, and back again, but these admissions and re-admissions were not fully recorded in the hospital’s admissions records.

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