OPERATIONS PERFORMED DURING QUARTER ENDING MARCH 1855

EXCISION OF MALIGNANT TUMOURS. … Case 2.–A man, aged 34, was admitted into the Dorset County Hospital on account of an ulcerated tumour in the posterior triangle of the neck. He stated that a lump had existed there without material change for seventeen years, and that it had been excited into activity by the use of salt and water as a friction. The ulcerated sore resembled in appearance an open cancer. There had been, prior to admission, rather sharp haemorrhage from it. In the operation it was found to have no connexion with the deep parts, and was easily removed. The subsequent microscopic examination showed it to be epithelial cancer. Recovered. [Statistical report of the principle operations performed during the quarter ending March, 1855. Medical Times & Gazette, 1855, new series, vol. 10, p. 596]

EXCISION OF MALIGNANT TUMOURS. … Case 9.–A man, aged 80, under the care of Mr. Tapp, in the Dorset County Hospital, on account of an epithelial cancer, affecting the lower lip. A freezing mixture was employed previous to the excision, and was successful in preventing pain almost completely. The wound healed in a fortnight. [Statistical report of the principle operations performed during the quarter ending March, 1855. Medical Times & Gazette, 1855, new series, vol. 10, p. 596]

AMPUTATIONS. Of the Leg. … Case 17.–A man, aged 30, under the care of Mr. Curme, in the Dorset County Hospital. In March, 1854, he had suffered a compound dislocation of the foot outwards, the tibia protruding two or three inches. The dislocation was reduced, and the leg being swung in a Salter’s apparatus and a liberal diet allowed favourable progress resulted. Much sloughing occurred during the first week ; but subsequently the wounds almost healed, leaving sinuses, however, which led down to bare bone. It was concluded, from the extent of bone which could be felt through the several openings, that the whole lower extremity of the tibia was in a state of caries ; and as, after nearly a year’s treatment, the diseased portion showed no tendency to separate, amputation was determined on. It was performed through the lower third of the leg, and a very good recovery ensued. The examination of the removed extremity showed the lower end of the tibia, about three inches and a half long, quite dead, separated from the shaft, and inclosed in a thin shell of new bone. The fibula was soundly united where it had been broken, its lower extremity being also anchylosed to the side of the astragalus. The astragalus and os calcis were also united by anchyloses. [Statistical report of the principle operations performed during the quarter ending March, 1855. Medical Times & Gazette, 1855, new series, vol. 10, pp. 571-72]

OPERATIONS PERFORMED DURING QUARTER ENDING JUNE 1855

LITHOTOMY. … Case 7.–A boy, under 5, in bad health, under the care of Mr. Curme, in the Dorset County Hospital. He suffered very much from prolapse of rectum, and for this it was necessary to pursue treatment preparatory to the operation. Injections of sesquichloride of iron (3iij. to 0j.) were used, and scammony purges given, by which latter two large lumbrici were brought away. The urine was phosphatic. The stone having always been felt at the same spot, near the neck of the bladder it was believed to be encysted. The removal was effected without unusual difficulty. It weighed nearly half-an-ounce, and showed a constriction at its middle, as if its larger half had lain in a pouch. The smaller and projecting part was much softer than the other. The boy recovered well. [Statistical report of the principle operations performed during the quarter ending June, 1855. Medical Times & Gazette, 1855, new series, vol. 11, p. 343]

AMPUTATIONS. Of the Thigh. … Case 10.–A woman, in fair health, aged 25, under the care of Mr. Tapp, in the Dorset Hospital, on account of diseased knee-joint. The joint had been partially anchylosed, in a bent position, for twenty years past. The whole joint was extremely tender, and there was a puffy swelling over its inner side. Recovered. [Statistical report of the principle operations performed during the quarter ending June, 1855. Medical Times & Gazette, 1855, new series, vol. 11, p. 344]

REMOVAL OF EXOSTOSIS. A man, aged 25, under the care of Mr. Tapp, in the Dorset County Hospital, had noticed, for about [a] year, a small swelling, near the inner side of one knee. It was not tender, but, in walking, gave him great pain, in consequence of which he now sought advice. It was found to be a small exostosis, growing from the line leading from the linea aspera, to the inner condyle. It was easily removed, and the wound healed well. [Statistical report of the principle operations performed during the quarter ending June, 1855. Medical Times & Gazette, 1855, new series, vol. 11, p. 368]

OPERATIONS PERFORMED DURING HALF-YEAR ENDING DECEMBER 1855

LITHOTOMY. Case 1.–A boy, aged 5, in poor health, under the care of Mr. Tapp, in the Dorset Hospital. A long oval stone, weighing five drachms and a-half, was removed by the usual operation. The symptoms had been severe. Recovered. [Statistical report of the principle operations performed during the half-year ending December, 1855. Medical Times & Gazette, 1856, new series, vol. 12, p. 363]

LITHOTOMY. … Case 9.–A healthy boy, aged 7, under the care of Mr. Tapp, in the Dorset County Hospital. A mulberry stone, the size of a marble, was removed. Recovery. [Statistical report of the principle operations performed during the half-year ending December, 1855. Medical Times & Gazette, 1856, new series, vol. 12, p. 363]

HERNIOTOMY … Case 3.–A woman, aged 51, under the care of Mr. Tapp, in the Dorset Hospital. Hernia femoral, the size of a goose’s egg: strangulated forty-eight hours. Reduction without opening the sac was attempted, but failed. The sac contained intestine and adherent omentum. The latter was not reducible, and was allowed to remain. Recovered well. [Statistical report of the principle operations performed during the half-year ending December, 1855. Medical Times & Gazette, 1856, new series, vol. 12, p. 412]

HERNIOTOMY. … Case 11.–A man, aged 80, under the care of Mr. Curme, in the Dorset Hospital. Hernia inguinal, strangulated fifty-three hours ; sac opened. There had been no sickness whatever, and the tumour, which was the size of an egg, was scarcely tender. He was in the Hospital two days before the operation was performed, and all the usual expedients for effecting the taxis were tried. The sac having been opened, a knuckle of bowel and some omentum were exposed, both of them in tolerably good condition. In the evening there was tenderness around the wound, for which leeches were applied, and calomel and opium ordered. On the following day the tenderness had passed away, but there was much tympanitis. The tympanitis increased in spite of remedies, and death took place four days after the operation. There had been no return of the tenderness on pressure, and, with one exception, no vomiting whatever had occurred throughout the case. [Statistical report of the principle operations performed during the half-year ending December, 1855. Medical Times & Gazette, 1856, new series, vol. 12, p. 412]

EXCISION OF MALIGNANT TUMOURS. . … Case 12.–A man, aged 64, under the care of Mr. Curme in the Dorset Hospital, on account of cancer of the lip of three years’ duration. Excision. Recovery. [Statistical report of the principle operations performed during the half-year ending December, 1855. Medical Times & Gazette, 1856, new series, vol. 12, pp. 462-63]

REMOVAL OF LOOSE CARTILEGE FROM THE KNEE JOINT. Case 1.–A healthy agricultural labourer, aged 24, was admitted into the Dorset County Hospital with the statement, that a month previously he had slipped while lifting a heavy sack, and had struck his knee, ever since which he had been lame. He had felt something move in his joint, and which threw him down whenever he attempted to walk. On examining the part, a loose cartilage was easily discovered in the outer side of the joint. Three weeks after admission, the operation for its removal was performed. A subcutaneous incision having been made into the joint, it was attempted to squeeze out the cartilage; but this not succeeding, some straps of plaster were applied, so as to retain the latter in its position immediately beneath the wound in the synovial membrane. The knee remained quiet for about thirty-six hours, when violent inflammation was set up, which resulted in suppuration. Under the profuse discharge which followed, the man sank very low, bedsores formed and increased his debility; and, about seven weeks after the operation, amputation was decided on. To this the man refused his consent. Since then the condition of the knee has much improved, and at the time of the report there was good hope that both life and limb would be saved. Postscript: Since this was in type we have received a further report. The man is now well, with a stiff knee. [Statistical report of the principle operations performed during the half-year ending December, 1855. Medical Times & Gazette, 1856, new series, vol. 12, p. 463]

OPERATIONS PERFORMED DURING THE FIRST HALF-YEAR OF 1856

AMPUTATIONS. Of the Thigh. … Case 6.–Mr. Curme.–A girl, aged 12, in very feeble health from the effects of disease of the knee-joint. The disease had first occurred two years ago, but had been subdued by treatment, and had relapsed. Amputation. Recovery. [Statistical report of the principle operations performed during the first half-year of 1856. Medical Times & Gazette, 1856, vol. 2, p. 344]

AMPUTATIONS. Of the Thigh. … Case 13.–Mr. Tapp. A man aged 42, in very feeble health, from the effects of acute disorganization of the knee-joint and a discharging abscess in the side. The thigh was in a very bad condition at the time of the operation, being greatly swollen, and a large abscess extending up it. Rather profuse haemorrhage occurred, and many vessels had to be tied; a ligature was also put upon the vein. He was so much exhausted after the operation, that it was judged best not to remove him from the operating table. By the very free administration of wine, etc., he at length rallied fairly, and was doing well up to the twelfth day, when a rigor occurred. Pleuritic pain in the right side followed, and he sank and died of pyaemia on the twenty-first day after the operation. The ligature had separated from the vein, but that on the artery still remained. At the autopsy the vein was found sealed up by firm clot, which had softened only in one spot, about the size of a pea. Both pleurae were lined with soft recent lymph. The left lung was healthy, but the right was universally in a state of grey hepatisation, and in many parts softening was commencing. There were no deposits of pus in the liver. [Statistical report of the principle operations performed during the first half-year of 1856. Medical Times & Gazette, 1856, vol. 2, p. 344]

REMOVAL OF MALIGNANT TUMOURS. … Case 7.–The Dorset County : Mr. Curme.–A man, aged 56. Excision of a large epithelial cancer of the lower lip, of four years’ duration. Recovery. [Statistical report of the principle operations performed during the first half-year of 1856. Medical Times & Gazette, 1856, vol. 2, p. 346]

OPERATION FOR UNUNITED FRACTURE. … Case 2.–The Dorset Hospital. A child, aged 4, admitted on account of an ununited fracture of the tibia in its middle third. The fracture had occurred 15 months before, and had been duly attended to by a Surgeon. The bone appeared to have been broken obliquely from before back wards, and there was still free motion. Mr. Tapp operated with a tenotomy knife, introducing it between the ends of the bone and freely breaking up the false joint. Two short splints about four inches long were tightly applied one either side the limb and over these longer ones. On the third day after the operation large bullae were observed and the splints were consequently laid aside. Sloughing of the skin had however set in, and two sloughs of considerable size separated from where the short splints had pressed. By careful treatment the child got well through this process, and the ulcers left slowly healed. Three months after the operation the healing had been complete several weeks, but there was still considerable motion between the ends of the bone, though certainly not quite so much as previously. Gutta percha splints are now worn. Under treatment. [Statistical report of the principle operations performed during the first half-year of 1856. Medical Times & Gazette, 1856, vol. 2, p. 347]

OPERATIONS PERFORMED DURING 1857

AMPUTATION. Of the Thigh. … Case 17.–The Dorset County : Mr. Curme.–A lad, aged 18, who had been long under treatment for disease of the knee-joint. Amputation. Recovery. [Statistical report of the principle operations performed during the year 1857. Medical Times & Gazette, 1858, new series, vol. 16, p. 350]

AMPUTATION. Of the Thigh. … Case 18.–The Dorset: Mr. Curme.–A girl, aged 12, for two years the subject of diseased knee-joint. Amputation. Recovery. [Statistical report of the principle operations performed during the year 1857. Medical Times & Gazette, 1858, new series, vol. 16, p. 350]

AMPUTATION. Of the Thigh. … Case 56.–The Dorset County : Mr. Curme. A navvy, aged 28, admitted with compound comminuted fracture of the leg. Secondary amputation on the eleventh day, on account of mortification. On the sixteenth day after the operation, all the ligatures having come away nearly a week before, a frightful attack of haemorrhage occurred (during the night), from the effects of which he sank the next day. On examination of the limb, it appeared that the bleeding had been from the femoral trunk. [Statistical report of the principle operations performed during the year 1857. Medical Times & Gazette, 1858, new series, vol. 16, p. 351]

AMPUTATION. Of the Leg. … Case 100.–The Dorset : Mr. Curme. – A lad, aged 18, of scrofulous habit, was admitted with a compound dislocation of the ankle. Secondary amputation through the leg. Recovered. [Statistical report of the principle operations performed during the year 1857. Medical Times & Gazette, 1858, new series, vol. 16, p. 373]

LITHOTOMY. … Case 18.–The Dorset : Mr. Curme.–A boy, aged 4. Usual operation. Recovery. [Statistical report of the principle operations performed during the year 1857. Medical Times & Gazette, 1858, new series, vol. 16, p. 428]

HERNIOTOMY. … Case 4.–The Dorset : Mr. Curme.–A feeble woman, aged 51. Hernia femoral, and strangulated fifty-six hours. Sac opened. Recovered. [Statistical report of the principle operations performed during the year 1857. Medical Times & Gazette, 1858, new series, vol. 16, p. 451]

EXCISION OF TUMOUR FROM FALL [FACE?]. Dorset County : Mr. Tapp.–Elizabeth Chal, aged 26, re-admitted October, 1857. Has never enjoyed good health. Had small-pox when four years old, and inflammation of eyes, which have never been well since ; she has some opacities on cornea, and has lost her eyelashes. States that two and a half years ago she noticed a tumour the size of a pea, situated near the articulation of the left molar with superior maxilla. It grew very slowly for two years, when it began to increase, and when admitted, three months ago, was the size of a walnut, and divided into two parts. Under the constant application of collodian it decreased to one-half its original size, and she left the Hospital September 3, 1857, much improved in every respect. The tumour remained quiet until three weeks before admission, when it began to grow, and has grown rapidly ; the two parts into which it was formerly divided have coalesced, and it is larger than it was on her first admission, the skin looking angry and ready to break. It was removed October 30, the day after admission, and the tumour upon examination was considered to be cancer. She left the Hospital, quite recovered, December 3, 1857. [Medical Times & Gazette, 1858, new series, vol. 16, pp. 576-77]

LITHECTASY. Mary Ann Selway, aged 6 years, admitted October 1857. Eighteen months ago began to suffer pain in passing water, and at other times as well ; viz. when she ran about. About three months before admission, she passed blood with her urine ; and for five or six months before admission, the urine passed involuntarily. A sound was introduced, and stone detected, which was removed on the 10^th of November, 1858, by dilatation. The patient was able to hold her water during the day, thirty-six hours after the operation, and for three nights before her discharge, November 30, there was no incontinence of urine. Size of stone,–large circumference, 3 inches ; small circumference, 2½ inches. [Statistical report of the principle operations performed during the year 1857. Medical Times & Gazette, 1858, new series, vol. 16, p. 577]

AMPUTATION OF THIGH. Edward Brown, a carter, was admitted December 28, 1857, with a curved wound situate on the inner side of the right thigh, about three inches above the condyle ; the length of wound was about three inches, it was caused by being trodden on by his horses while endeavouring to stop them, they having run away. The wound did not appear deep, the edges were clean like an incised wound ; it was brought together with sutures, went on well for a day or two, but on removing the sutures, no adhesion had taken place ; it took an inflamation and suppurated, the man being feverish and having an unsatisfactory look. On Saturday night, January 9, 1858, at 11 o’clocl, haemorrhage of artificial character occurred to a considerable extent ; the wound was immediately enlarged, clots removed, and the vessel sought for, but could not be found. The wound was them plugged with lint, and strictly watched ; all went on well until Thursday, January 14, when haemorrhage recurred, wound again enlarged, clots removed, but no vessel could be found. It was then determined to tie the femoral under the Sartorius ; but on further examination, the femur in the popliteal space was so much denuded of periosteum, that it was deemed advisable to amputate at the junction of middle and lower third. On examination of the limb, it was found that a small branch, apparently one of the articular, had sloughed at its junction with the main trunk, leaving a small hole in the popliteal. Discharged cured April 1, 1858. [Statistical report of the principle operations performed during the year 1857. Medical Times & Gazette, 1858, new series, vol. 16, p. 577]

REMOVAL OF STONE. Thomas Hawkins, admitted February 11, 1858, reported to be suffering from symptoms of stone. On admission an attempt was made to pass a sound, but it could not be done, owing to spasmodic structure ; the next day, and a day or two after that, attempts were made, but without success ; the sound passing some way down the urethra, but causing great pain, and the water flowing when the attempts were persevered with. Under these circumstances, and as the urine deposited a large quantity of tenacious mucus similar to that obtained in catarrh of bladder, it was resolved to treat him on that principle, by warm hip-baths, etc. ; this somewhat improved his condition ; and one day when trying again to pass a catheter, the instrument came down upon a hard body, evidently a stone in the urethra, one end of which was situated about one inch below the lower border of the scrotum. The man called my attention to a hard body, which he now told me he had found come down and go back again since September. He further informed me that since September, when re sat, this body came down, but went back when he stood up ; he could not ride astride his horse in consequence of this body. On introducing the finger into the rectum, the stone could be felt in the urethra, and evidently of some size ; an incision was made in the middle line of the urethra, over the tumour, and a stone extracted weighing 2½ drachms. The man’s condition improved, and it was supposed we had got to the bottom of his troubles, but Mr. Tapp thought there might be another, perhaps, and a catheter was again passed some two or three days after, and another stone detected much in the same place, weighing 3½ drachms, and which was removed by slightly enlarging the first wound. The man recovered and was discharged quite well, April 8, 1858. [Statistical report of the principle operations performed during the year 1857. Medical Times & Gazette, 1858, new series, vol. 16, p. 577]

OPERATIONS FOR THE REMOVAL OF MALIGNANT TUMOURS. … Case 21.–The Dorset County : Mr. Tapp.–A healthy chimney-sweep, aged 59, excision of a soot cancer from the scrotum. Recovery. A cancer had been removed from his scrotum fourteen years before, and he had been wholly free from the disease until within the last two years and a-half. [Statistical report of the principle operations performed during the year 1857. Medical Times & Gazette, 1858, new series, vol. 16, p. 656]

OPERATIONS FOR TUMOURS OF THE BREAST. … Case 51.–The Dorset County : Mr. Tapp.–A woman, in tolerable health, aged 64. A growth of hard cancer, the size of a chestnut, existed in one breast, and had been noticed for more than two years. It was excised, and the wound did well up to the fourth day, when a slight blush of erysipelas attacked it. This passed off, but she remained feeble, and without appetite. After a while one wrist-joint swelled, and then both legs became oedematous, and there was swelling about one ankle-joint. No fluctuation was ever detected in either joint. Stimulants and quinine were freely used, but on the 20^th day, whilst taking her dinner, she suddenly became much worse, and died in about half an hour. No autopsy was permitted. [Statistical report of the principle operations performed during the year 1857. Medical Times & Gazette, 1858, new series, vol. 16, p. 656]

OPERATIONS PERFORMED DURING 1858

HERNIOTOMY. … Case 21.–The Dorset : Mr. Curme.–A man aged 23 ; hernia, inguinal ; had never been down before, strangulated twenty-two hours. Sac opened. Death from acute peritonitis on the second day. [Statistical report of the principle operations performed during 1858. Medical Times & Gazette, 1859, new series, vol. 18, p. 366]

EXCISION OF THE BREAST, OR OF TUMOURS CONNECTED WITH IT. … Case 16.–The Dorset Infirmary : Mr. Tapp.–A woman, aged 54, unmarried. Excision of the whole left breast on account of infiltrated scirrhus. An enlarged gland in the axilla was left. The wound healed very slowly, and the axillary gland showed a tendency to increase. [Statistical report of the principle operations performed during 1858. Medical Times & Gazette, 1859, new series, vol. 18, pp. 471-72]

EXCISION OF THE BREAST, OR OF TUMOURS CONNECTED WITH IT. … Case 17.–The Dorset Infirmary : Mr. Curme.–A married woman, aged 45. Excision of the whole breast on account of cancer. Recovered from the operation, but remained in a very feeble state. [Statistical report of the principle operations performed during 1858. Medical Times & Gazette, 1859, new series, vol. 18, p. 472]

AMPUTATION. Of the Thigh. … Case 9.–The Dorset : Mr. Curme.–A boy, aged 10, in delicate health. Amputation for disease of the knee. Recovered. [Statistical report of the principle operations performed during 1858. Medical Times & Gazette, 1859, new series, vol. 18, p. 497]

AMPUTATION. Of the Thigh. … Case 14.–The Dorset : Mr. Tapp.–A man, aged 24, presented himself with a large even swelling about the left thigh, which had been three months in development. There had been but little pain. It was believed to be malignant, and amputation was advised. To this he refused to consent, and left the Hospital. Two months later, however, he applied for re-admission, and amputation was performed on July 28. The tumour was found to be developed from the periosteum, and not from the substance of the bone itself. The latter, however, was greatly hypertrophied and as hard as ivory. In the subsequent treatment, a spouting fungus repeatedly grew from the medulla of the bone, and required removal. Finally another portion of the bone was sawn away. The stump healed, and the man left the Hospital on October 7. [Statistical report of the principle operations performed during 1858. Medical Times & Gazette, 1859, new series, vol. 18, p. 497]

AMPUTATION. Of the Thigh. … Case 15.–The Dorset : Mr. Tapp.–A woman, aged 28, admitted on account of an unhealed stump, her thigh having been amputated for diseased knee two years before. A second amputation was performed ; but three months afterwards the stump was again still unhealed. The woman is decidedly of scrofulous habit, but there does not appear to be any disease of the bone itself. [Statistical report of the principle operations performed during 1858. Medical Times & Gazette, 1859, new series, vol. 18, p. 497]

AMPUTATION. Of the Thigh. … Case 43.–The Dorset : Mr. Tapp.–A woman, aged 23, the subject of diseased knee-joint, and in very feeble health. Amputation of the thigh. Death forty hours afterwards. She had appeared to do well during the day of the operation ; but her pulse subsequently without apparent cause became very rapid, and the tongue coated, with great irritability of stomach. The autopsy showed peritonitis in an early stage. [Statistical report of the principle operations performed during 1858. Medical Times & Gazette, 1859, new series, vol. 18, p. 497]

OPERATIONS PERFORMED IN 1859

LITHOTOMY. … Case 9.–The Dorset County Hospital : Mr. Tapp.–A boy, aged 7, in whom the calculus was impacted in the prostatic urethra, and a false passage existed by its side. The stone subsequently slipped back again into the bladder. His urine was loaded with phosphates and was very alkaline. Lateral lithotomy. Removal of a stone about the size of a walnut. Rapid recovery. [Statistical report of the principle operations performed during 1858. Medical Times & Gazette, 1859, new series, vol. 18, p. 367]

EXCISION OF JOINTS. KNEE. … Case 7.–The Dorset Hospital : Mr. Tapp.–A girl, aged 7, was admitted in the autumn of 1858, with disease of the right knee-joint. She was improved by treatment, and was subsequently discharged. She was readmitted on March 4, 1859. She was of scrofulous habit, nails clubbed, complexion pasty, and glands in the neck enlarged. The knee was anchylosed in a bent position, and there were some three fistulous openings, which communicated with diseased bone. Excision of the joint by the semilunar incision was performed on April 5, 1859. The bone was found very soft. About an inch was removed from the femur, and three quarters of an inch from the tibia. The girl did well after the operation until the tenth day, when scarlet fever showed itself, under which she became very weak. When the scarlet fever passed off, she again improved steadily. On September 9 she was allowed to sit up, the knee being firm, the splint having been removed. On November 12 she could walk without crutches or stick, and the shortening was very much less than had been expected, not appearing to be more than half-an-inch. On November 25 she was discharged quite well. The limb was quite firm, but the anchyloses was not bony. On February 24, 1860, an account was obtained from her parents that her health had much improved, and that the state of her knee continued good. [Statistical report of the principle operations performed during 1859. Medical Times & Gazette, 1860, vol. 1, pp. 395-96]

AMPUTATION OF THE THIGH. … Case 5.–The Dorset County Hospital : Mr. Curme.–A woman, aged 20, was admitted September 15, 1859, with a swelling below the left knee, which proved to be cancerous, and infiltrated the head of the tibia. It was of three months’ duration. The swelling was very puffy, and seemed to consist of blood and gelatinous matter. The knee was bent at a right angle. The swelling increased rapidly, and she was apparently sinking. Amputation in the middle third of the thigh. The muscles were found very flabby and infiltrated. The circular operation was performed, as the parts about the knee were infiltrated with the cancerous matter. On examination of the knee-joint after amputation, it was free from disease, as anticipated ; but immediately below the joint was a cavity with ten ounces of sanguineo-purulent fluid. The head of the tibia was the seat of malignant deposit, and three times its natural size. Her health speedily improved, and she was discharged cured on December 8. [Statistical report of the principle operations performed during 1859. Medical Times & Gazette, 1860, vol. 1, p. 420]

AMPUTATION OF THE THIGH. … Case 6.–The Dorset County Hospital : Mr. Curme.–A boy, aged 12, admitted in January, for strumous disease of the right knee-joint. The disease had existed for six months. The boy was at first treated with a view of obtaining anchyloses ; and he seemed progressing favourably until August [1859], when unfortunately he removed the splints and got out of bed. Inflammation of the joint set in, pus formed and collected in the joint. His health was correspondingly affected, and as he appeared sinking, the limb was removed by the circular operation in the middle third of the thigh. Recovered. [Statistical report of the principle operations performed during 1859. Medical Times & Gazette, 1860, vol. 1, p. 420]

AMPUTATIONS OF THE UPPER EXTREMITY. … Case 7.–The Dorset County Hospital : Mr. Curme.–A girl, aged 19. The arm crushed in a thrashing-machine from the fingers to the middle of the upper arm. The girl was in a state of syncope on admission, having been driven nine miles without any application to stem the haemorrhage. On recovering from this condition the arm was amputated by the circular method in the upper third. Recovered well, and was discharged sixteen days after admission. [Statistical report of the principle operations performed during 1859. Medical Times & Gazette, 1860, vol. 1, p. 447]

OPERATIONS FOR THE REMOVAL OF TUMOUR IN THE BREAST. … Case 14.–The Dorset County Hospital : Mr. Tapp.–A woman, aged 45, from whose breast a scirrhous tumour had been removed about a year before, was re-admitted with a return of the disease. A second operation was performed, and the wound healed well. A month later, however, the disease was again appearing. She was now discharged. [Statistical report of the principle operations performed during 1859. Medical Times & Gazette, 1860, vol. 1, p. 473]

OPERATIONS FOR THE REMOVAL OF TUMOUR IN THE BREAST. … Case 15.–The Dorset County Hospital : Mr. Tapp.–A washerwoman, aged 38, unmarried, was admitted with a tumour in the left breast, the size of a foetal head. It had existed for about nine months, and had caused much pain, but she was in good health, and there was no glandular complication. During the operation, apparent death from chloroform took place, but artificial respiration being immediately resorted to, the vital functions were resumed after a few minutes’ entire cessation. The operation was then completed. The wound healed rapidly. The woman left the Hospital about two months afterwards, and went to a union workhouse, where death took place six months afterwards, from anasarca and ascites. At the autopsy, the heart, liver, and kidneys were found to be in a state of fatty degeneration. No internal malignant disease was discovered. The fatty condition of the heart accounted for the chloroform accident. [Statistical report of the principle operations performed during 1859. Medical Times & Gazette, 1860, vol. 1, p. 473]

OPERATIONS FOR THE REMOVAL OF TUMOUR IN THE BREAST. … Case 18.–The Dorset County Hospital : Mr. Tapp.–A woman, aged 50. Scirrhus of the left breast. Duration, twelve months. It had been increasing rapidly for the last six months. On admission, it was as large as a man’s fist, and very painful. She was much reduced in strength by the want of sleep, and from the great pain. Excision. There was considerable haemorrhage, and seven vessels were tied. She, however, rapidly recovered. [Statistical report of the principle operations performed during 1859. Medical Times & Gazette, 1860, vol. 1, p. 473]

OPERATIONS FOR THE REMOVAL OF TUMOUR IN THE BREAST. … Case 19.–The Dorset County Hospital : Mr. Tapp.–A woman, aged 46. A malignant tumour in the right breast for thirteen months. On admission it was as large as a fist. No affection of glands apparent. Removed. The wound healed quickly, and she was about to be discharged, when she noticed a small pea-like swelling at the upper end of the cicatrix. In less than a week two others appeared, and she became cachectic, and affection of the axillary glands now appeared. She was discharged at her own request. In May following she died. No autopsy allowed. Cause of death–cancerous cachexia. [Statistical report of the principle operations performed during 1859. Medical Times & Gazette, 1860, vol. 1, p. 473]

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 45^o. 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 her 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]