Clinical Paper: Primary amputation of thigh in a child one year and a half old; recovery

The Lancet, 2 December 1871, volume 98, number 2518, page 779



(Under the care of Mr. J. GOOD.)

THE notes of the following case were recorded by Dr. Alfred Hollis, house-surgeon.

Samuel R—, aged a year and a half, was admitted with an injury sustained by the passage of the wheels of a laden cart over the right leg. On his admission, some two or three hours after the accident, the child was in a condition of extreme collapse ; it was at once placed in bed, and recourse was had to the usual restoratives. Brandy and egg and milk were freely administered; and, each time that the spoon was held to his lips the child was roused and received its contents, but returned immediately to a listless, unconscious state, with upturned eyes, general coldness of surface, and scarcely perceptible pulse—a condition from which it appeared hopeless to expect a recovery. The lower limb was found to hang from the thigh by a confused mass of muscle and bone, mixed with road-dust ; the patella was gone, and the lower end of the femur, to the extent of two or three inches, together with the condyles, lay quite bare. There was no pulsation in the posterior tibial artery, all the bloodvessels being completely divided at the seat of injury.

About fifteen minims of chloroform sufficed to produce insensibility, and the amputation was performed with lateral flaps, the femur being divided at about the middle third. It was thought desirable not to remove the patient to bed, and he was allowed to remain on the operating table for the night. The stump was lightly dressed with lint steeped in carbolic acid lotion. Some sickness occurred in the night, but the child obtained some sleep, and took brandy-and-egg mixture at intervals.

Some fever occurred on the day following the operation ; but on the third day he was very cheerful, and amused himself with his toys, and took food well.

On the forty-first day he was discharged in excellent health after an uninterruptedly favourable recovery.

The amount of brandy which was borne by this patient is noteworthy. In the short interval which occurred between admission into the hospital and the operation he took two ounces, with egg and milk; during the night he took another ounce; and daily, while the wound was discharging, he drank the same quantity. As soon as he began to take more substantial food this was reduced, and at length the stimulant was omitted.