Hospital Cleanings

Abstract

By T. HoLEs, Esq., Surgical Registrar to the Hospital. A YoUNG man of very issipated appearance and habits, who gave the fictitious name of Fitawallynge, was admitted some time ago, under the care of Mr. Cutler, on acout of an injury to the right elbow. This had occured about a fortnight before, when he was drunk. He could therefore give no account of the affair; but it was pthred frm what he sid that it was a blow or fall in some drunken quaml. He was positive in asserting that, before that date, his arm was healthy. When admitted, there was great swelling about the part, with an erysipelatous blush on the surface; and the cellular memfbrane was extensively undermined. It was thought liky that a fracture existed about the seat of injury; but the welling rendered an accurate diagnosis impossible. Fre incision were made on the ulnar side of the forearm into the cellular membrane, which was sloughy. Bark and acid, opiates, and a liberal allowance of spirits, were ordered. He seemed in danger of an attack of delirium tumens during the first few days of his stay in the house, but this passed over. Three weeks after his admission, it is aoted that very large sloughs had come away, exposing the uhs to a great extent. Six weeks after his admission (speakng accurately, on the forty-third day), the carpal atremity of the exposed portion of the Ulna separated, tbms causing a transverse fracture about one inch Eom the wrist. The shaft of the bone for a great distance was exposd, and evidently dead; but, as it was firmly fixed, it was decided to allow it to exfoliate without any operation. He improved much in health during the remaining period (one month) of his stay in the house, which he then quitted for change of air. Very shortly after his discharge, and eleven weeks after his ad ion, the piece of bone separated. It measured seven inches in length, and included the whole thickness of the shaft of the ulnae Some bone was still left exposed at the upper part of the wound. The patient returned to his old dissipated habits, and wsseen no more at the hospital. RDUNAnS. I was reminded of this case, which occurred a long while ago, by observing in the AssocIATION JOURNAL of November 22nd one reported by Mr. Jones, of Jersey, at the Medical Society of London, in which the whole shaft of the ulna had perished from disease. The present case is perhap more remarkable, as being an example of the same resut following an injury. There seemed no reason to suspect the accuracy of the man's history; nor did the appearance of the bone, when separated, indicate any long -ing diseae. The are several points of interest about the case. The firt is the conirmation which it afflrds of the doctrin, now, I suppose, unmrsally admitted, of the danger of. a ferring to make incissoan in diffiie cellular infiaatie. Here there was no very severe injury,-not more, as far as could be seen, than is inseparable from a fracture about the elbow; yet a fortnight's delay and neglect, in a pera of feeble habit of body, wa sufficient to cause destruction of all the soft pats (including the periosteum), ad sub quent gangrene of the bone Another intertig feature in the case is the short time required for casting off so extensive an exfoliation. Whatb ever might have been the case at the upper end, it seemed certain that there was no fracture of thelower end of the ulIna; still, so rapid wa the proces of sep tion, that it was complete only six weeks after his admision, and eight after the receipt of the injury. Unfortunately, the most interesting part of the case was lost by the patient's neglect of attendance,-I mean the process which Nature would have adopted to remedy as far as possible the loss of parts. As far as I could see at the time, this process could hardly be said to be then commenced. No new bone was discovered in the cavity left by the extraction of the old; nor was the formation or grow of new bone from the lower end sufficiently advanced to attract attention. Although the periosteum covering the subcutaneous surface of the bone was destroyed, that of the deeper surface was probably left, at least partially; and some repair of the bone from that source might be looked for; otherwise it is probable that the radius might hare become hypertrophied, or the interosseous membrane ossified in part, to afford support to the muscles of the limbs.* It would have been very interesting also to notice what interference remained to the action of the numerous muscles which take their origin from the ulna. Our patient, however, had no sooner left the house than he began tom amends for so long a restraint by indulging in his old habits, and was then probably ashamed to show himel again. The case, imperfect as it is, I thought worthy of record, especially as a companion to that reported by Mr. Jones.